What is the diagnosis and treatment for pancolitis (inflammation of the entire colon)?

From the Guidelines

Pancolitis, a severe form of ulcerative colitis, should be treated with mesalazine 2–4 g daily as the first line therapy for mild to moderately active disease, according to the most recent and highest quality evidence available 1. The diagnosis of pancolitis typically involves a combination of clinical presentation, endoscopic evaluation, and histological examination. Symptoms of pancolitis include bloody diarrhea, abdominal pain, urgency to defecate, weight loss, and fatigue.

• The treatment approach for pancolitis involves a step-up strategy, starting with aminosalicylates like mesalazine, which has been shown to be effective in reducing inflammation and inducing remission 1.
• For patients who do not respond to mesalazine or have more severe disease, corticosteroids like prednisolone 40 mg daily may be added, with a gradual tapering over 8 weeks to minimize the risk of early relapse 1.
• In cases of chronic active steroid-dependent disease, immunomodulators like azathioprine 1.5–2.5 mg/kg/day or mercaptopurine 0.75–1.5 mg/kg/day may be considered, as they have been shown to be effective in maintaining remission and reducing steroid dependence 1.
• Topical agents, such as steroids or mesalazine, may be added to the treatment regimen to manage troublesome rectal symptoms, although they are unlikely to be effective as monotherapy 1.
• Ciclosporin may be considered for severe, steroid-refractory colitis, as it has been shown to be effective in inducing remission in these cases 1.
• It is essential to note that the treatment of pancolitis should be individualized, taking into account the severity of the disease, patient response, and potential side effects of medications. Regular monitoring with colonoscopies is also crucial due to the increased risk of colorectal cancer associated with long-standing pancolitis.

From the FDA Drug Label

Ulcerative Colitis: • reducing signs and symptoms, inducing and maintaining clinical remission and mucosal healing, and eliminating corticosteroid use in adult patients with moderately to severely active disease who have had an inadequate response to conventional therapy. (1. 3) Pediatric Ulcerative Colitis: • reducing signs and symptoms and inducing and maintaining clinical remission in pediatric patients with moderately to severely active disease who have had an inadequate response to conventional therapy. (1. 4)

Ulcerative Colitis: • 5 mg/kg at 0,2 and 6 weeks, then every 8 weeks. (2.3) Pediatric Ulcerative Colitis: • 5 mg/kg at 0,2 and 6 weeks, then every 8 weeks. (2. 4)

The diagnosis of pancolitis, which is inflammation of the entire colon, is typically made based on clinical presentation, endoscopy, and histology. Treatment for pancolitis, which is a form of ulcerative colitis, may involve the use of medications such as infliximab 2 or adalimumab 3.

• The recommended dose for infliximab is 5 mg/kg at 0,2, and 6 weeks, then every 8 weeks.
• The goal of treatment is to reduce signs and symptoms, induce and maintain clinical remission, and eliminate corticosteroid use. Key considerations in the treatment of pancolitis include:
• The patient's response to conventional therapy
• The presence of any contraindications to treatment with infliximab or adalimumab
• The potential risks and benefits of treatment, including the risk of serious infections and malignancies.

From the Research

Diagnosis of Pancolitis

• Pancolitis, or inflammation of the entire colon, is a condition that can be diagnosed through a combination of clinical picture, tissue biopsy, and endoscopic appearance of mucosal ulceration, friable, edematous, erythematous granular appearing mucus 4.
• The diagnosis is typically made in patients with ulcerative colitis (UC), a chronic inflammatory condition of the large bowel 4, 5, 6, 7.

Treatment of Pancolitis

• The treatment of pancolitis typically involves the use of mesalamine, a 5-aminosalicylic acid compound that is the first-line therapy for patients with mild-to-moderate UC 4, 5, 7.
• Mesalamine has been shown to be effective in inducing and maintaining clinical remission in patients with UC, with response rates between 40%-70% and remission rates of 15%-20% 4.
• The optimal dosage of mesalamine for mild-moderate distal active disease is 4.8 g/day, while 2.4 g/day is optimal for maintenance therapy 4.
• In patients with moderately active UC, mesalamine has been shown to be more effective than placebo in achieving overall improvement at week 6 5.
• For patients who are refractory to mesalamine or have more severe disease, other treatment options such as steroids, azathioprine/mercaptopurine, cyclosporine, or infliximab may be used 5, 6.
• Anti-tumor necrosis factor (TNF) agents, such as adalimumab and golimumab, have also been shown to be effective in inducing and maintaining remission in patients with extensive UC 6.