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June 27, 2013

Are the symptoms permanent?
Although there are effective and safe medications for treating ulcerative colitis (UC), this disease cannot be cured. This means that your best chance of staying in remission is to continue on your prescribed medical therapy, even when you are feeling well.

Coping with UC?
...

What is UC?
Ulcerative colitis (UC) is a chronic relapsing and remitting inflammatory condition of the large intestine. (Inflammation is a localized protective reaction of tissue to irritation, injury, or infection.
It is characterized by pain, redness, swelling, and sometimes loss of function.)

June 27, 2013

Are the symptoms permanent?
Although there are effective and safe medications for treating ulcerative colitis (UC), this disease cannot be cured. This means that your best chance of staying in remission is to continue on your prescribed medical therapy, even when you are feeling well.

Coping with UC?
...

Are the symptoms permanent?
Although there are effective and safe medications for treating ulcerative colitis (UC), this disease cannot be cured. This means that your best chance of staying in remission is to continue on your prescribed medical therapy, even when you are feeling well.

June 27, 2013

Are the symptoms permanent?
Although there are effective and safe medications for treating ulcerative colitis (UC), this disease cannot be cured. This means that your best chance of staying in remission is to continue on your prescribed medical therapy, even when you are feeling well.

Coping with UC?
...

What is UC?
Ulcerative colitis (UC) is a chronic relapsing and remitting inflammatory condition of the large intestine. (Inflammation is a localized protective reaction of tissue to irritation, injury, or infection.
It is characterized by pain, redness, swelling, and sometimes loss of function.)

June 27, 2013

Are the symptoms permanent?
Although there are effective and safe medications for treating ulcerative colitis (UC), this disease cannot be cured. This means that your best chance of staying in remission is to continue on your prescribed medical therapy, even when you are feeling well.

Coping with UC?
...

Are the symptoms permanent?
Although there are effective and safe medications for treating ulcerative colitis (UC), this disease cannot be cured. This means that your best chance of staying in remission is to continue on your prescribed medical therapy, even when you are feeling well.

June 26, 2013

What is UC
Ulcerative colitis (UC) is a chronic relapsing and remitting inflammatory condition of the large intestine. (Inflammation is a localized protective reaction of tissue to irritation, injury, or infection. It is characterized by pain, redness, swelling, and sometimes loss of function.)


Ulcerative means a loss of the surface lining, and colitis means inflammation of that lining or mucosa. The inflammation is caused by an abnormal invasion of white blood cells into the mucosa. The exact cause of this attack is not known, but it is thought that a combination of genetic and environmental factors causes the immune system to react aggressively against the normal bacteria that inhabit the colon...

What is UC
Ulcerative colitis (UC) is a chronic relapsing and remitting inflammatory condition of the large intestine. (Inflammation is a localized protective reaction of tissue to irritation, injury, or infection. It is characterized by pain, redness, swelling, and sometimes loss of function.)

November 21, 2012

Marc Bradette, MD, FRCPC, CSPQ, Clinical Professor, Department of Gastroenterology, Pavillon Hôtel-Dieu de Québec, Québec, QC.


November 21, 2012

A. Hillary Steinhart, MD,Member of the Division of Gastroenterology, Mount Sinai Hospital/University Health Network, Professor of Medicine, University of Toronto, Toronto, ON.

Abstract
Although medical therapy for ulcerative colitis is usually effective at inducing clinical remission, numerous studies have shown that patients in clinical remission may have ongoing and varying degrees of mucosal inflammation. It appears that patients who have greater degrees of active mucosal inflammation, despite the absence of clinical symptoms, are at higher risk of developing a symptomatic flare in the near term. In patients with UC, the level of calprotectin in stool correlates not only with the degree of clinical severity but also with the presence or absence of mucosal inflammation. These findings raise the possibility of using fecal calprotectin as a non-invasive means of monitoring patients in clinical remission and adjusting treatment in those who demonstrate a rise in fecal calprotectin, before symptoms recur.
Key words: ulcerative colitis, fecal calprotectin, flare prediction, mucosal inflammation, non-invasive monitoring.

A. Hillary Steinhart, MD,Member of the Division of Gastroenterology, Mount Sinai Hospital/University Health Network, Professor of Medicine, University of Toronto, Toronto, ON.

November 21, 2012

Geoffrey C. Nguyen, MD, PhD, Associate Professor of Medicine, Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, ON.

Abstract
5-Aminosalicylates (5-ASAs) are considered first-line therapy for mild to moderate ulcerative colitis because of their proven effectiveness and safety profile, even in pregnancy. One formulation, however, contains dibutyl phthalate (DBP) in its coating. Though DBP may cause disruptions in utero reproductive development and other congenital abnormalities in rodents, it is unclear whether it leads to physiologically significant fetal abnormalities in humans. The US Food and Drug Administration has changed its classification for DBP-containing 5-ASAs from pregnancy category B to pregnancy category C to reflect a greater degree of uncertainty regarding its effect in humans. For pregnant women with ulcerative colitis, the most important message is to take their inflammatory bowel disease (IBD) medications to prevent disease relapse, which may have the most adverse effects on pregnancy. Physicians should, however, discuss with young women who are taking 5-ASA with DBP the benefits and risks of switching to another formulation of 5-ASA without the DBP compound.
Key words: phthalates, 5-aminosalicylate, ulcerative colitis, dibutyl phthalate, pregnancy.

Geoffrey C. Nguyen, MD, PhD, Associate Professor of Medicine, Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, ON.

November 21, 2012

Marc Bradette, M.D., FRCPC, CSPQ, professeur clinicien, département de gastroentérologie, Pavillon Hôtel-Dieu de Québec, Québec (Québec).

November 21, 2012

James Gregor, MD, Division of Gastroenterology, The University of Western Ontario, London, ON.
Co-authors: John Howard, MD, Nitin Khanna, MD, and Nilesh Chande, MD are members of the Division of Gastroenterology, London Health Sciences Centre, The University of Western Ontario, London, ON.

Abstract
Informed patients are one of the most important assets available in the management of patients with ulcerative colitis. Clinical experience reinforces that most patients have similar questions upon diagnosis. Anticipating these questions and tailoring them to a particular patient's disease severity and extent should not only streamline follow-up but also mitigate confusion and augment the benefit of the plethora of information available in the 21st century. Using our local experience, we have defined the 10 most common questions asked by patients and modified the answers, where necessary, to improve their specificity to patients with ulcerative proctitis, left-sided ulcerative colitis, and pancolitis.
Key words: ulcerative colitis, patient, questions, classification, management.

James Gregor, MD, Division of Gastroenterology, The University of Western Ontario, London, ON.
Co-authors: John Howard, MD, Nitin Khanna, MD, and Nilesh Chande, MD are members of the Division of Gastroenterology, London Health Sciences Centre, The University of Western Ontario, London, ON.

November 21, 2012

Brian Bressler, MD, MS, FRCPC,Clinical Assistant Professor of Medicine, Division of Gastroenterology,
St. Paul's Hospital, University of British Columbia, Vancouver, BC.

Abstract
A 28-year-old male presented to our office for a consultation about his bloody bowel movements. Colonoscopy revealed moderately active left-sided ulcerative colitis extending from the anal verge up to the mid-descending colon. He was prescribed both oral and rectal 5-ASAs for induction therapy, and is in remission. Appropriate patient education has helped him realize that the best chance of staying in remission is to continue on his medical therapy.
Key words: ulcerative colitis, 5-aminosalicylate, medication adherence, dysplasia surveillance, rectal inflammation.

Brian Bressler, MD, MS, FRCPC,Clinical Assistant Professor of Medicine, Division of Gastroenterology,
St. Paul's Hospital, University of British Columbia, Vancouver, BC.

November 19, 2012

Brian Bressler, M.D., M.Sc., FRCPC, est professeur adjoint clini-que de médecine dans
le service de gastroentérologie du St Paul's Hospital, Université de la Colombie-Britannique, à Vancouver (Colombie-Britannique).

Résumé
Un homme de 28 ans est venu nous consulter pour ses selles sanglantes. La coloscopie a mis en évidence une colite ulcéreuse gauche modérément évolutive, affectant une région allant de la marge de l'anus jusqu'au milieu du côlon descendant. Suite à un traitement d'induction avec des 5-AAS par voie orale et rectale, le patient est maintenant en rémission. Une éducation adaptée au patient lui a permis de réaliser que le meilleur moyen pour lui de rester en rémission était de continuer le traitement médicamenteux.
Mots clés : colite ulcéreuse, 5-aminosalicylate, respect du traitement médicamenteux, surveillance de la dysplasie, inflammation du rectum.

Brian Bressler, M.D., M.Sc., FRCPC, est professeur adjoint clini-que de médecine dans
le service de gastroentérologie du St Paul's Hospital, Université de la Colombie-Britannique, à Vancouver (Colombie-Britannique).

November 19, 2012

James Gregor, M.D., est membre du département de gastroentérologie de l'Université Western Ontario, London (Ontario).
Co-auteurs : John Howard, M.D., Nitin Khanna, M.D. et Nilesh Chande, M.D.
sont membres du département de gastro-entérologie du London Health Sciences Centre (Université Western) London (Ontario).

Résumé
L'un des atouts les plus importants dans la prise en charge des patients atteints de colite ulcéreuse consiste à avoir des patients bien informés. L'expérience clinique montre que la plupart des patients ont des questions similaires lors de leur diagnostic. En anticipant ces questions et en les adaptant à la gravité et l'étendue de la maladie d'un patient, il est possible non seulement de simplifier le suivi, mais également de réduire la confusion et d'augmenter les bienfaits apportés par la pléthore de renseignements disponibles au 21e siècle. D'après notre expérience locale, nous avons défini les 10 questions les plus couramment posées par les patients et modifié les réponses, au besoin, pour qu'elles soient mieux adaptées aux patients atteints de rectite ou proctite ulcéreuse, de colite ulcéreuse gauche ou de pancolite.
Mos clés : colite ulcéreuse, patient, questions, classification, prise en charge.

James Gregor, M.D., est membre du département de gastroentérologie de l'Université Western Ontario, London (Ontario).
Co-auteurs : John Howard, M.D., Nitin Khanna, M.D. et Nilesh Chande, M.D.
sont membres du département de gastro-entérologie du London Health Sciences Centre (Université Western) London (Ontario).

November 19, 2012

Geoffrey C. Nguyen, M.D., Ph. D., est professeur de médecine adjoint au Centre for Inflammatory Bowel Disease du Mount Sinai Hospital, Université de Toronto, Toronto (Ontario).

Résumé
Les 5-aminosalicylates (5-AAS) représentent le traitement de première intention pour les patients atteints de colite ulcéreuse (CU) légère à modérée, en raison de leur efficacité prouvée et de leur profil d'innocuité, même pour les femmes enceintes. Cependant, une préparation de 5-AAS possède un revêtement contenant du phtalate de dibutyle (DBP). Bien que, chez les rongeurs, le DBP puisse entraîner des troubles du développement reproducteur et d'autres anomalies congénitales in utero, on ne sait pas si le DBP provoque des anomalies foetales importantes sur le plan physiologique chez les humains. La Federal Drug Administration a modifié la classification des 5-AAS contenant du DBP en les faisant passer de la classe B à la classe C durant la grossesse, afin de refléter le degré plus grand d'incertitude concernant l'effet du DBP chez les humains. Le message le plus important destiné aux femmes enceintes atteintes de CU consiste à prendre les médicaments contre la CU afin d'empêcher une rechute de la maladie, qui pourrait entraîner le plus d'effets indésirables sur la grossesse. Cependant, les médecins doivent discuter avec les jeunes femmes prenant des 5-AAS contenant du DBP des bienfaits et des risques de prendre une autre préparation de 5-AAS sans DBP.
Mots clés : phtalates, 5-aminosalicylate, colite ulcéreuse, phtalate de dibutyle, grossesse.

Geoffrey C. Nguyen, M.D., Ph. D., est professeur de médecine adjoint au Centre for Inflammatory Bowel Disease du Mount Sinai Hospital, Université de Toronto, Toronto (Ontario).

November 19, 2012

A. Hillary Steinhart, M.D., est membre du service de gastroentérologie du Mount Sinai Hospital/University Health Network, et est professeur de médecine à l'Université de Toronto à Toronto (Ontario).

Résumé
Bien qu'une thérapie d'entretien pour la colite ulcéreuse permette généralement d'obtenir une rémission clinique, de nombreuses études ont montré que les patients en rémission clinique pourraient présenter des degrés variables d'inflammation de la muqueuse. Il semble que les patients présentant le plus haut degré d'inflammation évolutive de la muqueuse, malgré l'absence de symptômes cliniques, sont plus susceptibles de subir une poussée symptomatique à court terme. Chez les patients atteints de CU, le taux de calprotectine dans les selles est associé non seulement à la présence ou l'absence d'inflammation de la muqueuse, mais également au degré de gravité clinique de la CU. Ces observations soulèvent la possibilité d'utiliser le taux de calprotectine fécale pour surveiller de manière non effractive les patients en rémission clinique, et modifier le traitement de ceux montrant une augmentation du taux de calprotectine fécale, et ce, avant la réapparition des symptômes.
Mots clés : colite ulcéreuse, calprotectine fécale, prédiction des poussées, inflammation de la muqueuse, surveillance non effractive.

A. Hillary Steinhart, M.D., est membre du service de gastroentérologie du Mount Sinai Hospital/University Health Network, et est professeur de médecine à l'Université de Toronto à Toronto (Ontario).

June 12, 2012

Abstract
From time-to-time we select a topic and present the information and facts in an exciting and visually informative format. Today our choice of condition to present as an infographic is Ulcerative Colitis, an important topic for which we are also developing a CME program that is scheduled for release later this year.

Keybowrds: ulcerative colitis, gastrointestinal, IBD

Abstract
From time-to-time we select a topic and present the information and facts in an exciting and visually informative format.

April 27, 2011

I was a family physician for 7 years before becoming a radiologist. There are some things ...

I was a family physician for 7 years before becoming a radiologist. There are some things I miss about family practice. I miss the longitudinal relationship that I often had with multiple generations of family members.

August 1, 2008

M. Bachir Tazkarji, MD, CCFP, CAQ Geriatric Medicine, Lecturer, Family Medicine Department, University of Toronto; Toronto Rehabilitation Institute, Toronto, ON.

As the population is aging, physicians from all specialties are expected to see more older adults at their outpatient practices and in the acute settings. Abdominal pain remains one of the most common and potentially serious complaints that emergency physicians encounter. Vascular pathology should be considered early in the diagnostic course of all older adults who have abdominal pain because the time for intervention is critical.
Key words: abdominal pain, older adults, management of acute abdominal pain.

M. Bachir Tazkarji, MD, CCFP, CAQ Geriatric Medicine, Lecturer, Family Medicine Department, University of Toronto; Toronto Rehabilitation Institute, Toronto, ON.

July 1, 2008

Sander Veldhuyzen van Zanten, MD, PhD, Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB.

Dyspepsia is defined as an epigastric pain or discomfort thought to originate in the upper gastrointestinal (GI) tract. There is discussion, especially in uninvestigated patients, about whether gastroesophageal reflux disease (GERD) can be separated from dyspepsia. If heartburn and regurgitation are the dominant symptoms, GERD is the likely diagnosis. Among older adults, more severe esophagitis is often seen, while at the same time patients report less severe symptoms. The use of nonsteroidal anti-inflammatory drugs (NSAIDs), acetylsalicylic acid (ASA), and cyclo-oxygenase 2 selected inhibitors is associated with an increased frequency of dyspepsia and, more importantly, ulcers and upper GI bleeding. In new-onset dyspepsia among older adults, endoscopy should be considered given the increased risk of an upper GI malignancy. Among individuals taking NSAIDs, the medication should ideally be discontinued if it is thought to be the cause of dyspepsia. For NSAID prophylaxis, there is evidence that use of a once-daily proton pump inhibitor or misoprostol 200 µg two to four times per day decreases the risk of upper GI ulcers. NSAID prophylaxis is underused among older adults taking non-ASA NSAIDs, and the reasons for this and its consequences require further study.
Key words: dyspepsia, gastroesophageal reflux disease, NSAIDs, ASA,
H. pylori.

Sander Veldhuyzen van Zanten, MD, PhD, Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB.

February 1, 2008

The authors respond:
There appears to be no specific effect of aging on bowel function. It is more likely the cumulative result of decreased mobility, comorbid illness, and medication side effects that cause a higher incidence of constipation among older adults.1

While it is true that lactulose can be an effective osmotic laxative, the fact remains that it may also lead to painful abdominal cramping and flatus.2 For this reason, it is recommended as a second or third line laxative, usually in combination with other medications.

Hershl Berman, Shawna Silver, Laura Brooks

References

  1. Salles N. Basic mechanisms of the aging gastrointestinal tract. Dig Dis 2007;25:112-7.
  2. Hsieh C. Treatment of constipation in older adults. Am Fam Physician 2005;72:2277-85.

The authors respond:
There appears to be no specific effect of aging on bowel function. It is more likely the cumulative result of decreased mobility, comorbid illness, and medication side effects that cause a higher incidence of constipation among older adults.1

February 1, 2008

Neeraj Bhala, MBChB, MRCP, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Clinical Medicine, Oxford, UK.
Angel Lanas, MD, PhD, Service of Gastroenterology, Instituto Aragones de Ciencias de la Salud, University Hospital, CIBERehd. Zaragoza, Spain.

Low-dose acetylsalicylic acid (ASA) is widely used in the prevention of cardiovascular events but can be associated with upper gastrointestinal (GI) complications, including ulcers. In this article, the range of effects of GI toxicity and the epidemiology of ASA-associated events are discussed, as well as risk factors, such as increasing age, that predict bleeding. Strategies to minimize upper GI events in older adults include the use of mucosal protectants such as proton pump inhibitors. The use of alternative antiplatelet agents including clopidogrel or Helicobacter pylori infection eradication may not provide sufficient protection in at-risk individuals who need low-dose ASA.
Key words: low-dose ASA, upper gastrointestinal events, older adults, gastroprotection, proton pump inhibitor.

Neeraj Bhala, MBChB, MRCP, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Clinical Medicine, Oxford, UK.
Angel Lanas, MD, PhD, Service of Gastroenterology, Instituto Aragones de Ciencias de la Salud, University Hospital, CIBERehd. Zaragoza, Spain.

December 1, 2007

Hershl Berman, MD, FRCPC, Assistant Professor, University of Toronto Faculty of Medicine, Department of Medicine, University Health Network, Toronto, ON.
Laura Brooks, RegN, MscN, APN, Advanced Practice Nurse in Palliative Care, Department of Psychosocial Oncology and Palliative Care, University Health Network, Toronto, ON.
Shawna Silver, MD, PEng, Hospital for Sick Children; University of Toronto, Toronto, ON.

Constipation is a common complaint, especially in older adults. It results in millions of physician visits per year, with hundreds of millions of dollars spent on laxatives. Untreated it can lead to serious morbidity and can be a contributing factor in mortality. A rational approach to the patient presenting with constipation includes a detailed history, general and focused physical examination, specific investigations, and appropriate therapy. Treatment should aim to address the underlying cause, as should the choice of laxative. In general, it is best to clear out hard stool in the distal bowel before using an aggressive oral regimen.
Key words: constipation, laxatives, older adults, opioids.

Hershl Berman, MD, FRCPC, Assistant Professor, University of Toronto Faculty of Medicine, Department of Medicine, University Health Network, Toronto, ON.
Laura Brooks, RegN, MscN, APN, Advanced Practice Nurse in Palliative Care, Department of Psychosocial Oncology and Palliative Care, University Health Network, Toronto, ON.
Shawna Silver, MD, PEng, Hospital for Sick Children; University of Toronto, Toronto, ON.