Publication of THE LATEST IN ULCERATIVE COLITIS CARE supplement was made possible by an unrestricted educational grant from Aptalis Pharma

Brian Bressler, MD, MS, FRCPC,

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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.

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Stool samples should be tested for infectious causes of bloody diarrhea.

Treatment with steroids should be avoided, if possible, as this medication carries the most risk.

In most cases, clinical remission is an acceptable outcome.

In patients newly diagnosed with left-sided ulcerative colitis, if macroscopic evidence of inflammation stops before 35 cm from the anal verge, it is critical to take biopsies in the proximal left colon in normal-appearing mucosa to determine whether a patient with left-sided disease will require dysplasia surveillance.

Patient education at each follow-up visit helps to ensure medication adherence.

We need to help patients understand that UC can be managed with medication, but not cured.

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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.

Marisa Battistella, BScPhm, Pharm D, Education Coordinator & Hemodialysis Pharmacist, Pharmacy Department, University Health Network, Toronto, ON.
Shabbir M.H. Alibhai, MD, MSc, FRCP(C), Staff Physician, University Health Network, Toronto, ON.

Constipation is a common symptom in patients of all ages, but its occurrence is highest among persons 65 years of age or older.^1,2 Constipation has been shown to diminish both quality of life and feeling of well-being.^3-5 Although constipation can have many causes, it is most often functional or idiopathic.^5,6 Furthermore, constipation can lead to serious complications such as malnutrition, fecal impaction, fecal incontinence, colonic dilation and even perforation of the colon.⁷

Definition
Constipation has different meanings to patients and physicians. A patient's perception of constipation may include not only the objective observation of infrequent bowel movements but also subjective complaints of straining with defecation, incomplete evacuation, abdominal bloating or pain, hard or small stools or a need for digital manipulation to enable defecation. Because the definition of constipation can be subjective, an international committee has recommended an operational definition of chronic functional constipation in adults.

C.A. Fallone, MD, FRCP(C), Division of Gastroenterology, McGill University Health Centre, Montreal, QC.

Definition of Dyspepsia
Defining dyspepsia is a somewhat confusing endeavour mainly because the definition itself has varied somewhat over the last few decades. Moreover, the distinction between uninvestigated and investigated dyspepsia is not always clear. Clinically, dyspepsia symptoms must be distinguished from the lower gastrointestinal symptoms of irritable bowel syndrome. Furthermore, the term dyspepsia is often used synonymously for upper gastrointestinal symptoms, but because most experts feel that dyspepsia must be distinguished from gastroesophageal reflux disease (GERD), it does not represent all upper gastrointestinal symptoms.

The Rome II definition of dyspepsia is the most recent and widely accepted.¹ Dyspepsia is defined as a pain or discomfort centred in the upper abdomen. This epigastric discomfort can be associated with other gastrointestinal symptoms such as bloating, feeling full, nausea, early satiety and heartburn. It is important to note that burning sensation in the epigastrium is not heartburn. Rather, heartburn refers to a burning sensation that originates from the epigastric region and radiates up towards the neck. Heartburn alone is not considered dyspepsia according to this definition.

Christopher N. Andrews, MD, Gastroenterology Fellow, Faculty of Medicine, University of Calgary, Calgary, AB.
Eldon A. Shaffer, MD, FRCPC, Professor of Medicine, Division of Gastroenterology, Faculty of Medicine, University of Calgary, Calgary, AB.

Introduction
Diverticular disease of the colon (or diverticulosis) is an anatomical description of saccular outpouchings of mucosa through the wall of the colon. It is very common in the Western world, and its prevalence is rising. This paper will briefly review the epidemiology and pathophysiology of diverticular disease, followed by a focus on the diagnosis and management of the two most common complications of the disease: diverticulitis and diverticular bleeding.

Epidemiology
The true prevalence of diverticulosis is unknown, but autopsy reports suggest that up to half of patients over 60 years are affected.¹ The frequency increases with age and is much higher in developed societies in which fibre intake is lower. In the Western world, the most commonly affected site in the colon is the sigmoid colon, sometimes with more proximal involvement.² However, in Asian countries diverticulae tend to be right-sided (in the ascending colon) and fewer in number. The reason for this difference is unknown.

Pathophysiology
The colon is made up of circumferential and longitudinal (taenia coli) muscle layers, which act in unison to propel stool towards the rectum.