Review article: Updated management of acute severe ulcerative colitis: From steroids to novel medical strategies

Calméjane, Louis; Laharie, David; Kirchgesner, Julien; Uzzan, Mathieu

doi:10.1002/ueg2.12442

Cited by 9 publications

(2 citation statements)

References 91 publications

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“…The primary goals in managing UC are to achieve and maintain remission to prevent complications, surgery, and colon cancer (5). Current treatment options for UC include anti-inflammatory drugs such as aminosalicylates, corticosteroids, immunosuppressants, antibiotics, anti-TNFs, and probiotics (6)(7)(8)(9). However, a definitive treatment for UC has yet to be identified.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Protective and Healing Effects of Heracleum lasiopetalum Boiss on a Modified Acetic Acid-Induced Ulcerative Colitis Model in Rats

Malekshahi,

Bahrami,

Babaei

et al. 2024

Jundishapur J Nat Pharm Prod

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Background: Ulcerative colitis (UC), a chronic inflammatory condition of the colon with no definitive cure, necessitates the exploration of innovative therapies. Herbal remedies combined with conventional drugs may offer complementary benefits, enhancing treatment outcomes. Objectives: This study investigates the therapeutic effects of Heracleum lasiopetalum Boiss in a rat model of acetic acid-induced UC. Methods: Forty-eight adult female Wistar rats were randomly allocated to six groups (n = 8 per group) for each of two experiments. UC was induced by intracolonic administration of 1 ml of 4% acetic acid for 10 minutes. In the treatment groups, female rats received an oral gavage of 5%, 10%, and 40% aqueous plant extract, sulfasalazine (100 mg/kg), and distilled water for 6 days, starting 3 days after acetic acid administration. The protective groups received substances via oral gavage from 7 days before to 3 days after acetic acid administration. The extent of mucosal ulcers, hyperemia, inflammation, and mucosal bleeding was evaluated based on the Gerald Classification System Score (Macroscopic). Pathological assessment was conducted on prepared slides using the modified Wallace method (Microscopic). Changes in body and colon weight, along with food and water intake, were examined. Results: Significant changes in food intake were observed in both the extract and positive control treatment groups, exhibiting a notable difference compared to the negative control group (P < 0.05). Body weight changes experienced a significant increase in the positive control treatment group compared to the negative control group (P < 0.05), while no significant difference was evident between the extract and negative control treatment groups (P > 0.05). In terms of water and food intake, as well as weight changes, no significant differences were detected among the various protective groups (P > 0.05). Both microscopic and macroscopic examinations revealed a substantial enhancement in the colon of the extract and positive control treatment groups compared to the negative control group (P < 0.05), with no significant difference observed between the protective groups (P > 0.05). Conclusions: Heracleum lasiopetalum extract demonstrates a dose-dependent reduction in colon hyperemia, mucosal ulceration, inflammation, and fibrosis. This highlights its potential as a supplementary treatment option for UC, emphasizing the need for further investigation.

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Section: Introductionmentioning

confidence: 99%

Evaluation of the Protective and Healing Effects of Heracleum lasiopetalum Boiss on a Modified Acetic Acid-Induced Ulcerative Colitis Model in Rats

Malekshahi,

Bahrami,

Babaei

et al. 2024

Jundishapur J Nat Pharm Prod

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“…Recent advancements in UC management include the introduction of new drugs like vedolizumab, ustekinumab, and tofacitinib, which are also being explored for ASUC. However, the efficacy and safety of salvage therapies remain largely unknown [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Current Management of Acute Severe Ulcerative Colitis: New Insights on the Surgical Approaches

Lauricella,

Brucchi,

Cavalcoli

et al. 2024

JPM

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Acute severe ulcerative colitis (ASUC) is a life-threatening medical emergency with considerable morbidity. Despite recent advances in medical IBD therapy, colectomy rates for ASUC remain high. A scoping review of published articles on ASUC was performed. We collected data, such as general information of the disease, diagnosis and initial assessment, and available medical and surgical treatments focusing on technical aspects of surgical approaches. The most relevant articles were considered in this scoping review. The management of ASUC is challenging; currently, personalized treatment for it is unavailable. Sequential medical therapy should be administrated, preferably in high-volume IBD centers with close patient monitoring and indication for surgery in those cases with persistent symptoms despite medical treatment, complications, and clinical worsening. A total colectomy with end ileostomy is typically performed in the acute setting. Managing rectal stump is challenging, and all individual and technical aspects should be considered. Conversely, when performing elective colectomy for ASUC, a staged surgical procedure is usually preferred, thus optimizing the patients’ status preoperatively and minimizing postoperative complications. The minimally invasive approach should be selected whenever technically feasible. Robotic versus laparoscopic ileal pouch–anal anastomosis (IPAA) has shown similar outcomes in terms of safety and postoperative morbidity. The transanal approach to ileal pouch–anal anastomosis (Ta-IPAA) is a recent technique for creating an ileal pouch–anal anastomosis via a transanal route. Early experiences suggest comparable short- and medium-term functional results of the transanal technique to those of traditional approaches. However, there is a need for additional comparative outcomes data and a better understanding of the ideal training and implementation pathways for this procedure. This manuscript predominantly explores the surgical treatment of ASUC. Additionally, it provides an overview of currently available medical treatment options that the surgeon should reasonably consider in a multidisciplinary setting.

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Immunity in digestive diseases: new drugs for inflammatory bowel disease treatment—insights from Phase II and III trials

Massironi,

Furfaro,

Bencardino

et al. 2024

J Gastroenterol

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Background Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), continues to challenge treatment paradigms. Advancements in therapeutic options have been have been driven by Phase 2 and 3 clinical trials of new drug classes, particularly sphingosine-1-phosphate (S1P) modulators and interleukin-23 (IL-23) inhibitors. Methods This review synthesizes findings from Phase 2 and 3 clinical trials conducted up to early 2024, focusing on the impact of S1P modulators and IL-23 inhibitors on IBD management. Drugs such as ozanimod, etrasimod, risankizumab, mirikizumab, guselkumab, and brasikumab were evaluated for their efficacy and safety profiles. Results S1P modulators, such as ozanimod and etrasimod, effectively regulate immune cell trafficking to reduce inflammation and several trials highlight their clinical effectiveness in both inducing and maintaining remission in IBD, highlighting its long-term safety and sustained therapeutic effects. Additionally, IL-23 inhibitors including risankizumab, mirikizumab, and guselkumab, which disrupt key inflammatory cytokine pathways, have already shown significant effectiveness in inducing and maintaining remission in both CD and UC, with favorable safety profiles across multiple studies, suggesting their potential as critical components in managing IBD. Conclusions The clinical trials indicate that both S1P modulators and IL-23 inhibitors offer promising therapeutic benefits and maintain strong safety profiles, positioning them as potential cornerstone treatments for IBD. Despite these advancements, further exploration into long-term safety and the development of personalized treatment strategies is essential for maximizing clinical outcomes.

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Review article: Updated management of acute severe ulcerative colitis: From steroids to novel medical strategies

Cited by 9 publications

References 91 publications

Evaluation of the Protective and Healing Effects of Heracleum lasiopetalum Boiss on a Modified Acetic Acid-Induced Ulcerative Colitis Model in Rats

Evaluation of the Protective and Healing Effects of Heracleum lasiopetalum Boiss on a Modified Acetic Acid-Induced Ulcerative Colitis Model in Rats

Current Management of Acute Severe Ulcerative Colitis: New Insights on the Surgical Approaches

Immunity in digestive diseases: new drugs for inflammatory bowel disease treatment—insights from Phase II and III trials

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