Mild-to-Moderate Ulcerative Colitis - Management Algorithm Curcumin: • Natural phytochemical from turmeric • 2g/day divided in 2-3 doses: ↑ induction & maintenance rates with 5ASA vs placebo • Potential GI SE, liver injury, inhibit platelet aggregation Probiotics: • VSL#3/Visbiome, Megaspore, E. coli Nissle • VSL#3: ↑ clinical response & remission with 5ASA vs placebo • RD consult re: diet rich in pre/probiotics Budesonide and UC: • Budesonide-MMX PO (delayed, extended release): controlled delivery to the colon • Budesonide Foam PR, Enema PR • Caution with long-term dosing given risk for steroid AEs; consider decreased dosing if liver disease • 5-ASA = Budesonide to induce remission Patient Experience • >50% combination PO/PR 5-ASA therapy most effective • PO 5-ASA more tolerated than PR 5-ASA • Ostomy pts: poor release in extended-release 5-ASA formulations • Difficult to retain enemas if severe rectal inflammation, elderly ; consider suppository or foam formulations • Some notice change in efficacy when switching 5-ASA brands Algorithm by Dr. Waseem Ahmed @Waseem_AhmedMD #Ulcerative #Colitis #UC #Management #Mild #Moderate #Algorithm #treatment #IBD
