Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
What research is being done regarding ulcerative colitis?
Active research is also ongoing to find other biological agents that are
potentially more effective with fewer side effects in treating ulcerative
colitis including adalimumab, visilizumab, and alpha-4 integrin blockers.
Research in ulcerative colitis is very active, and many questions remain to
be answered. The cause, mechanism of inflammation, and optimal treatments have
yet to be defined. Researchers have recently identified genetic differences
among patients which may allow them to select certain subgroups of patients with
ulcerative colitis who may respond differently to medications. Newer and safer
medications are being developed. Improvements in surgical procedures to make
them safer and more effective continue to emerge.
It is recommended that adults with inflammatory bowel disease generally
follow the same vaccination schedules as the general population.
receive a 1 time dose of Tdap, then Td booster every 10 years.
Women between the
ages of 9 and 26 should receive 3 doses of
HPV vaccine (and consideration should
be given to older patients who are HPV negative on
Men in the same
age range should also consider being vaccinated given the increased risk of HPV
Influenza (flu) vaccine should be given annually to all patients
(though the live intranasal vaccine is contraindicated in patients on
One dose of pneumococcal vaccine should be given
between age 19-26 and then revaccination after 5 years.
Meningococcal vaccine is only recommended for patients with
anatomic or functional asplenia, terminal complement deficiencies, or others at
higher risk (college students, military recruits, etc).
MMR, varicella, and
zoster vaccines (shingles
vaccine) are contraindicated for patients on biologic therapy, as they
are all live vaccines.
Osteoporosis has also increasingly been recognized as a significant health
problem in patients with IBD. IBD patients tend to have markedly reduced bone
mineral densities. Screening with a bone density study is recommended in:
men > age 50,
patients with prolonged steroid use (>3
consecutive months or recurrent courses),
For this reason, most
patients with IBD should be on calcium and vitamin D supplementation.
Balatsos, V et al. Adalimumab in patients with ulcerative colitis. Annals
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Burisch, EM et al. A new rapid home test for faecal calprotectin in
ulcerative colitis. Alimentary Pharmacology and Therapeutics (2010) 31, 2:
Feagan, BG et al. Treatment of Ulcerative Colitis with a Humanized
Antibody to the α4β7 Integrin. The New
England Journal of Medicine (2005) 352: 2499-507.
Fisher, SA et al. Genetic Determinants of ulcerative colitis include the
ECM1 locus and five loci implicated in Crohn's disease. Nature Genetics (2008)
40, 6: 710-712.
Franke, A et al. Genome-wide association study for ulcerative colitis
identifies risk loci at 7q22 and 22q13 (IL17REL). Nature Genetics (2010) 42, 4:
Johnson KT et al. Evaluation of colitis: usefulness of CT enterography
technique. Emergency Radiology (2009) 16, 4: 277-282.
Kao, J et al. Inducing and Maintaining Remission in Ulcerative Colitis:
Role of High-dose, Extended-release Mesalamine. Journal of Clinical
Gastroenterology (2010) 44: 531-535.
Kornbluth, A and Sachar, D. Ulcerative Colitis Practice Guidelines in
Adults: American college of Gastroenterology, Practice Parameters Committee. The
American Journal of Gastroenterology. (2010) 105: 501-523.
Laclotte, OA et al. Long-term outcome of adalimumab therapy for
ulcerative colitis with intolerance or lost response to infliximab: a
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American Journal of Gastroenterology (2009), 1-19.
McGovern, DP et al. Genome-wide association identifies multiple ulcerative
colitis susceptibility loci. Nature Genetics (2010) 42, 4: 332-339.
Mehdizadeh, S et al. Diagnostic yield of capsule endoscopy in ulcerative
colitis and inflammatory bowel disease of unclassified type (IBDU). Endoscopy
(2008) 40: 30-35.
Moscandrew, M, Mahadevan, U, and Kane, S. General Health Maintenance in
IBD. Inflammatory Bowel Disease (2009) 15, 1399-1409.
Palm, O et al. Prevalence of ankylosing spondylitis and other
spondyloarthropathies among patients with inflammatory bowel disease: a
population study (The IBSEN Study). The Journal of Rheumatology (2002) 29:
Plevy, S et al. A Phase I Study of Visilizumab, a Humanized Anti-CD3
Monoclonal Antibody in Severe Steroid-Refractory Ulcerative Colitis.
Gastroenterology (2007) 133: 1414-1422.
Rahier, JF et al. European evidence-based Consensus on the prevention,
diagnosis and management of opportunistic infections in inflammatory bowel
disease. Journal of Crohn's and Colitis (2009).
Sherlock, ME et al. Oral budesonide for induction of remission in
ulcerative colitis. Cochrane Database Systematic Reviews (2010, Oct 6).
Silverberg, MS et al. Ulcerative colitis – risk loci on chromosome 1p36
and 12q15 found by genome-wide association study. Nature Genetics (2009) 41, 2:
Solberg, IC et al. Clinical course during the first 10 years of
ulcerative colitis: results from a population-based inception cohort (IBSEN
Study). Scandinavian Journal of Gastroenterology (2009) 44: 431-440.
Strange, EF et al. European evidence-based Consensus on the diagnosis and
management of ulcerative colitis: Definitions and diagnosis. Journal of Crohn's
and Colitis (2008) 2, 1-33.
Travis, SPL et al. European evidence-based Consensus on the diagnosis and
management of ulcerative colitis: Current management. Journal of Crohn's and
Colitis (2008) 2, 24-62.
VanRheenen, PF, Van de Vijver, E and Fidler, V. Faecal calprotectin for
screening of patients with suspected inflammatory bowel disease: diagnostic
meta-analysis. British Medical Journal (2010) 341:c3369.
Vella, M, Masood, MR, and Hendry WS. Surgery for ulcerative colitis.
Surgeon (2007) 5, 6; 356-62.