Comprehensive Patient Care in the Treatment of Ulcerative Colitis

Given the correlation of patients' perception of potential harm imposed by drug therapy with rates of non-adherence, Dr. Nguyen emphasizes that physicians must communicate to their female patients the importance of taking their medication to "prevent disease relapse, which may have the most adverse effects on pregnancy." He advocates pursuing this discussion prior to pregnancy, with all female patients of child-bearing age, as changing 5-ASA formulations involves a hypothetical and small possibility of relapse.

The importance of patient education and the value of a tacit contract between the patient and care provider for adherence to treatment regimens is illustrated in a case report from Dr. Brian Bressler, of St Paul's Hospital, University of British Columbia. This real-life scenario profiles a young adult with moderately active left-sided ulcerative colitis. Dr. Bressler stresses that the patient's treatment plan had to involve "appropriate education" to first obtain and then extend disease remission. In this case, Dr. Bressler shows that when patients with UC feel well, they often struggle with adhering to their medical regimen; however, they must accept the idea of and commit to long-term adherence. In addition to discussing treatment options for moderately active left-sided UC, and the importance of adherence, Dr. Bressler also addresses concerns related to self-administration of enemas.

Medical therapies for UC are effective, but as the condition is characterized by recurrence, early detection of symptoms is valued. Calprotectin levels in stool correlate not only with the degree of clinical severity of UC but also with the presence or absence of mucosal inflammation. In an effort to extend remission in UC, current research has focussed on laboratory testing results with fecal calprotectin to help guide medication adjustments, with the aim of mitigating the risk of flares or full-blown relapses. In his article "Optimizing Targets in Patient Management of Ulcerative Colitis," A. Hillary Steinhart, of Mount Sinai Hospital/University Health Network and the University of Toronto, states 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." As a result, there has been increased interest in detecting mucosal inflammation in asymptomatic patients, surveillance that is usually performed using flexible sigmoidoscopy or colonoscopy. Because these tests are invasive, patients in clinical remission may oppose repeated endoscopic evaluations. Fecal calprotectin testing offers a non-invasive means of monitoring patients in clinical remission. As such testing is easy and non-invasive—indeed, the possibility of performing home testing of fecal calprotectin has been explored—patients may be more likely to use it regularly to monitor their mucosal inflammation.

These articles are intended to address the practical issues of day-to-day care in managing patients with UC. It is our sincere hope that this special issue of the JCCC will provide additional insight and perspective, arming HCPs with concrete tools to facilitate successful outcomes.


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