Ulcerative colitis: treatment
Last reviewed: 23.04.2024
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Modern methods of treatment of ulcerative colitis and Crohn's disease.
Unclear etiology of ulcerative colitis complicates their treatment. The currently used therapy is essentially empirical, and the search for drugs that have antibacterial, anti-inflammatory and immunosuppressive effects is based on a common theory of the onset of both diseases, which recognizes the leading role of antigens of intestinal origin, under the influence of which the reactivity and inflammation of the intestine change.
The requirements for drugs were primarily met by corticosteroids, which were used in the treatment of ulcerative colitis since 1950. To date, corticosteroid therapy remains the most effective treatment for acute forms of these diseases.
In addition to corticosteroids, other drugs with antibacterial and anti-inflammatory effects are used. These include, first of all, sulfasalazine and its analogues (salazopyrine, salazopyridazine, salazodimethoxin).
Sulfasalazine is azo compound of 5-aminosalicylic acid and sulfapyridine. Until now, the mechanism of its action has been studied. It was believed that the ingested sulfasalazine, with the participation of the intestinal microflora, loses the azo link and decomposes into 5-aminosalicylic acid and sulfapyridine. Unabsorbed sulfapyridine temporarily inhibits the growth of anaerobic microflora in the intestine, including clostridia and bacteroides. Recently, it has been established that the active principle of sulfasalazine is mainly 5-aminosalicylic acid, which inhibits the lipoxygen pathway of the transformation of arachidonic acid and thus blocks the synthesis of 5,12-hydroxyicatetraenoic acid (HEET), a potent chemotactic factor. Consequently, the effect of sulfasalazine on the pathological process was more complicated than previously thought: the drug causes changes in the intestinal microflora, modulates immune responses and blocks the mediators of the inflammatory process.
Correct application of corticosteroids, sulfasalazine and its analogs makes it possible in a significant percentage of cases to suppress the activity of the inflammatory process with ulcerative colitis. However, it should be noted that in many patients sulfasalazine has to be canceled because of its intolerance. Responsibility for undesirable side effects of the drug rests with the sulfapyridine that enters it. The constantly existing danger of complications with prolonged use of corticosteroids, side effects accompanying sulfasalazine, dictate the need for studying new pathogenetically valid methods of treatment.
The results of studies that established that the active ingredient of sulfasalazine is 5-aminosalicylic acid served as the basis for the development of new drugs in which the 5-aminosalicylic acid molecule is linked through an amino-linkage to another same or neutral molecule. An example of such a preparation is salofalk, which does not contain sulfapyridine and, therefore, is devoid of its side properties.
As an immunoreactive agent in the treatment of patients with ulcerative colitis try to use azathioprine - a heterocyclic derivative of 6-mercaptopurine.
According to some publications, azathioprine reduces the likelihood of recurrence of ulcerative colitis and makes it possible to reduce the dose of prednisolone in patients who are forced to take it. According to other data, patients who received azathioprine did not feel better than patients who received a placebo.
Thus, the effectiveness of azathioprine has not yet been conclusively proven.
In the treatment of patients with ulcerative colitis, antilymphocytic globulin, some immunostimulants (levamisole, BCG) are also recommended. The detection of circulating immunocomplexes in the blood of patients with Crohn's disease led to an attempt to use plasmapheresis in the treatment. Interferon and superoxide dismutase treatment was performed. To determine the role of these drugs in a complex of therapeutic measures for ulcerative colitis, further accumulation of experimental and clinical materials is required, followed by careful processing of the data.
In the treatment of ulcerative colitis, it is important not only to stop the acute attack, but also to extend the period of remission, thereby making patients less dependent on the intake of such drugs as corticosteroids. In this respect, the method of hyperbaric oxygenation (HBO) is of interest.
The ability of HBO to affect microorganisms and reduce their toxicity is particularly important, since bacteria play a significant role in the pathogenesis of ulcerative colitis.
Given that treatment with HBO in the midst of exacerbation of ulcerative colitis is impossible due to the severity of the condition of patients, tenesmus and diarrhea, HBO are included in complex therapy at the end of an acute period, when clinical and laboratory indicators improved. Patients admitted to treatment with HBO received sessions in single-chamber medical pressure chambers. The speed of compression and decompression should not exceed 0.1 atm per minute. The test session is performed in 1.3 atm mode for 20 minutes. Therapeutic - is carried out at an operating oxygen pressure of 1.7 atm for 40 minutes. Thus, each session in total lasts about 1 hour. The course of treatment with HBO on the outcome of an exacerbation should consist of 10-12 sessions, preventive courses in the period of remission (with an interval of 1 year) - from 8-10 sessions.
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