Comprehensive Patient Care in the Treatment of Ulcerative Colitis
Marc Bradette, MD, FRCPC, CSPQ, Clinical Professor, Department of Gastroenterology, Pavillon Hôtel-Dieu de Québec, Québec, QC.
With this special issue of the Journal of Current Clinical Care (JCCC), we aim to provide community healthcare professionals (HCPs) with practical clinical insight and support in managing patients with ulcerative colitis (UC)—both those who are newly diagnosed as well as those who have responded to medical therapy and are in remission. The articles included here address day-to-day care for a newly or recently diagnosed population, where treatment selection with first-line therapy such as 5-Aminosalicylates (5-ASA) may be appropriate. Further, each article references concrete clinical experience, giving a sense of how real-world patient care has influenced practice. Physicians invest substantial time and resources in patient counselling and education at the time of diagnosis, and this supplement seeks to share best practices and ideas to improve both dialogue and, most importantly, clinical outcomes.
While the etiology of Ulcerative Colitis is largely unknown, it is a chronic condition for which there is no cure. Upon learning of their diagnosis, patients may struggle to accept the limitations often imposed by such chronic conditions, and incomplete information regarding prognosis and treatment options only further interferes with ongoing care—trouble that often manifests around medication adherence. Newly diagnosed patients need their physicians' counselling and support. Patients have many questions about their condition, and studies show that the better they understand their disease and its management, the more they adhere to treatment regimens. Yet many practitioners are forced to guesstimate, through trial and error, how much time is required to optimize the impact from patient counselling.
In their article, James Gregor, John Howard, Nitin Khanna, and Nilesh Chande, of London Health Sciences Centre, Western University, explain that most patients have similar questions upon their diagnosis with UC. They are often anxious and frustrated, and some are skeptical that ongoing therapy is needed. It is up to the physicians who manage their care to educate these patients about UC and to convince them that maintenance therapy is crucial, even during remission. As Dr. Gregor and colleagues assert, "Informed patients are one of the most important assets available in the management of patients with ulcerative colitis." To this end, they present 10 frequently asked questions—five general and five disease-extent specific—and their answers to help physicians effectively communicate with their patients.
Geoffrey C. Nguyen, of the Mount Sinai Hospital Centre for Inflammatory Bowel Disease, addresses medication adherence during pregnancy. 5-Aminosalicylates have a positive safety profile, and decades of clinical use emphasize this fact. 1 However, concerns have been raised about some formulations using an enteric coating that contains dibutyl phthalate (DP). Toxicology studies suggest that certain phthalates may be associated with endocrine and reproductive toxicities. While the extent of risk of DP in humans is unknown, the potential effects on reproductive development in fetuses suggest that special consideration is warranted when deciding which 5-ASA formulation to prescribe to a female patient of child-bearing age.