Nonspecific Ulcerative Colitis - Treatment

Modern methods of treatment of nonspecific ulcerative colitis and Crohn's disease.

The unclear etiology of nonspecific ulcerative colitis complicates their treatment. The currently used therapy is essentially empirical, and the search for drugs with antibacterial, anti-inflammatory and immunosuppressive effects is based on the widespread theory of the origin of both diseases, recognizing the leading role of intestinal antigens, under the influence of which a change in reactivity and inflammation of the intestine occurs.

The requirements for drugs were primarily met by corticosteroids, which have been used in the treatment of nonspecific ulcerative colitis since 1950. To this day, corticosteroid therapy remains the most effective method of treating acute forms of these diseases.

In addition to corticosteroids, other drugs with antibacterial and anti-inflammatory effects are also used. These primarily include sulfasalazine and its analogues (salazopyrine, salazopyridazine, salazodimethoxine).

Sulfasalazine is an azo compound of 5-aminosalicylic acid and sulfapyridine. Its mechanism of action is still being studied. It was believed that sulfasalazine taken orally, with the participation of intestinal microflora, loses its azo bond and decomposes into 5-aminosalicylic acid and sulfapyridine. Unabsorbed sulfapyridine temporarily suppresses the growth of anaerobic microflora in the intestine, including clostridia and bacteroids. Recently, it has been established that the active ingredient of sulfasalazine is mainly 5-aminosalicylic acid, which inhibits the lipoxygenic pathway of arachidonic acid conversion and thus blocks the synthesis of 5,12-hydroxyeicosatetraenoic acid (OETE), a powerful chemotactic factor. Consequently, the effect of sulfasalazine on the pathological process turned out to be more complex than previously assumed: the drug causes changes in the intestinal microflora, modulates immune responses and blocks inflammatory mediators.

Correct use of corticosteroids, sulfasalazine and its analogues makes it possible to suppress the activity of the inflammatory process in nonspecific ulcerative colitis in a significant percentage of cases. However, it should be noted that in many patients sulfasalazine has to be discontinued due to its intolerance. Responsibility for the undesirable side effects of the drug is assigned to sulfapyridine, which is part of it. The constantly existing risk of complications with long-term use of corticosteroids, the side effects accompanying the use of sulfasalazine, dictate the need to study new pathogenetically substantiated methods of treatment.

The results of studies that established that the active component of sulfasalazine is 5-aminosalicylic acid served as the basis for the creation of new drugs in which the molecule of 5-aminosalicylic acid is connected by an amino bond to another similar or neutral molecule. An example of such a drug is salofalk, which does not contain sulfapyridine and, therefore, is devoid of its side effects.

Azathioprine, a heterocyclic derivative of 6-mercaptopurine, is being used as an immunoreactive agent in the treatment of patients with ulcerative colitis.

According to some publications, azathioprine reduces the likelihood of relapses of nonspecific ulcerative colitis and makes it possible to reduce the dose of prednisolone in patients who are forced to take it. According to other data, patients who received azathioprine did not feel better than patients who received placebo.

Thus, the efficacy of azathioprine has not yet been convincingly proven.

Antilymphocyte globulin and some immunostimulants (levamisole, BCG) are also recommended for the treatment of patients with nonspecific ulcerative colitis. The discovery of circulating immune complexes in the blood of patients with Crohn's disease led to an attempt to use plasmapheresis in treatment. Interferon and superoxide dismutase treatment was performed. Further accumulation of experimental and clinical materials with subsequent careful processing of the data obtained is required to determine the role of these drugs in the complex of therapeutic measures for nonspecific ulcerative colitis.

In the treatment of ulcerative colitis, it is important not only to stop the acute attack, but also to prolong the period of remission, thereby making patients less dependent on taking such drugs as corticosteroids. In this regard, the hyperbaric oxygenation (HBO) method is of interest.

The property of HBO to affect microorganisms and reduce their toxicogenicity seems to be especially important, since bacteria play a significant role in the pathogenesis of nonspecific ulcerative colitis.

Considering that treatment with HBO is impossible at the height of exacerbation of nonspecific ulcerative colitis due to the severity of the patient's condition, tenesmus and diarrhea, HBO is included in the complex therapy at the end of the acute period, when clinical and laboratory parameters have improved. Patients admitted to HBO treatment received sessions in single-seat therapeutic pressure chambers. The rate of compression and decompression should not exceed 0.1 atm per minute. A trial session is performed at 1.3 atm for 20 minutes. A therapeutic session is performed at a working oxygen pressure of 1.7 atm for 40 minutes. Thus, each session lasts about 1 hour in total. A course of treatment with HBO at the end of an exacerbation should consist of 10-12 sessions, prophylactic courses during remission (with an interval of 1 year) - of 8-10 sessions.

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