From the Guidelines
Pancolitis is a severe form of ulcerative colitis that affects the entire colon, from the rectum to the cecum, causing inflammation and ulceration throughout the large intestine, leading to symptoms such as bloody diarrhea, abdominal pain, urgency to defecate, weight loss, and fatigue. This condition is more extensive than other forms of ulcerative colitis that may only affect portions of the colon. According to the most recent guidelines, treatment typically involves anti-inflammatory medications like 5-aminosalicylates, corticosteroids, immunomodulators, and biologics 1.
Key Characteristics of Pancolitis
- Affects the entire colon, from the rectum to the cecum
- Causes inflammation and ulceration throughout the large intestine
- Symptoms include bloody diarrhea, abdominal pain, urgency to defecate, weight loss, and fatigue
- More extensive than other forms of ulcerative colitis
Treatment Options
- Anti-inflammatory medications: 5-aminosalicylates (such as mesalamine 2-4g daily) 1
- Corticosteroids: prednisone 40-60mg daily for acute flares 1
- Immunomodulators: azathioprine 2-3mg/kg/day or 6-mercaptopurine 1-1.5mg/kg/day 1
- Biologics: infliximab, adalimumab, vedolizumab, or ustekinumab 1
Management and Monitoring
- Regular monitoring with colonoscopies every 1-2 years after 8-10 years of disease due to increased risk of colorectal cancer 1
- Hospitalization may be necessary for intravenous steroids, fluids, and electrolyte replacement during severe flares
- Surgical removal of the colon (colectomy) may be required in cases resistant to medical therapy 1
- Maintaining good nutrition, staying hydrated, and avoiding trigger foods are important aspects of managing this chronic condition 1
From the Research
Definition of Pancolitis
- Pancolitis refers to inflammation of the entire colon, which is a characteristic feature of ulcerative colitis (UC) 2.
- In UC, the inflammation typically starts in the rectum and extends proximally in a continuous fashion, which can lead to pancolitis in severe cases.
Relationship with Ulcerative Colitis
- Ulcerative colitis is a chronic inflammatory bowel disease that can involve any part of the colon, and pancolitis is a type of extensive colitis that affects the entire colon 2, 3.
- The treatment of pancolitis usually involves pharmacological therapy to induce and maintain remission, and aminosalicylates are commonly used as first-line therapy for mild to moderate UC, including pancolitis 4, 5, 6.
Treatment Options
- Aminosalicylates, such as mesalazine, are effective in inducing and maintaining remission in patients with UC, including those with pancolitis 5, 3, 6.
- High-dose aminosalicylate therapy may be a valuable option for patients with moderately active disease, including pancolitis 6.
- In some cases, combination therapy with oral and rectal aminosalicylates may provide additional efficacy for patients with extensive colitis, including pancolitis 5.