Practical Treatment of Ulcerative Colitis

INTRODUCTION Before choosing the initial therapeutic approach for the patient with ulcerative colitis (UC), three issues must be clarified: 1) demonstration that the diagnosis is ulcerative colitis and not another cause of bloody diarrhea, 2) determination of clinical and endoscopic disease severity, and 3) documentation of disease extent. An accurate diagnosis remains the foundation for a successful therapeutic plan and therefore all other possible causes of bloody diarrhea must be excluded expeditiously. Infectious colitides that may present with colonic mucosal ulcerations and bloody diarrhea include: Clostridium difficile, E. coli 0157: H7, CMV, Salmonella, Shigella, and amoebiasis. Non-infectious causes of bloody diarrhea in the differential diagnosis include: ischemia, radiation, NSAIDs, oral contraceptives, hormone replacement therapy, medications, and Crohn’s disease. Please refer to Table 1. INFLAMMATORY BOWEL DISEASE: A PRACTICAL APPROACH, SERIES #52