CLINICAL MANAGEMENT GUIDELINE

Ulcerative colitis

ICD10: Ulcerative colitis, unspecified [K51.9]

Treatment: Induction therapy; proctitis or proctosigmoiditis

Defined as chronic, recurrent and progressive GIT mucosal inflammation (autoimmune); commonly as proctitis, proctosigmoiditis, Left-sided colitis, and Extensive colitis.

Microscopically:

Only mucosal, with the formation of crypt abscesses and reduction in goblet cell mucin. In severe cases, the submucosa or deeper muscular layers can be affected.


Success criteria:

induce remission; endoscopic and clinical remission.

Defining UC severity is a key factor in management:

Mild; commonModerate 27%Sever < 1%
≤4 stools per day +/- little blood.≤6 stools per day + hematochezia+ anime Hb> 10g/dL.>6 bloody stools per day + anime Hb< 10g/dL.
No signs of systemic toxicity (eg, no tachycardia)Minimal systemic manifestations; low-grade fever.Systemic toxicity; fever > 37.5 C, tachycardia .
Normal CRP & ESRNormal CRP & ESRHigh CRP, ESR, fecal calprotectin & Low Albumin.
Mild abdominal pain, tenesmus, or constipation.Moderate abdominal pain, tenesmus, or constipation.Sever abdominal pain, Weight loss, extraintestinal complications
No response to mild-moderate regimen.
History of hospitalization
Endoscope: extensive colitis w/ deep ulcerations.

How to use levels:

Level 1-3 is to treat mild to moderate UC. Level 3-5 is to treat moderate to severe UC.

Treatments

Level 1 / 5
pharmacological
mesalamine
ROUTE
suppository
DOSE
1.000 g
FREQUENCY
OD-BID
pharmacological
Hydrocortisone
ROUTE
suppository
DOSE
30.000 mg
FREQUENCY
OD-BID
pharmacological
mesalamine
ROUTE
Oral
DOSE
3.000 g
FREQUENCY
OD

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  • Duplicating mechanism of action of effect
  • Weight based dosing
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  • Renal dosing
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  • Hepatic dosing

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