Ulcerative colitis

Ulcerative colitis is a lifelong inflammatory disease affecting the rectum and colon to a variable extent. In 2023, the prevalence of ulcerative colitis was estimated to be 5 million cases around the world, and the incidence is increasing worldwide. Ulcerative colitis is thought to occur in people w...

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Veröffentlicht in:The Lancet (British edition) Jg. 402; H. 10401; S. 571 - 584
Hauptverfasser: Le Berre, Catherine, Honap, Sailish, Peyrin-Biroulet, Laurent
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Elsevier Ltd 12.08.2023
Elsevier Limited
Schlagworte:
Adrenal Cortex Hormones - therapeutic use
Biomarkers
Colitis, Ulcerative - diagnosis
Colitis, Ulcerative - epidemiology
Colitis, Ulcerative - therapy
Corticoids
Corticosteroids
Crohn's disease
Cytokines
Diarrhea
Disease prevention
Drugs
Epidemiology
Fecal incontinence
Humans
Immune response
Immunosuppressive agents
Industrialized nations
Infections
Inflammation
Inflammatory bowel disease
Inflammatory bowel diseases
Integrins
Janus kinase
Kinases
Mesalamine - therapeutic use
Modulators
Pathogenesis
Pathophysiology
Patients
Permeability
Precision medicine
Remission
Remission (Medicine)
Sphingosine 1-phosphate
Tumor necrosis factor-TNF
Ulcerative colitis
ISSN:0140-6736, 1474-547X, 1474-547X
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Beschreibung
Zusammenfassung:Ulcerative colitis is a lifelong inflammatory disease affecting the rectum and colon to a variable extent. In 2023, the prevalence of ulcerative colitis was estimated to be 5 million cases around the world, and the incidence is increasing worldwide. Ulcerative colitis is thought to occur in people with a genetic predisposition following environmental exposures; gut epithelial barrier defects, the microbiota, and a dysregulated immune response are strongly implicated. Patients usually present with bloody diarrhoea, and the diagnosis is based on a combination of clinical, biological, endoscopic, and histological findings. The aim of medical management is, first, to induce a rapid clinical response and normalise biomarkers and, second, to maintain clinical remission and reach endoscopic normalisation to prevent long-term disability. Treatments for inducing remission include 5-aminosalicylic acid drugs and corticosteroids. Maintenance treatments include 5-aminosalicylic acid drugs, thiopurines, biologics (eg, anti-cytokines and anti-integrins), and small molecules (Janus kinase inhibitors and sphingosine-1-phosphate receptor modulators). Although the therapeutic options are expanding, 10–20% of patients still require proctocolectomy for medically refractory disease. The keys to breaking through this therapeutic ceiling might be the combination of therapeutics with precision and personalised medicine.
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ISSN:0140-6736
1474-547X
1474-547X
DOI:10.1016/S0140-6736(23)00966-2