Treatment Options For Ulcerative Colitis Research Articles

Five commonly used traditional Chinese medicine formulas in the treatment of ulcerative colitis: A network meta-analysis.

Currently, traditional Chinese medicine (TCM) formulas are commonly being used as adjunctive therapy for ulcerative colitis in China. Network meta-analysis, a quantitative and comprehensive analytical method, can systematically compare the effects of different adjunctive treatment options for ulcerative colitis, providing scientific evidence for clinical decision-making. To evaluate the clinical efficacy and safety of commonly used TCM for the treatment of ulcerative colitis (UC) in clinical practice through a network meta-analysis. Clinical randomized controlled trials of these TCM formulas used for the adjuvant treatment of UC were searched from the establishment of the databases to July 1, 2022. Studies that met the inclusion criteria were screened and evaluated for literature quality and risk of bias according to the Cochrane 5.1 standard. The methodological quality of the studies was assessed using ReviewManager (RevMan) 5.4, and a funnel plot was constructed to test for publication bias. ADDIS 1.16 statistical software was used to perform statistical analysis of the treatment measures and derive the network relationship and ranking diagrams of the various intervention measures. A total of 64 randomized controlled trials involving 5456 patients with UC were included in this study. The adjuvant treatment of UC using five TCM formulations was able to improve the clinical outcome of the patients. Adjuvant treatment with Baitouweng decoction (BTWT) showed a significant effect [mean difference = 36.22, 95% confidence interval (CI): 7.63 to 65.76]. For the reduction of tumor necrosis factor in patients with UC, adjunctive therapy with BTWT (mean difference = -9.55, 95%CI: -17.89 to -1.41), Shenlingbaizhu powder [SLBZS; odds ratio (OR) = 0.19, 95%CI: 0.08 to 0.39], and Shaoyao decoction (OR = -23.02, 95%CI: -33.64 to -13.14) was effective. Shaoyao decoction was more effective than BTWT (OR = 0.12, 95%CI: 0.03 to 0.39), SLBZS (OR = 0.19, 95%CI: 0.08 to 0. 39), and Xi Lei powder (OR = 0.34, 95%CI: 0.13 to 0.81) in reducing tumor necrosis factor and the recurrence rate of UC. TCM combined with mesalazine is more effective than mesalazine alone in the treatment of UC.

Comparing the efficacy of vedolizumab between males and females: a post-hoc analysis of GEMINI-1 and VARSITY.

Vedolizumab is a first-line treatment option for ulcerative colitis. There are differences in incidence of ulcerative colitis between males and females, but whether sex affects treatment outcomes is less clear. We examined sex-based differences in patients with ulcerative colitis initiated on vedolizumab from two major randomized controlled trials (RCTs). We conducted a post-hoc analysis on participants with ulcerative colitis from the VARSITY and GEMINI-1 RCTs who received vedolizumab. Outcomes of interest were rates of clinical improvement, clinical remission, and endoscopic improvement at weeks 6, 14, and 52 in male and female participants, as were differences in concentrations of trough vedolizumab and C-reactive protein; 1009 persons in GEMINI-1 and VARSITY trials were included. Male and female patients had similar disease characteristics aside from males being more likely to have Mayo 3 grade endoscopic severity at baseline (62.8 vs. 48.9%, P < 0.001). At week 6, females were more likely to have endoscopic improvement (47.4 vs. 35.2%, P = 0.001) and increased vedolizumab trough levels [34.0 (23.0-44.5) vs. 28.9 (19.0-34.6), P < 0.001]. The probability of achieving clinical remission (28.9 vs. 34.5%, P = 0.057) or endoscopic improvement (35.5 vs. 39.3%, P = 0.212) at week 52 was not different between males and females. Females with ulcerative colitis treated with vedolizumab appear more likely to achieve early endoscopic improvement than males, though longer-term outcomes demonstrated no difference. Further studies are required to better understand mechanisms through which sex or sex-associated factors could influence response to therapy in ulcerative colitis.

DNA methylation fine-tunes pro-and anti-inflammatory signalling pathways in inactive ulcerative colitis tissue biopsies

DNA methylation has been implied to play a role in the immune dysfunction associated with inflammatory bowel disease (IBD) and the disease development of ulcerative colitis (UC). Changes of the DNA methylation and correlated gene expression in patient samples with inactive UC might reveal possible regulatory features important for further treatment options for UC. Targeted bisulfite sequencing and whole transcriptome sequencing were performed on mucosal biopsies from patients with active UC (UC, n = 14), inactive UC (RM, n = 20), and non-IBD patients which served as controls (NN, n = 11). The differentially methylated regions (DMRs) were identified by DMRseq. Correlation analysis was performed between DMRs and their nearest differentially expressed genes (DEGs). Principal component analysis (PCA) was performed based on correlated DMR regulated genes. DMR regulated genes then were functional annotated. Cell-type deconvolutions were performed based on methylation levels. The comparisons revealed a total of 38 methylation-regulated genes in inactive UC that are potentially regulated by DMRs (correlation p value < 0.1). Several methylation-regulated genes could be identified in inactive UC participating in IL-10 and cytokine signalling pathways such as IL1B and STAT3. DNA methylation events in inactive UC seem to be fine-tuned by the balancing pro- and anti- inflammatory pathways to maintain a prevailed healing process to restore dynamic epithelium homeostasis.

UCFN[sbnd]Net: Ulcerative colitis evaluation based on fine-grained lesion learner and noise suppression gating

Background and ObjectiveUlcerative colitis (UC) is a chronic disease characterized by recurrent symptoms and significant morbidity. The exact cause of the disease remains unknown. The selection of current treatment options for ulcerative colitis depends on the severity and location of the disease in each patient. Therefore, developing a fully automated endoscopic images for evaluating UC is crucial for guiding treatment plans and facilitating early prevention efforts. MethodsWe propose a network called ulcerative colitis evaluation based on fine-grained lesion learner and noise suppression gating (UCFNNet). UCFNNet contains three novel modules. Firstly, a fine-grained lesion feature learner (FG-LF Learner) is proposed by integrating local features and a Softmax category prediction (SCP) module to improve the feature accuracy in small lesion areas. Subsequently, a graph convolutional feature combiner (GCFC) is developed to connect features across adjacent convolutional layers and to incorporate short connections between input and output, thereby mitigating feature loss during transmission. Thereafter, a noise suppression gating (NS gating) technique is designed by implementing a grid attention mechanism and a feature gating (FG) module to prioritize significant lesion features and suppress irrelevant and noisy regions in the input feature map. ResultsWe evaluate the performance of the proposed network on both privately-collected and publicly-available datasets. The evaluation of UC achieves excellent results on privately-collected dataset, with an accuracy (ACC) of 89.57 %, Matthews correlation coefficient (MCC) of 85.52 %, precision of 89.26 %, recall of 89.48 %, and F1-score of 89.78 %. The results are also impressive on publicly-available dataset, with ACC of 85.47 %, MCC of 80.42 %, precision of 85.62 %, recall of 84.00 %, and F1-score of 84.53 %, surpassing the performance of state-of-the-art techniques. ConclusionOur proposed model introduces three innovative algorithm modules, which outperform the current state-of-the-art methods and achieve high ACC and F1-score. This indicates that our method has superior performance compared to traditional machine learning and existing deep methods, which means that our method has good application prospects. Meanwhile, it has been verified that the proposed model demonstrates good interpretability. The source code is available at github.com/YinLeRenNB/UCFNNet.

THE IMPACT OF TREATMENT SWITCH AMONG PATIENTS WITH ULCERATIVE COLITIS NEWLY TREATED WITH A BIOLOGIC – A JAPAN RETROSPECTIVE CLAIMS DATABASE STUDY

Abstract INTRODUCTION Biologics have largely expanded treatment options for ulcerative colitis (UC) patients. Despite advanced treatments, up to 50% of patients treated with any biologic also suffer loss of response or intolerance. This study assessed the healthcare resource utilization (HCRU) associated with treatment switch as an indicator of suboptimal treatment of UC in patients newly treated with a biologic in a real-world setting in Japan. METHODS A retrospective cohort analysis was performed using the Japan Medical Data Center (JMDC) claims database for the period from 01/01/2016 through 09/30/2022. Adult patients with at least two UC diagnoses and newly treated with a biologic on or after the UC diagnosis were included. The index date was defined as the date of the first observed biologic prescription fill or injection after the UC diagnosis. Patients with a record of pregnancy one year before or one year after the index date and patients with at least two CD diagnosis were excluded. Patients were classified as switchers if they discontinued their index biologic treatment and switched to another biologic or 5-aminosalicylic acid or immunomodulator during a 12-month study period after the index date. All-cause HCRU during the study period were described and compared (unadjusted) between the 2 cohorts (switchers vs non-switchers). RESULTS Among 47,572 patients diagnosed with UC, 1,214 met criteria for inclusion, of which 261 (21.5%) were in the switchers cohort and 953 (78.5%) in the non-switchers cohort. Overall, the mean age (SD) was 41.3 (12.4) years old and 31% (n=376) were female. In the switchers group, 85.8% (n=224) discontinued index treatment and switched to another biologic, 5.0% (n=13) to a 5-ASA and 11.1% (n=29) to an immunomodulator. Among switchers, 59.0% (n=154) of switching occurred during the first 6 months after index treatment. During the 12-months follow-up period, the mean number of outpatient visits were similar between cohorts (15.5 visits vs 14.3 visits, p = 0.01). However, a greater proportion of the switchers cohort experienced inpatient hospitalization compared to non-switchers (43.7% [n=114] vs 19.6% [n=187], p&amp;lt;0.001). In addition, the inpatient hospitalizations had a longer mean length of stay in the switchers group vs non-switchers (12.9 days vs 4.5 days, p&amp;lt;0.001). CONCLUSION This real-world analysis using the JMDC database showed that roughly one out of five patients newly treated with a biologic switched to another treatment within 12 months of the treatment initiation. Those who experience treatment switch were also more likely to be hospitalized and had a longer length of stay versus patients who did not switch treatment. These findings highlight the continued burden of non-remission associated with treatment switch and the need for more efficacious and safe treatment interventions early in disease management.

Patient preferences in treatment options of ulcerative colitis: a discrete choice experiment

Introduction Since the number of medical treatment options for Ulcerative Colitis (UC) has expanded over the last decades, patients and physicians face challenges regarding decisions about the medication options. We aimed to identify patients’ preferences about their UC treatment options in the Netherlands. Furthermore, we assessed after how many failed treatment options, patients are willing to consider surgical treatment. Methods We conducted a web-based, multicenter, discrete choice experiment (DCE) among adult UC patients. Patients were repeatedly asked to choose between two hypothetical medicinal treatment options. The choice tasks were based on administration route, administration location, chance of symptom reduction (on short and long term) and chances on infection and other adverse events. Data were analyzed by using Hierarchical Bayes estimation. Results A total of 172 UC patients participated in the DCE. More than half were anti-TNF experienced (52.9%). The chance of symptom reduction after one year (relative importance (RI) 27.7 (95% CI 26.0–29.4)) was most important in choosing between medicinal treatments, followed by the chance of infection (RI 22.3 (21.4 − 23.3)) and chance of symptom reduction after eight weeks (RI 19.5 (18.3 − 20.6)). Considering surgical treatment, nineteen patients (14.3%) would not even consider surgery after failing eight treatment options without any new available therapies left. Nine patients would consider surgery before trying any treatment options. Conclusion We found that symptom reduction after one year was the most important attribute in choosing between treatments in UC patients. These outcomes can help understand the trade-offs and preferences of UC patients.

Therapeutic Effects of Aloe saponaria against Ulcerative Colitis Induced by Dextran Sulfate Sodium.

Aloe vera (A. vera) has been studied as a treatment option for ulcerative colitis (UC), but there is a lack of scientific evidence showing whether treatment with Aloe saponaria (A. saponaria) can also be beneficial. To investigate the therapeutic potential of A. saponaria as a treatment for UC, clinical symptoms, histopathological characteristics of the colon, inflammatory response, and toxicity were analyzed in dextran sulfate sodium (DSS)-induced UC mice after administration of aqueous extracts of A. saponaria (AAS) for 7 days. The total polyphenol and tannin content of AAS was 272 µg/g and 163 µg/g, respectively. AAS exhibited significant antioxidant activity. Several clinical symptoms, including body weight, colon length, and hematochezia, remarkably improved in the DSS+AAS treated group compared to the DSS+Vehicle-treated group. In addition, similar improvements were detected in the histopathological characteristics and mucin-secreting ability in the colon of DSS-induced UC mice after the administration of AAS. The levels of infiltrated inflammatory cells and cytokine expression were significantly decreased in a dose-dependent manner in the colon of the DSS+AAS-treated group. These alterations in inflammatory response were accompanied by a significant recovery of the protein kinase C/extracellular signal-regulated kinase (PKC/ERK) and phosphatidylinositol-3-kinase/serine-threonine protein kinase (PI3K/Akt) signaling pathways. However, the levels of key markers for hepatotoxicity and nephrotoxicity consistently remained between those of the DSS+AAS-treated and the No groups. Therefore, the results of the present study provide novel evidence that AAS may improve the clinical symptoms and attenuate the inflammatory response in DSS-induced UC mice and does not have any significant hepatotoxicity or nephrotoxicity.

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Gastrointestinal NursingVol. 21, No. 1 NewsNewsMelissa McAleesMelissa McAleesE-mail Address: [email protected] Twitter: @MfjMcaleesFreelance journalistSearch for more papers by this authorMelissa McAleesPublished Online:17 Feb 2023https://doi.org/10.12968/gasn.2023.21.1.10AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bowel Cancer UK. Plant-based diet may reduce bowel cancer risk. https://tinyurl.com/37vb4jf3 (accessed 3 January 2023) Google ScholarRutgers University. Gut microbes disturbed by COVID-19 infection, especially with antibiotics. 2022. https://tinyurl.com/vcd6msmc (accessed 7 January 2023) Google ScholarNorth A. Coeliac UK urges manufacturers to sign up to labelling scheme. 2022. https://tinyurl.com/3am74avd (accessed 8 January 2023) Google ScholarCrohn's & Colitis UK. Upadacitinib to be available as a treatment option for ulcerative colitis throughout the UK. 2022. https://tinyurl.com/7578bet6 (accessed 4 January 2023) Google ScholarIpsos Veracity Index. Homepage. 2022. https://tinyurl.com/3mcrfsj9 (accessed 3 January 2023) Google ScholarITV News. Alnwick mum trying to be first person with stoma bag to swim Channel to help beat stigma. 2023. https://tinyurl.com/2jzszrfe (accessed 3 January 2023) Google ScholarBowel Cancer UK. NICE approves new treatment that provides more options for advanced bowel cancer patients. 2022. https://tinyurl.com/mr2cbm3d (accessed 3 January 2023) Google Scholar FiguresReferencesRelatedDetails 2 February 2023Volume 21Issue 1ISSN (print): 1479-5248ISSN (online): 2052-2835 Metrics History Published online 17 February 2023 Published in print 2 February 2023 Information© MA Healthcare LimitedPDF download

P688 Patient preferences in medication to treat Ulcerative Colitis: a discrete choice experiment

Abstract Background Since the number of treatment options for Ulcerative Colitis (UC) has expanded, patients and physicians face challenges regarding decisions about the medication options. In shared decision making, treating physicians help patients understand the trade-offs and their own preferences. We aimed to identify patients preferences about the relative risks and benefits of UC treatment options in patients with UC in the Netherlands. Furthermore, we assessed after how many failed treatment options, patients are willing to consider surgical treatment. Methods We conducted a web-based, discrete choice experiment (DCE) among adult UC patients. Patients were repeatedly asked to choose between two hypothetical treatment options with varying combinations of attribute levels (fig 1). Attributes were based on consecutively a literature search, patient interviews, surveys and a focus group. The six included attributes were: administration route, administration location, chance on symptom reduction (short and long term), chances on infection and on adverse events. A balanced overlap design was used. Patients were recruited via the patient association Crohn &amp; Colitis NL and in two academic hospitals. Data were analyzed by using Hierarchical Bayes estimation. Results A total of 172 patients participated in the DCE. Median disease duration was 8 (IQR 3-16) years. Most patients were anti-TNF experienced (52.9%). Symptom reduction after one year (relative importance (RI) 27.7 (95% CI 25.6-29.7)) was the most important when choosing between treatment options (table 1), followed by the chance of infection (22.3 (21.2 - 23.4)) and chance of symptom reduction after eight weeks (RI 19.5 (18.1 - 20.9)). The location of administration of the treatment and the chance of adverse events were the least important (8.7 (7.7 - 9.79) and 8.5 (7.9 - 9.2), respectively). Patients preferred oral administration over subcutaneous injections. Intravenous route of administration was least favorite. The differences in average utilities of patients previous treated with biologic therapy or small molecules or naïve patients are displayed in table 2. 133 patients filled in the trade off questions regarding surgery. Forty-four patients (33.1%) responded with unknown. Nineteen patients (14.3%) would not even consider surgery after failing all treatment options without any new available therapies left. Nine patients would consider surgery before trying any treatment options. Of the remaining patients, nine (6.8%) would consider surgery after failing six treatment options. Conclusion We found that symptom reduction after one year was the most important treatment attribute in UC patients. These outcomes can help understand the trade-offs and preferences of UC patients.

Cassane diterpenoid ameliorates dextran sulfate sodium-induced experimental colitis by regulating gut microbiota and suppressing tryptophan metabolism.

Ulcerative colitis (UC) is one form of inflammatory bowel disease (IBD), characterized by chronic relapsing intestinal inflammation. As increasing morbidity of UC and deficiency of conventional therapies, there is an urgent need for attractive treatment. Cassane diterpenoids, the characteristic chemical constituents of Caesalpinia genus plants, have been studied extensively owing to various and prominent biological activities. This study attempted to investigate the bioactivity of caesaldekarin e (CA), a cassane diterpenoid isolated from C. bonduc in our previous work, on dextran sulfate sodium (DSS)-induced experimental colitis and clarify the function mechanism. The results indicated that CA ameliorated mice colitis by relieving disease symptoms, suppressing inflammatory infiltration and maintaining intestinal barrier integrity. Furthermore, 16S rRNA gene sequencing analysis indicated that CA could improve the gut microbiota imbalance disrupted by DSS and especially restored abundance of Lactobacillus. In addition, untargeted metabolomics analysis suggested that CA regulated metabolism and particularly the tryptophan metabolism by inhibiting the upregulation of indoleamine 2,3-dioxygenase 1 (IDO-1). It also been proved in IFN-γ induced RAW264.7 cells. Overall, this study suggests that CA exhibits anti-UC effect through restoring gut microbiota and regulating tryptophan metabolism and has the potential to be a treatment option for UC.

Medical Treatment Options for Ulcerative Colitis.

The landscape of management of ulcerative colitis, a type of inflammatory bowel disease, continues to change with advancement in pharmaceutical options as well as clinical treatment targets. Ulcerative colitis primarily involves the superficial layers of the large bowel, and cause active inflammation that can affect the colon from the rectum to the cecum in a relapsing and a remitting course. In this review, we provide evidence-based guidance on the selection of appropriate medical therapies based on individual patient and disease characteristics, with a focus on biologics and small molecules. We also review the role of surgery and management of acute severe ulcerative colitis.

Gancao Xiexin Decoction Ameliorates Ulcerative Colitis in Mice via Modulating Gut Microbiota and Metabolites.

PurposeUlcerative colitis (UC) is a chronic inflammatory bowel disease that starts with mucosal inflammation of the rectum and extends proximally in the colon in a continuous manner over a variable distance. Although it is more common in North America and Western Europe, its incidence is also increasing in Asia. Despite the introduction of several different classes of medications, the treatment options for UC may be insufficiently effective and burdened with significant side effects. In the present study, the therapeutic effects of Gancao Xiexin decoction (GCXX) were investigated on mice with dextran sulfate sodium (DSS)-induced colitis with exploration of the underlying mechanisms.MethodsColitis was induced in C57BL/6 mice by administering 3% DSS in drinking water for 7 days. GCXX and (or) the standard of care anti-inflammatory drug, mesalazine (5-aminosalicylic acid) were then administered for 7 days. The gut microbiota was characterized by 16S rDNA high-throughput gene sequencing and gut metabolites were detected by untargeted metabolomics. Germ-free mice were subsequently used to determine whether GCXX ameliorated UC principally through modulation of the gut microbiota.ResultsGCXX treatment was demonstrated to significantly reduce disease activity index (DAI) scores, prevent colonic shortening, ameliorate colonic tissue damage and reduce the levels of pro-inflammatory cytokines. Furthermore, analysis of the gut microbiota showed that GCXX-treated mice had higher relative quantity of Dubosiella (P<0.05) and lower relative quantity of Escherichia-Shigella (P<0.05). Metabolomics analysis indicated that GCXX could reduce the level of linoleic acid (P<0.05) and regulate its metabolism pathway. Moreover, in germ-free mice, GCXX failed to increase body weight, reduce DAI scores, or alleviate either colonic shortening or colonic damage.ConclusionThe present study demonstrated that GCXX ameliorated DSS-induced colitis principally through modulating the gut microbiota and metabolites. This information should be integrated into the overall mechanisms of GCXX treatment of UC.

OP26 Efficacy and safety of mirikizumab as induction therapy in patients with moderately to severely active Ulcerative Colitis: Results from the Phase 3 LUCENT-1 study

Abstract Background Anti-IL23p19 inhibitors are emerging as promising treatment options for ulcerative colitis (UC). Mirikizumab (miri) is a humanized, IgG4 monoclonal antibody directed against the p19 subunit of IL-23, a key mediator in the pathogenesis of inflammatory bowel diseases. We assessed the induction efficacy and safety of miri with a Phase 3, multi-center, randomized, parallel-arm, double-blind, placebo (PBO)-controlled trial (LUCENT 1; NCT03518086) in patients with moderately to severely active UC (Modified Mayo Score 4–9 points and centrally read Mayo endoscopic subscore ≥2) who had inadequate response, loss of response, or intolerance to corticosteroids, immunosuppressants, biologic therapies, or tofacitinib. Methods Adult patients (N=1281) were randomized in a 3:1 ratio to receive blinded intravenous administration of 300 mg miri or PBO every 4 weeks for 12 weeks. Randomization was stratified by biologic failure status, baseline (BL) corticosteroid use, BL disease activity as measured by modified Mayo score, and world region. The primary objective was to test the hypothesis that miri was superior to PBO in inducing clinical remission at Week 12. Key secondary objectives were clinical response, endoscopic remission, symptomatic remission, clinical response in biologic-failed patients, histologic-endoscopic mucosal improvement, and improvement in bowel urgency at Week 12 (see Figure for endpoint definitions). Mixed Model for Repeated Measures was used to assess urgency; the Cochran-Mantel-Haenszel test, with missing data imputed as nonresponse, was used to assess all other outcomes. Results BL characteristics were balanced across the two treatment groups. A significantly greater proportion of patients treated with miri achieved clinical remission at Week 12 (Miri: 24.2%; PBO: 13.3%; Δ=11.1 [99.875%CI: 3.2, 19.1]; p=0.00006). Miri-treated patients achieved all key secondary endpoints, including a significantly greater average reduction in bowel urgency severity compared to PBO (p&amp;lt;0.00001). The frequencies of treatment-emergent adverse events in miri-treated patients were similar to PBO. There were numerically fewer serious adverse events (Miri: 27 [2.8%], PBO: 17 [5.3%]) and discontinuations due to adverse events (Miri: 15 [1.6%], PBO: 23 [7.2%]) in miri-treated patients compared to PBO. There were 2 colon malignancies in the miri arm (0.2%) and no deaths during the treatment period. Conclusion In this phase 3 UC study, 300mg miri IV demonstrated statistically significant and clinically meaningful improvements vs PBO in all primary and key secondary endpoints across clinical, endoscopic, histologic, and symptomatic measures, with an acceptable safety profile.

Notable gaps between patients' and physicians' perspectives on communication and disease management in Japan: multifaceted ad hoc analyses of the global Ulcerative Colitis Narrative Survey for further optimal care.

Introduction:The patient–physician relationship is important in implementing appropriate management strategies. The Ulcerative Colitis (UC) Narrative Global Surveys examined patient and physician views on multiple aspects of living with UC. However, there are many other important undiscovered aspects of UC to consider for patients in Japan.Aim:The aim of these ad hoc analyses was to identify detailed practical issues for further optimal care.Methods:Patient and physician questionnaires covered broad aspects of living with UC and practical care. Results were compared to identify gaps. We conducted multifaceted ad hoc analyses on the responses from Japan.Results:In Japan, 210 patients with UC and 151 physicians were surveyed. Most (64%) patients felt they would be more successful if they did not have UC. Physicians were more likely to discuss treatment-related topics, including side effects as a proxy for medication satisfaction, than quality of life-related topics. Physicians underestimated the importance to patients of toileting accidents (28% vs 54%) and overestimated the importance of mucosal healing (59% vs 29%). Although 72% of patients felt comfortable raising concerns with their physician, 53% worried about asking too many questions, as they thought they would be seen as a difficult patient, and 66% wished they had talked more about medication fears. The majority (83%) of patients said they were honest with their physician when discussing their experiences with UC, although 45% regretted not telling them more. Some (26%) patients believed, and some (20%) were not sure, that if their symptoms were under control then their UC was not active. More positively, 65% of patients agreed that UC had made them more appreciative of the important things in life.Conclusion:This survey revealed notable gaps between patients’ and physicians’ perspectives. Consequently, the importance of patient–physician communication remains constant, even in the era of biologics and treat-to-target strategies.Plain Language Summary Overlap and differences in views around communication and management of ulcerative colitis between patients and doctors It is important to discover the different ways that ulcerative colitis (UC) can impact individual patients, and to identify differences in views between people with UC and the doctors treating them, to improve patient care. The UC Narrative is a global survey (containing two questionnaires, one for patients, and one for doctors) that gathers information on how UC impacts patients. The survey aims to identify differences between patients’ and doctors’ views on communication and disease management.In this analysis, we report the results from 210 patients with UC and 151 doctors who completed the UC Narrative survey in Japan, between November 2017 and January 2018. Most patients (85%) were satisfied with their communication with their doctor. However, doctors underestimated patient satisfaction, as they believed that about 71% of their patients were satisfied with communication. Around two-thirds of patients (65%), and most doctors (82%), wanted more discussion about goals for managing or treating UC. Most patients (83%) said they were honest with their doctor when discussing their experiences with UC, although almost half of patients (45%) said they regretted not telling their doctor more. Three-quarters of doctors (75%) felt that their patients were honest with them. Doctors underestimated the importance of toileting accidents to patients and thought that healing the patients’ intestine would be more important to the patients than toileting accidents. Some patients had misconceptions about treatment. For example, only 69% of patients knew that it was not OK to stop taking their UC medications once they felt better. This survey shows that even though treatment options for UC have developed, sufficient communication between patients and doctors is very important for overall patient care.

An evidence mapping of systematic reviews and meta-analysis on traditional Chinese medicine for ulcerative colitis

BackgroundTraditional Chinese Medicine (TCM) has been a proposed treatment option for ulcerative colitis (UC), however it has been difficult to understand the breadth and depth of evidence as various Chinese medicine therapies may produce effects differently. The aim of this evidence mapping is to visually understand the available evidence in the use of TCM in the treatment of UC, and to identify gaps in evidence to inform priorities of future research.MethodsA systematic electronic literature search of six databases were performed to identify systematic reviews (SRs) on different Chinese medicine therapies in the treatment in UC. Methodological quality of the included SRs was assessed using AMSTAR 2.ResultsThe mapping was based on 73 SRs, which included nine interventions that met eligibility criteria. The quality of the included SRs was very low. The diseases stages of patients with UC varied greatly, from active to remission, to non-acute outbreak, to not reported. The results mostly favored the method of intervention. Oral administration combined with enema was the most widely used route of administration in secondary research.ConclusionBased on the current evidence, the treatment of UC with TCM can only be recommended cautiously. A majority of included SRs did not report the location of the disease, the disease classification, and the route of administration of the intervention. Further research is needed on the effectiveness of Chinese medicine alone in the treatment of UC. The effectiveness of combined Chinese and conventional medicine combined with different routes of administration cannot be confirmed. Attention should be paid to the methodological quality of the systematic review. Unifies the outcome indicators used in the evaluation of effectiveness.

P569 Online education significantly improved gastroenterologists’ knowledge of management strategies and treatment options for ulcerative colitis

Abstract Background Ulcerative colitis (UC) is a challenging condition for gastroenterologists to manage. With the rapid evolution of the treatment landscape and more stringent goals for therapy, many physicians may struggle to stay abreast of current best practice in UC management. We assessed whether online continuous medical education (CME) can improve gastroenterologists’ knowledge of management strategies and treatment options for UC. Methods Gastroenterologists participated in an online CME activity entitled ‘Key Considerations for Treatment Success in Patients With UC’. This was a 45-minute segmented video activity with accompanying slides. Questions were developed to address each of the educational objectives for the activity. Educational effect was assessed using a repeated-pair design, pre-/post-assessment. A Chi-square test of independence determined if a statistically significant improvement (5% significance level, P&amp;lt;.05) existed in the number of correct responses between the pre-test and post-test scores. Cramer’s V estimated the effect size of the education (&amp;lt;.06, modest impact; .06-.15, noticeable impact; .16-.26, considerable impact; &amp;gt;.26, extensive impact). The activity launched on 16 May 2019 with data collection through 11 September 2019. Results A total of 1173 gastroenterologists participated in the activity. Of those, 171 completed both pre- and post-questions, providing a set of linked learner data for analysis. The results showed: • Significant improvement in average percentage of correct responses, rising from 47% at baseline to 77% post-activity (P&amp;lt;.001) and extensive educational impact (Cramer’s V=.260) • The percentage of gastroenterologists (n=171) answering all 3 questions correctly more than tripled, from 13% pre-activity to 41% post-activity • Significant improvements in knowledge of UC pathogenesis, treatment targets according to STRIDE recommendations, and which drug targets IL-12 and IL-23 (P&amp;lt;.001 for all 3 questions) • 38% of gastroenterologists reported increased confidence in selecting an appropriate therapy for a patient with UC Conclusion Online education significantly improved gastroenterologists’ knowledge of management strategies and treatment options in UC which should support them in achieving successful outcomes for their patients. However, there remains a notable gap in knowledge of the STRIDE recommendations and in confidence regarding treatment selection. These results suggest that gastroenterologists would benefit from additional education to reinforce their knowledge of UC management strategies and improve their confidence in translating these principles into clinical practice.

Ulcerative colitis: A comprehensive review

Ulcerative colitis (UC) is a common chronic inflammatory disorder that mainly affect large intestine. It started with mucosal inflammation and extends proximally in continuous way. The clear etiology of UC is not yet clear. The characteristic manifestations of UC include bloody diarrhea, fecal urgency, hematochezia and abdominal pain. The present study includes epidemiology, pathophysiology, diagnosis and available novel treatment options for UC. It is most important to rule out infectious and noninfectious etiology. Most cases of UC are treated with available pharmacological agents firstly for remission then maintenance of remission. First choice of drug for UC is 5-aminosalicylic acid with or without addition of corticosteroid depending upon response of mono-therapy. Patients nonresponsive to drug therapy should be hospitalized with critical care attention.

Administration of Nrf-2-Modified Hair-Follicle MSCs Ameliorates DSS-Induced Ulcerative Colitis in Rats.

Ulcerative colitis (UC) is a common chronic nonspecific intestinal inflammation of unknown etiology associated with a low cure rate and a high relapse rate. Hair follicle mesenchymal stem cells (HF-MSCs) are a class of pluripotent stem cells that have differentiation potential and strong proliferation ability. Nuclear factor red system related factor (Nrf-2) is a key factor in the oxidative stress response. Dextran sulfate sodium- (DSS-) induced rat UC models closely mimic human UC in terms of symptoms and histological changes. Animals were divided into five groups, including a healthy group and UC model rats treated with normal saline, Nrf-2, HF-MSCs, or Nrf-2-expressing HF-MSC group. Based on the expression of intestinal stem cells, inflammatory factors, anti-inflammatory factors, and disease activity index scores, Nrf-2-expressing HF-MSCs had the most obvious therapeutic effect under the same treatment regimen. This study provided a new potential clinical treatment option for ulcerative colitis.

Transdermal Nicotine as a Treatment Option for Ulcerative Colitis: A Review.

Ulcerative colitis (UC) is primarily a disease of non-smokers or ex-smokers. Since there have been previous claims of the beneficial effects of transdermal nicotine, researchers studied its efficacy to include it in the treatment regimen: to prevent remissions and as maintenance therapy. This review aims to evaluate the efficacy of transdermal nicotine as a treatment option for mild to moderately active ulcerative colitis. We shortlisted 22 articles after a careful analysis and elimination process. These articles were reviewed and analyzed, and it was found that transdermal nicotine in combination with conventional therapy was more beneficial than individual treatment with either. Further controlled studies evaluating the appropriate dosage for remission and maintenance treatment needs to be done.

Osteopathic Primary Care Treatment Options for Ulcerative Colitis

Ulcerative colitis is a multifactorial, chronic inflammatory disease of the bowel that can cause physical, social and emotional injury to the patient. While perhaps not always making the initial diagnosis or providing primary treatment, the primary care physician can play a critical role in providing direction and clarity to the overall treatment plan for the patient. In addition, monitoring for complications or side effects of treatment will help maintain the patient’s optimal health.&#x0D; Methods: A literature search using PubMed, NCBI and WorldCat.org was done using the terms ulcerative colitis treatment, psychosocial association of ulcerative colitis, surgical management of ulcerative colitis, epidemiology of ulcerative colitis, the pathophysiology of ulcerative colitis, probiotics in ulcerative colitis, OMT for ulcerative colitis, and diagnosis of ulcerative colitis. A primary date range of 2015-2019 was used with a secondary search extending back to 1985.&#x0D; Discussion: An Osteopathic approach to the treatment of ulcerative colitis will help the patient remain highly functioning and reduce complications of this disease. By being aware of the various pharmaceutical and non-pharmaceutical treatment options available, one can collaborate with the patient to create a treatment plan to minimize morbidity and increase functional days.