Ulcerative Colitis (cont.)

Active research is also ongoing to find other biological agents that are potentially more effective with fewer side effects in treating ulcerative colitis including adalimumab, visilizumab, and alpha-4 integrin blockers.

Research in ulcerative colitis is very active, and many questions remain to be answered. The cause, mechanism of inflammation, and optimal treatments have yet to be defined. Researchers have recently identified genetic differences among patients which may allow them to select certain subgroups of patients with ulcerative colitis who may respond differently to medications. Newer and safer medications are being developed. Improvements in surgical procedures to make them safer and more effective continue to emerge.

Health Maintenance

It is recommended that adults with inflammatory bowel disease generally follow the same vaccination schedules as the general population.

• Adults should receive a 1 time dose of Tdap, then Td booster every 10 years.
• Women between the ages of 9 and 26 should receive 3 doses of HPV vaccine (and consideration should be given to older patients who are HPV negative on Pap smear).
• Men in the same age range should also consider being vaccinated given the increased risk of HPV with immunosuppression.
• Influenza (flu) vaccine should be given annually to all patients (though the live intranasal vaccine is contraindicated in patients on immunosuppressive therapy).
• One dose of pneumococcal vaccine should be given between age 19-26 and then revaccination after 5 years.
• If not previously vaccinated, all adults should receive 2 doses of hepatitis A vaccine and 3 doses hepatitis B.
• Meningococcal vaccine is only recommended for patients with anatomic or functional asplenia, terminal complement deficiencies, or others at higher risk (college students, military recruits, etc).
• MMR, varicella, and zoster vaccines (shingles vaccine) are contraindicated for patients on biologic therapy, as they are all live vaccines.

Osteoporosis has also increasingly been recognized as a significant health problem in patients with IBD. IBD patients tend to have markedly reduced bone mineral densities. Screening with a bone density study is recommended in:

• postmenopausal woman,
• men > age 50,
• patients with prolonged steroid use (>3 consecutive months or recurrent courses),
• patients with a personal history of low-trauma fractures, and
• patients with hypogonadism.

For this reason, most patients with IBD should be on calcium and vitamin D supplementation.

REFERENCES:

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Burisch, EM et al. A new rapid home test for faecal calprotectin in ulcerative colitis. Alimentary Pharmacology and Therapeutics (2010) 31, 2: 323-330.

Feagan, BG et al. Treatment of Ulcerative Colitis with a Humanized Antibody to the α4β7 Integrin. The New England Journal of Medicine (2005) 352: 2499-507.

Fisher, SA et al. Genetic Determinants of ulcerative colitis include the ECM1 locus and five loci implicated in Crohn's disease. Nature Genetics (2008) 40, 6: 710-712.

Franke, A et al. Genome-wide association study for ulcerative colitis identifies risk loci at 7q22 and 22q13 (IL17REL). Nature Genetics (2010) 42, 4: 292-294.

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Palm, O et al. Prevalence of ankylosing spondylitis and other spondyloarthropathies among patients with inflammatory bowel disease: a population study (The IBSEN Study). The Journal of Rheumatology (2002) 29: 511-515.

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Source: MedicineNet.com
http://www.medicinenet.com/ulcerative_colitis/article.htm