Idiopathic Colitis Diagnosis and Treatment Updated

Therapy for ulcerative colitis and Crohn disease has been transformed with the introduction of anti–tumor necrosis factor (anti-TNF) treatment, and combination therapy with an anti-TNF agent and a thiopurine currently is the most effective treatment for patients with moderate to severe Crohn's disease and ulcerative colitis, according to authors Maria T. Abreu, MD, and Sebastian G. Strobel, MD, Division of Gastroenterology, Department of Medicine, at the University of Miami Miller School of Medicine in Florida.

Drs Abreu and Strobel discuss the latest developments for 3 types of idiopathic colitis—ulcerative colitis, Crohn disease, and microscopic colitis—in their article “Update on Idiopathic Colitides” in the latest issue of Current Opinion in Gastroenterology.

Other key points in the authors’ review include the following:

• Crohn disease and ulcerative colitis are closely related genetically.

• Colonoscopy remains the gold standard for making a diagnosis. Adding chromoendoscopy can help identify and remove colonic dysplasia.

• Prolonged use of infliximab for ulcerative colitis is effective and well tolerated and early mucosal healing is associated with a decreased risk of colectomy, recent data have shown.

• There is no evidence of a significant increased risk of anti–TNF-therapy-induced malignancies.

• Combination therapy with azathioprine and infliximab has been shown to be superior to monotherapy for patients with ulcerative colitis.

• When anti-TNF therapy has not succeeded, natalizumab is effective and patients may be risk stratified for progressive multifocal leukoencephalopathy by testing for antibodies to John Cunningham virus.

• Microscopic colitis may be associated with medication use, and symptoms may be worsened by coexisting celiac disease.

• Stem cell therapy for perianal fistulas is a promising new treatment approach for patients with Crohn disease.

Dr Abreu will be presenting at 2012 Advances in Inflammatory Bowel Diseases, the Crohn’s & Colitis Foundation’s Clinical & Research Conference, to be held December 13-15 in Hollywood, Florida. Her sessions will include advances in understanding the role of the immune system in inflammatory bowael disease (IBD), genetics in IBD, and how the microbiota modulates the innate immune system in IBD.

For more information on these conditions, see “Crohn's Disease and Ulcerative Colitis: A Photo Essay.”

Reference

1. Strobel S, Abreu MT. Update on idiopathic colitides. Curr Opin Gastroenterol. 2013 Jan;29:60-65.