Journal Reading Diagnosis and Treatment Colitis Ulcerative

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Journal Reading

Ulcerative Colitis

Diagnosis and TreatmentBy:Ayu Setyaningrum Iswandari Safitri

01.210.6100

SULTAN AGUNG ISLAMIC UNIVERSITY

SEMARANG

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The greatest challenge

Symptom-

oriented

(step-up)

strategies

prevention-

oriented

(earlyintervention)

strategies

Molecular

diagnostics

Molecular diagnostics: antibody serology

Biomarkers

genotyping

Stratifying

patients with IBD

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earlyintervention witheffective therapy

significantimprovement

mucosal healing

reduction in the progression of

disease

Biomarker(fecal

calprotectin)

correlate with endoscopicdisease severity in both

CD and UC

help

identify patients with active

disease

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Treatment goals

minimize toxicity

induce remission as quickly as possible

maintain remission as long as possible

facilitate mucosal healing

improve quality of life

minimize cost

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Treatment Options for UC

oral and rectal

5-aminosalicylic acid (5-ASA)agents

corticosteroids (IV [eg, hydrocortisone]

or

oral [eg, prednisone,methylprednisolone])

immuno-modulators (eg, azathioprine[AZA], 6-mercaptopurine [6-MP],

cyclosporine )

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Cont

reduction of signs and symptoms

induction of clinical remission

and mucosal healing

elimination of corticosteroid use

infliximab adalimumab

anti-tumor necrosis factor(TNF) agents

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Colitis arthritis sulfasalazine

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5-ASA: First-Line Therapy

5-ASA

cytokine

5-lipoxygenasepathways of

arachidonic acidmetabolism

COX

transcriptionalactivity of nuclear

factor-kappa B

(NF-B)

Prostaglandin

Leukotrien

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MESALAMINETHERAPYDURING

PREGNANCY

Acetyl-5-ASA clearly cross the placenta

all mesalamine therapies

Asacol/Asacol HD

Classification

B

Classification

C

fetal malformations

th i t i di t f A l t i

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the inert ingredient of Asacolsenteric

coating, dibutyl phthalate (DBP)

maximum daily human intake

48 g

reproductive anomalies in male offspring

injury to androgenic-dependent development

higher doses

cryptorchidism hypospadias

atrophy or

agenesis of sexaccessoryorgans

reduced dailysperm production

permanentretention of

nipples

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Cont

Exposure to DBP at dosesequivalent to 106 times

incidences of cleft palate

skeletal abnormalities

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Thank You!