Treatment of upper gastrointestinal lesions in patients with ulcerative colitis

Post by Master, Doctor Mai Vien Phuong - Gastrointestinal endoscopy - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital.

Ulcerative colitis (UC) is an idiopathic, chronic, recurrent inflammatory bowel disease (IBD) that occurs in the colon and rectum. It has long been agreed that ulcerative colitis begins in the rectum and often spreads to part or all of the colon. The main typical symptoms of ulcerative colitis include frequent bowel movements, purulent stools, bloody diarrhea, abdominal pain and discomfort, urgency, weight loss, and straining. However, great progress and progress has been made in our understanding of this disease over the past 2 decades.

The drugs 5-aminosalicylate, infliximab, corticosteroids, anti-tumor necrosis factor (TNF), or calcium antagonists have been reported to be effective for the control of ulcerative colitis. However, at present, standard treatment for upper gastrointestinal lesions in ulcerative colitis has not been reached. Steroids, leukocyte electrophoresis, and/or mesalazine in the peroral region can be used to treat upper gastrointestinal tract lesions in ulcerative colitis. Furthermore, immunosuppressants such as cyclosporin, tacrolimus, or infliximab may be the treatment of choice for upper GI inflammation.
For example, for people with ulcerative colitis-related esophageal ulceration, intravenous prednisolone (50 mg/day or 60 mg/day) has been used and some symptoms include chest pain, stools blood, pain when swallowing, and diarrhea that improved in a few days. For people with peptic ulcers, especially those with mild symptoms, certain medications, such as sulfasalazine or mesalazine, can effectively relieve symptoms, while for those with peptic ulcers. In some people with severe peptic ulcers, TNF antagonists, infliximab, or calcium antagonists may be more effective than sulfasalazine or steroid hormones. Therefore, the use of sulfasalazine or mesalazine is a rapid and effective therapy to relieve the symptoms of peptic ulcer disease. Steroids can be used as second-line therapy and TNF antagonists, infliximab or calcium antagonists can be given to patients who are insensitive to hormone therapy or those with progressive symptoms. fast.

Endoscopic image of esophageal ulceration and gastritis-associated ulcerative colitis after treatment. A: Endoscopic images show a healing scar of multiple esophageal ulcers following remicade (infliximab for injection); B: Endoscopic images show multiple convex lesions of gastric mucosa after treatment with remicade and methylprednisolone.
Upper gastrointestinal manifestations associated with ulcerative colitis are infrequent and often nonspecific compared with intestinal manifestations. Therefore, an ongoing diagnostic challenge should be widely considered. Although the occurrence of upper gastrointestinal tract associated with ulcerative colitis is rare. Esophagogastroduodenoscopy is particularly recommended for patients with ulcerative colitis who present outside the gastrointestinal tract and have undergone surgical resection or presently have colitis.

References
Sun Y, Zhang Z, Zheng CQ, Sang LX. Mucosal lesions of the upper gastrointestinal tract in patients with ulcerative colitis: A review. World J Gastroenterol 2021; 27(22): 2963-2978 [DOI: 10.3748/wjg.v27.i22.2963]