Current medical therapy for ulcerative colitis

Table 1 Treatment of active ulcerative colitis

Severity	Extent
	Distal	Left-sided	Extensive
Mild	Topical GCS or 5-ASA	Topical GCS or 5-ASA + oral 5-ASA	Oral 5-ASA ( + topical therapy)
Moderate/severe	Topical GCS or 5-ASA (+ oral 5-ASA?)	Oral GCS	Oral or GCS iv
Refractory	Increase dose and duration	GCS iv + CSA	GCS iv + CSA
	Switch enemas	Surgery	Surgery
	Combine topical GCS and 5-ASA
	Oral GCS
	Others

Table 2 Adverse events reported with use of cyclosporin (iv + oral) in IBD[18]

Type of side effect	%	Type of side effect	%
Paresthesias	26	Headache	5
Miscellaneous	13	Infection	3
Hypertrichosis	13	Hepatotoxicity	3
Hypertension	11	Gingival hyperplasia	2
Tremor	7	Seizure	1
Nausea/vomiting	6	Anaphylaxis	0.3
Renal insufficiency	6	Side effects/patient	0.94

Table 3 Major side effects of glucocorticosteroids

	Short-term and long-term therapy	Long-term therapy
CNS	Pseudotumor cerebri
	Psychosis
Musculoskeletal	Myopathy	Osteoporosis
	Aseptic necrosis
Ocular	Graucoma	Cataracts
Gastrointestinal	Ulcer-pancreatitis
Cardiovascular	Hypertension
	Fluid retention
Endocrinological		Permanent suppression of HPA-axis
		Growth failure
Metabolic	Hyperglycemia	Fatty liver
	Hyperosmolar state	Hypokalemia
	Hyperlipidemia
Skin	Acne, ecchymosis	Striae, atrophy, wound
		Infection
		Cushingoid fat
		Distribution

Table 4 Immunosuppressives used in inflammatory bowel diseases

Drug	Mode of action	Mechanism of action
AZT/6-MP	Inhibition of ribonucleotide sysnthesis	Inhibition of proliferation of T-cell clones
Methotrexate	Folic acid inhibitor	Inhibition of T and B-cell
		Function decrease of IL-1 and IL-6
Cyclosporin (CsA	Inhibition of T-cell-receptor-stimulated	Inhibition of IL-2 production and
Tacolimua (FK 506)	Transcription of lymphokine genes	IL-2 receptors; inhibition of cytokines(TNFα, IFNγ)
Mycophenolate	Inhibition of guanosin nucleotide synthesis

Table 5 Immunomodulation therapy in inflammatory bowel disease

	Cytokines	Anticytokines	Antisense nucleotides
Current studies	rhu IL-10, rhu IL-11	TNF antibodies, inhibitors	ICAM-1
Future studies		IL-1 antibodies IL-1 ra	NFκB
		IFN-γ antibodies
		IL-12 antibodies