Ulcerative colitis: an update

Abstract

Ulcerative colitis is a relapsing and remitting disease that is increasing in incidence and prevalence. Management aims to achieve rapid resolution of symptoms, mucosal healing and improvement in a patient's quality of life. 5-aminosalicylate acid medications remain the first-line treatment for mild to moderate disease. In the event of suboptimal response to these medications, escalation to immunosuppressive medications and biologics may be necessary. Importantly, despite best medical therapy, surgery may be required in a proportion of patients. The future will likely see an array of new therapeutic options for those with ulcerative colitis with the potential for a more personalised treatment approach.

Keywords: biologics; inflammatory bowel disease; ulcerative colitis.

Fig 1.

Mechanisms of action for biologics and small molecules used in ulcerative colitis. α4β7 = alpha-4 beta-7 integrin; αeβ7 = alpha-e beta-7 integrin; IL = interleukin; Jak = Janus kinase; MAdCAM-1 = mucosal vascular addressing cell adhesion molecule-1; s1p1 = sphingosine-1-phosphate receptor; Stat = signal transducer and activator of transcription; TNF = tumour necrosis factor.