Premium
Maintenance of remission in ulcerative colitis
Author(s) -
Kamm M. A.
Publication year - 2002
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.16.s4.4.x
Subject(s) - sulfasalazine , medicine , azathioprine , ulcerative colitis , gastroenterology , fulminant , immunosuppression , aminosalicylic acid , colitis , mercaptopurine , surgery , disease
Summary Seventy percent of patients with ulcerative colitis can expect to experience a relapse over a 12 month period. Sulfasalazine was the first drug demonstrated to reduce this relapse rate to 21 percent. Subsequent studies have demonstrated that 5‐aminosalicylic acid (5‐ASA) is the main active component, and preparations containing only 5‐ASA have similar efficacy to sulfasalazine. 5‐ASA is readily absorbed from the small intestine; to achieve high a colonic lumenal concentration therefore requires special release formulation. A variety of 5‐ASA preparations is available, differing in their release mechanism, efficacy and side effect profile. Most patients can be maintained in remission using oral 5‐ASA medication. For patients with distal or left sided disease the use of rectal 5‐ASA is also of proven benefit in maintaining remission. Some patients with frequent or severe relapses require stronger immunosuppression, and in these patients azathioprine or 6‐mercaptopurine (6‐MP) are of proven benefit. Azathioprine is also invaluable for maintaining remission in patients who have been treated with cyclosporin for a fulminant acute episode of colitis. The exciting spectre of natural bacterial therapies (probiotics) deserves further exploration.