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  1. Feb 2020
    1. Aminosalicylates — mesalazine and sulfasalazine may be considered for a mild-to-moderate first presentation

      They are often prescribed topically (suppository or enema) initially, and orally if remission is not achieved within four weeks. For extensive disease, topical and high-dose oral treatment may be offered first-line.

      Corticosteroids — monotherapy with a time-limited course of corticosteroids may be used for induction of remission

      Calcineurin inhibitors — tacrolimus or ciclosporin may be added to oral corticosteroids to induce remission in people with mild to moderate disease if there is an inadequate response to oral corticosteroids after 2–4 weeks.

      Immunosuppressive drugs — the thiopurines (azathioprine, mercaptopurine) or methotrexate (second-line) may be considered to maintain remission if there are two or more inflammatory exacerbations in a 12-month period that require treatment with oral corticosteroids, or if remission cannot be maintained by aminosalicylates.

      Biologic therapy — the anti-tumour necrosis factor (TNF)-alpha monoclonal antibody agents intravenous infliximab and subcutaneous adalimumab and golimumab are effective at inducing remission in people with severe active disease which has not responded to conventional therapy, or where conventional therapy is not tolerated. These drugs are also effective at maintaining remission.

      • Appendicectomy and smoking protect from UC.
      • NSAIDs worsen UC.
      • UC 2.4x greater risk of bowel cancer - needs screening colonoscopy 10 years after diagnosis
      • In a flare-up, use Tuelove and Witt criteria to exclude acute severe colitis (6-8 episodes of bloody diarrhoea + SIRS + raised ESR)
      • Severe flare-ups need emergency hospital admission, non-severe flare-ups need specialist review within 5 days