Dr. Gholam Reza Khatami Ulcerative colitis is a chronic gastrointestinal disease Given modern...
Transcript of Dr. Gholam Reza Khatami Ulcerative colitis is a chronic gastrointestinal disease Given modern...
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IN THE NAME OF GOD
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Ulcerative Colitis in children
Diagnosis and treatment
Dr. Gholam Reza Khatami
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Ulcerative colitis is a chronic gastrointestinal disease
Given modern treatment, medical management is not curative
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Clinical characteristicsGastrointestinal symptomsExtaintestinal manifestationsHepatobiliary
PSC , AHJoints
Knee, Wrist, Hip, Ankle, ElbowAnkylosing spondilitis
Skin Pyoderma gangrenosumErythema nodosum
Occular disordersEpiscleritis, Uveitis
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DiagnosisHistory
weight loss, amenorrhea
Abdominal pain
Underweight
Diarrhea
Rectal bleeding
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Physical examination
Abdominal sensitivity
Perianal skin tag, fistula
Skin lesions
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Laboratory studies in suspected UCCBC, ESRElectrolytes, Protein, Albumin, LFTSerum Iron, IBC, FerritinStool for enteric pathogensStool for clostridium difficile toxinsStool for ova and parasitesPANCA, ASCA, Anti-ompCFecal calpotectin
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ImagingUGI Series
Small bowel follow through
CT
MR enterography
Capsule endoscopy
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Endoscopy
Disease starts from anal verge
Mild form
Active form
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ManagementAbout 20-30 % of patients have spontaneus improvementNutrition (Short chain fatty acid, n-3 fatty acid)Corticosteroids5-AminosalicylatesImmunomodulatorsBiologicsProbioticsLeukocyte ApheresisSurgery
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Corticosteroids
One year
complication
Budesonide ( Oral, Enema)
Complete reaction 57%Steroid dependant 14%Colectomy 29%
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5- Aminosalicylates
Sulfasalazine G6PD
5.ASA Mesalamin, Olsalazin, Balsalazide
Delayed – release ASA Pentasa, Asacol
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Management of proctitis or left-sided colitis
Mesalamin Suppository better than oralEnema better than rectal corticosteroidFoam
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Management of moderate to severe forms of UC
Corticosteroid
Remission
2 weeks (2 doses / day)4 weeks (one dose / day)Taper Mesalamin
Clinical 85%Endoscopic 40%Histologic 15%
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Management of moderate to severe forms of UC (Cont)
Corticosteroid resistant or dependant
Azathioprine + Steroid
Metotrexate + Steroid
Ciclosporine delaying surgery
Infleximab
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Probiotics, Prebiotics
Decreases the secretion of proinflammatory cytocaines ( inteferon γ , TNF – α , IL- 12 )
Increases anti inflammatory cytocaine ( Il 10 )
Saccharomyces boulardii mild form of UC 61% remission
add to standard medical treatment 93% remission
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Surgery
After 5 years 19% colectomy
2 stagesSubotal colectomy + ileostomyIlial pouch anal
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PouchitisMetronidazole, Ciprofloxacin
5 - ASA
Coticosteroids
Probiotics
Antitumor necrosing factor
Resection
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