- Local complications (involving the colon) occur in the majority of ulcerative colitis patients. Relatively minor complications include hemorrhoids, anal fissures, or perirectal abscesses.
- A major complication is toxic megacolon, a severe condition that occurs in up to 7.9% of ulcerative colitis patients admitted to hospitals. The patient with toxic megacolon usually has a high fever, tachycardia, distended abdomen, elevated white blood cell count, and a dilated colon.
- The risk of colonic carcinoma is much greater in patients with ulcerative colitis as compared with the general population.
- Approximately 11% of patients with ulcerative colitis have hepatobiliary complications including fatty liver, pericholangitis, chronic active hepatitis, cirrhosis, sclerosing cholangitis, cholangiocarcinoma, and gallstones.
- Arthritis commonly occurs in IBD patients and is typically asymptomatic and migratory. Arthritis typically involves one or a few large joints such as the knees, hips, ankles, wrists, and elbows.
- Ocular complications (iritis, episcleritis, and conjunctivitis) occur in up to 10% of patients. Five percent to 10% of patients experience dermatologic or mucosal complications (erythema nodosum, pyoderma ganrenosum, aphthous stomatitis).
Treatment of Ulcerative Colitis:
The first line of drug therapy for the patient with mild to moderate colitis is oral sulfasalazine or an oral mesalamine derivative, or topical mesalamine or steroids for distal disease (Figure 25-1).
When given orally, usually 4 g/day, up to 8 g/day of sulfasalazine is required to attain control of active inflammation. Sulfasalazine therapy should be instituted at 500 mg/day and increased every few days up to 4 g/day or the maximum tolerated.
Oral mesalamine derivatives (such as those listed in Table 25-5) are reasonable alternatives to sulfasalazine for treatment of ulcerative colitis but they are not more effective than sulfasalazine (Figure 25-2).
Steroids have a place in the treatment of moderate to severe ulcerative colitis that is unresponsive to maximal doses of oral and topical mesalamine. Prednisone up to 1 mg/kg/day may be used for patients who do not have an adequate response to sulfasalazine or mesalamine.
Steroids and sulfasalazine appear to be equally efficacious; however, the response to steroids may be evident sooner.
Rectally administered steroids or mesalamine can be used as initial therapy for patients with ulcerative proctitis or distal colitis.
Transdermal nicotine in the highest tolerated dose improved symptoms of patients with active ulcerative.