GASTROENTEROLOGY ARTICLE OF THE WEEK
September 16, 2004
Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults (Update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol doi:10.1111/j.1572-0241.2004.40036.x
1, Histologic features favoring chronic UC vs. acute infections colitis include
a. mucosal inflammation
b. crypt branching
c. increased plasma cells near crypt bases
d. crypt abscess
e. Paneth cell metaplasia
2. Maintenance of remission in UC
a. all mesalamine compounds except olsalazine are useful in maintaining
remission
b. low dose corticosteroid is an acceptable option to maintain remission
c. Azathioprine maintains remission in patients who required this medication to
go into remission.
d. colectomy should be discussed with patients on long term azathioprine
maintenance.
3. Severe colitis
a. TPN is useful as a therapeutic modality
b. ASA compounds should be included in the initial management of these
patients
c. systemic antibiotics should be given to patients with toxic megacolon
d. IV corticosteroids in excess of the equivalent of 300mg of hydrocortisone is
not likely to add to the therapeutic response
e. CMV can be a cause of toxic megacolon refractory to therapy.
True or False
4. The finding of patchy cecal inflammation discontinuous from more distal inflammatory changes in the colon excludes the diagnosis of UC and suggests Crohn’s disease.
5. Colon cancer risk after 10 years of pancolitis is approximately 0.5% - 1% per year.
6. Topical mesalamine preparations are superior to oral mesalamine or topical steroids.
7. Oral mesalamine does not add to the effectiveness of topical mesalamine.
8. All mesalamine compounds have the potential for decreasing male fertility.
9. Topical corticosteroids are not effective in maintaining remission.
10. Patients with moderate extensive colitis should be treated with corticosteroid monotherapy initially.
11. Low grade dysplasia associated with a mass lesion is an indication for colectomy.
12. Eudragit-S coated mesalamine is Asacol, ethylcellulose-coated mesalamine is Pentasa.
13. Daily doses of mesalamine below 2grams are considered ineffective.
14. Bone mass density should be measured in any patient treated with 5mg or more of prednisone for longer than 2 months.
15. Endoscopic removal of masses that look like typical pedunculated adenomas may be sufficient and does not require colectomy.