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

From the Guidelines

For moderate to severe ulcerative colitis, treatment with oral corticosteroids such as prednisolone 40 mg daily, weaning over 6–8 weeks, is strongly recommended. This approach is based on the highest quality and most recent evidence available, as outlined in the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults 1. The guidelines emphasize the importance of treating moderate to severe ulcerative colitis aggressively to reduce inflammation, control symptoms, and prevent complications.

Key Considerations in Management

• The treatment of colitis depends on the specific type of colitis, with ulcerative colitis being a common form that requires tailored management strategies.
• For mild to moderate ulcerative colitis, first-line medications often include 5-aminosalicylates like mesalamine, which can be used orally or topically.
• Corticosteroids, such as prednisone, are crucial for managing moderate to severe flares of ulcerative colitis but are not suitable for long-term use due to potential side effects.
• Maintenance therapy may involve immunomodulators like azathioprine or biologics such as infliximab for patients who require ongoing management of their disease.

Evidence-Based Recommendations

The recommendation for using oral corticosteroids like prednisolone for moderate to severe ulcerative colitis is supported by high-quality evidence 1. While other studies discuss the use of intravenous steroids and ciclosporin for severe cases 1, and the importance of evaluating disease activity and extent in therapeutic decisions 1, the most recent and highest quality guideline recommends oral corticosteroids as the first line for moderate to severe disease.

Clinical Application

In clinical practice, it is essential to assess the severity and extent of ulcerative colitis to guide treatment decisions. Patients with moderate to severe disease should be started on oral corticosteroids, with careful monitoring and adjustment of the treatment plan as needed to minimize side effects and maximize efficacy. The goal of treatment is to induce and maintain remission, improve quality of life, and prevent long-term complications associated with ulcerative colitis.

From the FDA Drug Label

RENFLEXIS is indicated for reducing signs and symptoms, inducing and maintaining clinical remission and mucosal healing, and eliminating corticosteroid use in adult patients with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy. RENFLEXIS is indicated for reducing signs and symptoms and inducing and maintaining clinical remission in pediatric patients 6 years and older with moderately to severely active ulcerative colitis who have had an inadequate response to conventional therapy.

Infliximab (IV) is used to treat ulcerative colitis in adult and pediatric patients. The recommended dose is 5 mg/kg given as an intravenous induction regimen at 0,2, and 6 weeks, followed by a maintenance regimen of 5 mg/kg every 8 weeks.

• Key points:
  • Reducing signs and symptoms
  • Inducing and maintaining clinical remission
  • Mucosal healing
  • Eliminating corticosteroid use
• Patient population:
  • Adult patients with moderately to severely active ulcerative colitis
  • Pediatric patients 6 years and older with moderately to severely active ulcerative colitis 2 2

From the Research

Definition and Treatment of Colitis

• Colitis is a chronic inflammatory disease of the colon that typically manifests as diarrhea, abdominal pain, and bloody stool 3.
• The goals of management are to induce and maintain clinical remission and to screen for complications of this disease 3.
• Mesalamine is a 5-aminosalicylic acid compound that is the first-line therapy to induce and maintain clinical remission in patients with mild-to-moderate colitis 3, 4.

Mesalamine Formulations and Efficacy

• Mesalamine with Multi-Matrix System(®) (MMX) technology is an oral, once-daily tablet formulation of mesalamine used for the treatment of colitis 3.
• MMX mesalamine effectively induced and maintained clinical remission in patients with active mild-to-moderate colitis 3.
• Combined oral and rectal mesalazine treatment achieved a significantly higher rate of improvement in disease activity index compared with oral-only treatment 5.

Treatment Algorithms and Patient Care

• The management of colitis therapy should be guided by the endoscopic extent of inflammation, disease severity, and prognostic factors of poor outcome 6.
• Complete remission, defined as durable symptomatic and endoscopic remission without corticosteroid therapy, is the desired treatment goal 6.
• Patient care in colitis remains challenging despite an array of established treatment options and emerging new therapies 6.

Effectiveness of Mesalamine

• Oral or topical mesalamine is a well-known treatment for colitis, and it is the standard for starting and maintaining recovery in mild-to-moderate illnesses 7.
• The majority of patients start mesalamine treatment in the first year after diagnosis and continue it for long periods 7.
• Further investigation is required to ascertain the optimal approach for managing colitis, with the aim of incorporating it into routine clinical procedures and enhancing our understanding of the subject matter 7.