| Theme |
How Do You Choose Treatment Strategies for IBD Patients with a Critical Situation? |
| Title |
Therapeutic Strategies for Patients with Mild to Moderate Active Ulcerative Colitis Refractory to High—dose 5—Aminosalicylic Acids |
| Author |
Motohiro Esaki |
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University |
| Author |
Junji Umeno |
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University |
| [ Summary ] |
The rotation of oral 5‒aminosalicylic acids (5‒ASA) or concurrent application of topical therapy has been described as able to enhance remission induction by high‒dose oral 5‒ASA treatment among patients with mild to moderate active ulcerative colitis (UC). Thus, such medications could possibly help avoid unnecessary application of subsequent systemic steroid therapy in a certain proportion of patients with mild to moderate active UC who show insufficient response to initial high‒dose oral 5‒ASA treatment. However, careful observation of and communication with patients are critical to improve clinical efficacy of the medications. The site of involvement needs to be considered when rotating oral 5‒ASA. However, pH‒dependent 5‒ASA is occasionally excreted without elution in patients with diarrhea. When applying either 5‒ASA or steroid enema to patients with active distal UC, excessive amount of enema frequently deteriorates the adherence to topical enema therapy. In patients who fail to achieve remission with these medications, aggressive treatments need to be considered, whereas systemic steroid therapy should be strictly avoided in patients with proctitis UC. |