Ulcerative colitis (UC) is a serious condition that triggers the development of ulcers in the lining of the colon. The ulcer then can affect the rectum and the sigmoid colon of the patient. UC is a chronic inflammatory disorder that is characterized by abdominal pain, bloody diarrhea, the increased frequency of bowel movements, and other negative issues (Sandbord et al., 2017). These manifestations of the disease can have a significant negative impact on the patient’s daily activities and quality of life (Panaccione et al., 2014). The present paper will provide a review of the most recent scholarly literature on the topic of UC and the description of a particular patient case. Further, solutions will be offered, based on the articles’ findings. In the conclusion, the major points of the paper will be summarized.
The Review of the Literature
While there is currently no single effective approach to UC treatment, researchers are constantly working to find solutions to this problem. In the studies published within the past few years, much attention is paid to treatment options for patients suffering from UC. The randomized trial conducted by Panaccione et al. (2014) was focused on the investigation of the UC combined treatment by infliximab and azathioprine and argued that it is superior to monotherapy with either agent. A 16-week randomized, double-blinded trial allowed researchers to analyze which of the approaches is more effective. 231 participants were divided into three groups: (1) receiving infliximab only, (2) receiving azathioprine only, and (3) receiving a combination of the two (Panaccione et al., 2014). The results indicated the occurrence of mucosal healing after 16 weeks in 62.8% of cases among group 3 patients. In group 1, the healing was recorded in 54.6% of patients. In group 2, the result was 36.8% (Panaccione et al., 2014). Thus, researchers concluded that the combination therapy was more effective in mucosal healing than monotherapy.
The ways of managing inappropriate mucosal immunological response as the leading cause of UC are the focus of Rossen et al.’s (2015) research. In their study, the authors investigate the patients’ response to the gut microbiota constituents. Rossen et al. (2015) remark that in individuals with UC, the microbiota composition differs from that of a healthy organism. Scholars mention that one of the radical approaches to manage the intestinal microbiota is by fecal microbiota transplantation (FMT) extracted from feces of a healthy donor (Rossen et al., 2015). Out of 50 participants, 37 completed the primary endpoint evaluation. The results of research indicated that within the 12 weeks of treatment, the responders’ microbiota in the FMT group was similar to that of their donors (Rossen et al., 2015). However, Rossen et al. (2015) admitted that there was no statistically significant difference in endoscopic and clinical remission between the participants suffering from UC who received FMT from healthy donors and those receiving their microbiota.
Sandborn et al. (2016) investigated the treatment of UC patients with ozanimod. Researchers divided the participants into three groups: (1) receiving 0.5 mg ozanimod, (2) receiving 1 mg ozanimod, and (3) receiving placebo. The medicines were distributed daily for 32 weeks (Sandborn et al., 2016). The primary effect was clinical remission at the 8th week. The primary outcome was noticed in 16% of patients from group 2 and in 14% of patients from group 1. In group 3, the effect reached as little as 6% (Sandborn et al., 2016). There were no significant differences between the 1st and 3rd groups. At 8 weeks, the clinical response (“decrease in Mayo Clinic score of ≥3 points and ≥30% and decrease in rectal-bleeding subscore of ≥1 point or a subscore ≤1”) constituted 54% in group 1, 57% in group 2, and 37% in group 3 (Sandborn et al., 2016, p. 1754). At 32 weeks, the clinical remission rate was 26% in group 1, 21% in group 2, and 6% in group 3. Thus, Sandborn et al. (2016) concluded that the daily dose of 1 mg ozanimod has a slightly better effect on UC remission than placebo.
A more recent study by Sandborn et al. (2017) was focused on the use of tofacitinib as induction and maintenance therapy for UC. Three-phased trials were conducted in adults with UC, which resulted in 18.5% remission at 8 weeks (Sandborn et al., 2017). The variety of therapeutic methods suggested and investigated by scholars to treat UC gives hope that in the nearest future, the most effective approach will be found. However, some research studies lack reliability and validity, which means that considerable further work is needed.
The Description of the Case
An example from practice that will be used in this paper is the case of Tahjae Jay Nelson, a 20-year-old African American male. The patient reports abdominal pain 8 out of 10 on the pain scale. Also, he has noticed mucus and bloody stool, which is bright red to dark at times. These symptoms, along with the pain while eating, have been observed by Jay for three weeks. The patient does not report any allergies or previous history of illness. Since the disease occurred suddenly and progressed rapidly, there is a possibility of genetic factors. Laboratory testing techniques, namely biopsy, and colonoscopy have indicated active colitis that requires immediate management.
Based on the research summarized in the literature review, it is possible to use several approaches to manage Jay’s case. The most suitable option seems to be combined treatment by infliximab and azathioprine suggested by Panaccione et al. (2014). The results of the study are statistically significant, and the number of participants is 231, which means that the research has a high degree of validity and reliability. The same concerns the treatment by tofacitinib, the sample being 593 participants, and the duration of the trial being 52 weeks (Sandborn et al., 2017). Other options cannot be considered suitable since they either have a very small sample (Rossen et al., 2015) or are not sufficient enough (Sandborn et al., 2016). Thus, it seems viable to try managing Jay’s case with tofacitinib or the combination of infliximab and azathioprine. Since the effect of the second option was reported as more beneficial for patients, this approach is more relevant to select for the patient.
The paper aimed at reviewing scholarly literature on the approaches to UC treatment, describing the case of a patient, and offering solutions based on research. The analysis of four scholarly articles published within the past 5 years allows concluding that there is still no single solution to UC management, but scholars are working on finding it. The most viable option for the present case seems to be the combined treatment by infliximab and azathioprine.
Panaccione, R., Ghosh, S., Middleton, S., Márquez, J. R., Scott, B. B., Flint, L., … Rutgeerts, P. (2014). Combination therapy with infliximab and azathioprine is superior to monotherapy with either agent in ulcerative colitis. Gastroenterology, 146(2), 392-400.
Rossen, N. G., Fuentes, S., van der Spek, M. J., Tijssen, J. G., Hartman, J. H., Duflou, A., … Ponsioen, C. Y. (2015). Findings from a randomized controlled trial of fecal transplantation for patients with ulcerative colitis. Gastroenterology, 149(1), 110-118.
Sandborn, W. J., Feagan, B. G., Wolf, D. C., D’Haens, G., Vermeire, S., Hanauer, S. B., … Olson, A. (2016). Ozanimod induction and maintenance treatment for ulcerative colitis. The New England Journal of Medicine, 374(18), 1754-1762.
Sandborn, W. J., Su, C., Sands, B. E., D’Haens, G. R., Vermeire, S., Schreiber, S., … Panes, J. (2017). Tofacitinib as induction and maintenance therapy for ulcerative colitis. The New England Journal of Medicine, 377(5), 496-497.