Editing Ulcerative colitis (section)

=== '''Medication classes (see Crohn's topic for details):''' ===

** Induction of remission
*** Mainstay has been steroids, enemas, oral or IV
*** If that fails or for severe disease, sometimes need immunomodulators
** Maintenance therapy
*** Aminosalicylates (a.k.a. 5-ASA/5-aminosalicylic acid)
*** Can include steroids, but preferably not
*** Immunomodulators
*** Biologics
*** Calcineurin inhibitors - cyclosporin/tacrolimus, sometimes used as rescue therapy for ASUC
*** Antibiotics - low-quality data to support use as induction agents
* '''Initial therapy for active proctitis or distal colitis (distal to splenic flexure):'''
** Mesalazine orally and rectally. Rectal topical therapy is probably the easiest way to target treatment to the affected area, but may not be effective for many reasons. Rectal preparation best given before bed, tolerated better at night.
*** Isolated ulcerative proctitis: suppositories
*** Extends >20cm from anal verge: foam or enema
*** Proximal to sigmoid: enema
** If 5-aminosalicylates are ineffective, add rectal steroids (e.g. 'Predsol' prednisolone enemas 20mg/100mL, can start off with a 1-2 week course).
** Continue until symptoms have resolved, then taper over several weeks.
** If symptoms recur, restart induction therapy.
* '''For induction therapy for colitis proximal to splenic flexure'''
** For mild-mod disease, PO prednisolone/5-aminosalicylate
** For severe, probably need an immunomodulator
* '''For unresponsive active colitis'''
** Oral prednisolone 40-50mg PO daily, then taper over 6-8 weeks
* '''For acute severe ulcerative colitis (Truelove and Witts criteria)'''
** Hydrocortisone 100mg IV q6h 3-5 days
** If they fail to respond to that, 'salvage therapy' is infliximab (possibly cyclosporin), and possibly upadacitinib
* '''Standard maintenance regime:'''
** Mesalazine 1-3g orally per day and a mesalazine rectal preparation 2-3 times per week
** If more severe, or frequent relapses, add an immunomodulator or biologic (usually infliximab)