From the Guidelines
Ileocolitis treatment should prioritize high-dose aminosalicylates, such as mesalazine 4g daily, for mild disease, and oral corticosteroids, like prednisolone 40mg daily, for moderate to severe disease, as recommended by the most recent guidelines 1.
Treatment Overview
When managing ileocolitis, it's essential to consider the severity of the disease and the patient's response to treatment.
- For mild ileocolonic disease, high-dose mesalazine (4g daily) may be sufficient as initial therapy, as supported by grade A evidence 2.
- For patients with moderate to severe disease, or those who have failed to respond to oral mesalazine, oral corticosteroids such as prednisolone 40mg daily are appropriate, with a gradual reduction over 8 weeks to minimize the risk of early relapse 2.
Additional Therapies
Other treatment options may be considered based on the patient's condition and response to initial therapy:
- Budesonide 9mg daily can be used for patients with isolated ileo-caecal disease and moderate disease activity, although it is marginally less effective than prednisolone 2.
- Intravenous steroids, such as hydrocortisone or methylprednisolone, are recommended for patients with severe disease, often in combination with intravenous metronidazole to address potential septic complications 2.
- Elemental or polymeric diets may be used as adjunctive therapy or to induce remission in selected patients with contraindications to corticosteroids or a preference to avoid such therapy 2.
Biologics and Surgery
- Infliximab 5mg/kg is effective for active disease but should be avoided in patients with obstructive symptoms, as noted in section 6.5 of the guidelines 2.
- Surgery should be considered for patients who have failed medical therapy and may be appropriate as primary therapy in those with limited ileal or ileo-caecal disease, although it is generally reserved for complications unresponsive to medical therapy 2, 1.
From the FDA Drug Label
RENFLEXIS is a tumor necrosis factor (TNF) blocker indicated for: 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)
The FDA drug label indicates that infliximab is used for ulcerative colitis, including inducing and maintaining clinical remission in adult and pediatric patients with moderately to severely active disease who have had an inadequate response to conventional therapy 3.
Key points:
- Infliximab is used to reduce signs and symptoms of ulcerative colitis.
- It is used to induce and maintain clinical remission in patients with ulcerative colitis.
- It is used in both adult and pediatric patients with moderately to severely active disease.
From the Research
Definition and Diagnosis of Ileo Colitis
- Ileo colitis is not explicitly defined in the provided studies, but it can be inferred that it refers to inflammation of the ileum and colon.
- Ulcerative colitis (UC) is a chronic idiopathic inflammatory bowel disorder of the colon that causes continuous mucosal inflammation extending from the rectum to the more proximal colon, with variable extents 4.
- The diagnosis of UC is based on the combination of clinical presentation, endoscopic findings, histology, and the absence of alternative diagnoses 4.
- Ileocolonoscopy with biopsy is the only way to make a definitive diagnosis of UC 4.
Types and Causes of Colitis
- Immune-mediated colitis is a common adverse event associated with the use of immune checkpoint inhibitors (ICIs), occurring in 35% to 50% of patients receiving ICIs 5.
- Infectious colitis is diagnosed in someone with diarrhea and one or more of the following: fever and/or dysentery, stools containing inflammatory markers, or positive stool culture for an invasive or inflammatory bacterial enteropathogen 6.
- The causes of colitis can be infectious, inflammatory, or immune-mediated 5, 6.
Treatment and Management of Colitis
- The goals of treatment in UC are to improve quality of life, achieve steroid-free remission, and minimize the risk of cancer 4.
- Mesalamine is considered a first-line therapy for ulcerative colitis, with doses of more than 2.4 g/d achieving significantly higher rates of clinical and endoscopic remission 7.
- Systemic corticosteroids and biologic therapy may be used to treat immune-mediated colitis, depending on the severity of symptoms 5.
- Pathogen-specific antimicrobial therapy should be initiated for all forms of infectious colitis, other than Shiga toxin-producing Escherichia coli (STEC) 6.