1、The Clinical Application of Corticosteroids in Ulcerative ColitisTwo parts The introduction of Ulcerative colitis The clinical application of Corticosteroids in Ulcerative colitisUlcerative colitis Definition:Chronic non-specific colitis Inflammation of the mucosa and submucosa of the large intestin
2、e Features:diarrhea with feces containing mucus,pus and blood,abdominal pain and tenesmus;and recurrence is common Mostly seen in 20-50 years of age,and in Europe Less common in ChinaInfection Environmental factorsGenetic susceptibleImmune&inflammatory systemEtiology and pathogenesisLocation:rectum
3、and sigmoid colon,then descending,transverse or pan-colon,even terminal ileumMucosa diffused inflammation with edema,congestion and local bleedings.Pathology Infiltration of lymphocytes,plasma cells,eosinophilic cells and neutrophilic cells in mucosa Cryptic abscess and superficial ulcers Inflammato
4、ry polyps or pseudopolyps;UCUCCryptic abscess in UCClinical Manifestations Symptoms:diarrhea abdominal pain,others:tenesmus,anorexia,nausea and vomiting Signs:tenderness in the left hypogastrium and rebound tendernessManifestations of digestive systemSystemic manifestations fever,tachycardia,Anemia,
5、malnutrition,volume depletion,disturbance in acid-basebalance and hypoalbuminemia in advanced patientsExtra-intestinal manifestations erythema nodosum,arthritis,ankylosing spondylitis,iritis，episcleritis,conjunctivitis,ulcers of oral mucosa,chronic active hepatitis and so on.erythema nodosumA.course
6、 classificationinitial typechronic relapse typechronic permanent type acute and fulminant typeClinical classificationUC B.Extent classification (1)mild type (2)moderate type (3)severe typeClassificationUC C.range classificationProctitis or proctosigmoiditis:40-50%Left-sided or intermediate colitis:3
7、0-40%Pancolitis:20%D.period classificationActive phaseAlleviative phaseClassificationUCUCendoscopic examination Diseased mucosa:hyperemic and edematous,blood vessels not clear-cut,mucosa erosions and multiple shallow ulcers;rough,fragile,bleeding easily granular,pus;pseudopolyps seen Mucosa irregula
8、rity,saw-tooth like,loss of haustrations,shortening of colon and pseudopolyps formationContraindicated in fulminant typeUCBarium enematypical symptoms+one of endoscopic appearances and biopsy(or one of x-ray barium enema signs)+elimination of other alike disease Notice:1.symptoms are not typical,whi
9、le endoscopic appearances are typical-diagnosis 2.symptoms are typical,while endoscopic appearances are not typical-suspectDiagnosisTreatmentGeneral treatmentDrug treatmentSulfasalazineCorticosteroidsImmune inhibitorFirst choiceSevere patientsSurgical therapyIndications:abscess formation,canceration
10、,perforation,fistula,mega-colon and refractory colitis,failure of medical therapy etcSecond partThe clinical application of Corticosteroids in Ulcerative colitisFinding CORTISONE IN ULCERATIVE COLITIS FINAL REPORT ON A THERAPEUTIC TRIALBRITISH MEDICAL JOURNAL On OCTOBER 29 1955S.C.TRUELOVE,M.D.,M.R.
11、C.P.AND L.J.WITTS,M.D.,F.R.C.P.Conclusion the patients receiving cortisone enjoyed a clear-cut advantage over the patients on a dummy preparation.About two out of every five patients on cortisone therapy were in clinical remission at the end of six weeks treatment,compared with less than one out of
12、every six patients receiving the inert therapy.Among the patients treated with cortisone those in their first attack have fared somewhat better than those in relapse.How to decide the dose of CorticosteroidsThe American Journal of GASTROENTEROLOGY Ulcerative Colitis Practice Guidelines in Adults by
13、American College of Gastroenterology Practic Parameters CommitteeUlcerative Colitis Practice Guidelines in Adults Oral prednisone shows a dose response effect between 20 and 60 mg per day,with 60 mg per day modestly more effective than 40 mg per day but at the expense of greater side-effects.Ulcerat
14、ive Colitis Practice Guidelines in Adults No randomized trials have studied Corticosteroids taper schedules;most recommendations have advised 40 60 mg per day until significant clinical improvement occurs and then a dose taper of 5 10 mg weekly until a daily dose of 20 mg is reached.At this point ta
15、pering generally proceeds at 2.5 mg per week.The therapeutic plan is determined by the Patients condition and preferencessevere and fulminant typeFor patients who suffer from severe and fulminant type of UC：intravenous injection Corticosteroids is First choice,recommend dosage hydrocortisone 300mg o
16、r meprednisone 60mg。mild and moderate type with largely lesion For mild and moderate patient,First choice oral Sulfasalazine，while it is not effective，recommend oral prednisone 2060 mg/dmild and moderate type with Distal lesion Corticosteroids topical therapiesEffect of topical administration of bud
17、esonide and tranditional corticosteroids on active distal ulcerative colitis or proctitisShang hai Jiao tong University School of MedicineResearch fromConclusion The effects of budesonide and traditional corticosteroids on active distal Ulcerative colitis or Proctitis are similar.However,budesonide
18、maybe Preferable to traditional corticosteroids,since its inhibitory effect on Plasma cortisol level is lower than traditional corticosteroids.adverse effects Such as cushingoid features,emotional and psychiatric disturbances,infections,glaucoma.Complications include gastroduodenal mucosal injury,im
19、paired wound healing,and metabolic bone disease.steroid-dependency Although short term control of symptoms can be achieved with steroid treatment,followed by recurrence during alleviating dose or stopping administration this pattern of drug response，known as steroid-dependency The therapeutic plan f
20、or steroid-dependency Azathioprine 2-2.5mg/kg*d Cyclosporin therapy for severe ulcerative colitis Infliximab could not only maintain the clinical remission in UC patients，but also decrease the colon resection rate for patients with moderate to severe refractory UC Else therapies intestinal stem cells antibiotics If failure of medical therapy，the Surgical therapy should be taken.谢谢 谢谢 大大 家家
