1) ULCERATIVE COLITIS- (sulfasalazine most effective to maintain remission)
- Well balanced diet
- Colectomy if
- refractory to medical Tx or
- if have cancerous changes
- Colonoscopy surveillance recommended starting 7 yrs from time of diagnosis
- Meds:
- mild-mod disease – sulfasalazine high dose for 12-16 weeks (6-8gms/day)
- once in remission then maintenance dose 2gms/day divided QID
- Severe disease- prednisone 30-60mg/day tapering to 0mg over 12-16 weeks,
- if in remission add maintenance dose sulfasalazine
- if poor control iv steroids/azathioprine/surgery
- mild-mod disease – sulfasalazine high dose for 12-16 weeks (6-8gms/day)
- NO NSAIDS
- asacol/mesalamine is a sulfasalazine with a different coating to release active ingredient
- Use extreme caution when prescribing narcotics and anticholinergic drugs in pts with active ulcerative colitis due to risk of toxic megacolon
2) CROHNS- (prednisone is most effective to maintain remission)
- stop smoking, adequate calorie intake (don‘t arbitrarily limit food)
- surgery for
- strictures/abscesses
- psychological support
- Meds:
- mild disease-induce remission with sulfasalazine over 10-16 weeks
- mod disease-induce remission with prednisone 40-60mg over 10-16 weeks,
- once in remission use sulfasalazine,
- if no remission use immunosuppressive therapy
- e.g. azathioprine/imuran or methotrexate or cyclosporine, po cipro/flagyl also used
- severe disease-iv steroids x 3-14 days
- then PO steroids or surgery if no response
- If terminal ileum resected may require cholestyramine or antidiarrheals and B12 supps
- In crohns disease, only use sulfasalazine as maintenance Tx for those at high risk for relapse based on previous disease.
- NO NSAIDS
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