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Ulcerös kolit

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Sakkunnig:

Definition:
Ospecifik, sammanhängande slemhinneinflammation i kolon. Orsaken är okänd, ökad förekomst bland förstagradssläktingar.
Förekomst:
Incidens i Sverige är 20/100 000 årligen. Debut vanligen vid 20–40 års ålder.
Symtom:
Blodig och slemmig diarré.
Kliniska fynd:
Varierar med sjukdomsaktivitet och utbredning. Ömhet vid bukpalpation, eventuellt tecken på anemi. 
Diagnostik:
Hb, SR, CRP, LPK, TPK och albumin ger en indikation på systemisk påverkan. Kalprotektin i avföring  som screening om inflammatorisk tarmsjukdom och vid försämring.
Behandling:
Aminosalicylater (5-ASA) och kortikosteroider används oftast initialt. Immunmodulerande behandling används vid dålig effekt och vid remission trots underhållsbehandling med 5-ASA. Utebliven respons på läkemedel är indikation för kolektomi.
  1. Maaser C, Sturm A, Vavricka SR, et al. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. Journal of Crohn's and Colitis, Volume 13, Issue 2, February 2019, Pages 144–164K . academic.oup.com  
  2. Satsangi J, Silverberg MS, Vermeire S, et al. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55:749-753. PubMed  
  3. Behandlingsrekommendation läkemedelsbehandling vid inflammatorisk tarmsjukdom. Läkemedelsverket (2021) www.lakemedelsverket.se  
  4. Ardizzone S, Bianchi PG. Inflammatory bowel disease: new insights into pathogenesis and treatment. J Intern Med 2002; 252: 475-96. PubMed  
  5. Orholm M, Munkholm P, Langholz E, Nielsen OH, Sørensen TIA, Binder V. Familial occurrence of inflammatory bowel disease. N Engl J Med 1991; 324: 84-8. PubMed  
  6. Podolsky DK. Inflammatory bowel disease. N Engl J Med 2002; 347: 417-29. PubMed  
  7. Forrest K, Symmons D, Foster P. Systematic review: is ingestion of paracetamol or non-steroidal anti-inflammatory drugs associated with exacerbations of inflammatory bowel disease? Aliment Pharmacol Ther 2004; 20: 1035-43. PubMed  
  8. Bastida G, Beltran B. Ulcerative colitis in smokers, non-smokers and ex-smokers. World J Gastroenterol. 2011 Jun 14; 17(22): 2740–2747.
  9. Moum B. Ulcerøs kolitt, Crohns sykdom og 5-aminosalisylsyreforbindelser. Tidsskr Nor Lægeforen 2003; 123: 2565-7. PubMed  
  10. Kornbluth A, Sachar DB, for the Practice Parameters Committee of the American College of Gastroenterology. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 2004; 99: 1371-85. PubMed  
  11. Rothfuss KS, Stange EF, Herrlinger KR. Extraintestinal manifestations and complications in inflammatory bowel diseases. World J Gastroenterol 2006; 12: 4819-31. PubMed  
  12. Blomberg B, Jarnerot G. Clinical evaluation and management of acute severe colitis. Inflammatory Bowel Diseases 2000; 6: 214-27. PubMed  
  13. van Rheenen PF, De Vijver EV, Fidler F. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ 2010; 341: c3369. PMID: 20634346. PubMed  
  14. SBU Kommenterar 2014-09-04: Bestämning av kalprotektin i feces kan skilja mellan inflammatorisk tarmsjukdom och icke-inflammatoriska tarmbesvär. www.sbu.se  
  15. Waugh, N, Cummins, E, Royle, P, et al. Faecal calprotectin testing for differentiating amongst inflammatory and non-inflammatory bowel diseases: systematic review and economic evaluation. Health Technol Assess 2013: 17; xv-xix, 1–211. PMID: 24286461. PubMed  
  16. Turvill J. High negative predictive value of a normal faecal calprotectin in patients with symptomatic intestinal disease. Frontline Gastroenterology 2012; 3: 21-8. PubMed  
  17. Mosli MH, Zou G, Garg SK, et al. C-reactive protein, fecal calprotectin, and stool lactoferrin for detection of endoscopic activity in symptomatic inflammatory bowel disease patients: A systematic review and meta-analysis. Am J Gastroenterol. 2015. PMID: 25964225. PubMed  
  18. Zhan YL, Zhan YA, Dai SX. Is a low FODMAP diet beneficial for patients with inflammatory bowel disease? A meta-analysis and systematic review. Clin Nutr. 2017. pmid:28587774 PubMed  
  19. Nationell riktlinje 2020 På uppdrag av Svensk Gastroenterologisk Förenings styrelse Fertilitet, graviditet och amning vid inflammatorisk tarmsjukdom. Hämtad 2020-10-15 svenskgastroenterologi.se  
  20. Gisbert JP, Gomollon F, Mate J, Pajares JM. Role of 5-aminosalicylic acid (5-ASA) in treatment of inflammatory bowel disease. A systematic review. Dig Dis Sci 2002; 47: 471 - 88. PubMed  
  21. Klotz U. The role of aminosalicylates at the beginning of the new millenium in the treatment of chronic inflammatory bowel disease. Eur J Clin Pharmacol 2000; 56: 353 - 62. PubMed  
  22. Sutherland LR. Aminosalicylates in the treatment of ulcerative colitis and Crohn's disease. I: Rutgeerts P, Colombel J-F, Hanauer SB, Schölmerich J, Tytgat GNJ, van Gossum A, red. Advances in inflammatory bowel diseases. Dordrecht: Kluwer, 1999: 201 - 9.
  23. Safdi M, deMicco M, Sninsky C, Banks P, Wruble L, Deren J et al. A double-blind comparison of oral versus rectal mesalazine versus combination therapy in the treatment of distal ulcerative colitis. Am J Gastroenterol 1997; 92: 1867 - 71. PubMed  
  24. Hauso Ø, Martinsen TC, Waldum H. 5-Aminosalicylic acid, a specific drug for ulcerative colitis.. Scand J Gastroenterol. 2015. pmid:25733192 PubMed  
  25. Sutherland L, Macdonald JK. Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database Syst Rev, issue 2, 2006. PMID:16625537. PubMed  
  26. Wang Y, Parker CE, Feagan BG, MacDonald JK. Oral 5-aminosalicylic acid for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev 2016; May 9;(5): CD000544. pmid:PMID: 27158764 PubMed  
  27. Läkemedelsverket. Nyheter. EMA bekräftar att Xeljanz ska användas med försiktighet hos patienter med hög risk för blodproppar. 2019-11-19 lakemedelsverket.se  
  28. Weiss E, Wexner S. Surgical therapy for ulcerative colitis. Gastroenterol Clin North Am 1995; 24: 559. PubMed  
  29. Cima RR, Pemberton JH. Medical and surgical management of chronic ulcerative colitis. Arch Surg 2005; 140: 300-10. PubMed  
  30. Sagar PM, Lewis W, Holdsworth PJ, Johnston D, Mitchell C, MacFie J. Quality of life after restorative proctocolectomy with a pelvic ileal reservoir compares favorably with that of patients with medically treated colitis. Dis Colon Rectum 1993; 36: 584-92. PubMed  
  31. Bülow S. Ileoanal pouch-kirurgi. Ugeskr Læger 2008; 170: 1719. PubMed  
  32. Bach SP, Mortensen NJM. Revolution and evolution: 30 years of ileoanal pouch surgery. Inflamm Bowel Dis 2006; 12: 131-45. PubMed  
  33. Allgayer H, Kruis W. Aminosalicylates: potential antineoplastic actions in colon cancer prevention. Scand J Gastroenterol 2002; 38: 125 - 31. PubMed  
  34. Moum B, Ekbom A, Vatn M, Elgjo K. Change in the extent of colonoscopic and histological involvement in ulcerative colitis over time. Am J Gastroenterol 1999; 94: 1564-9. PubMed  
  35. Hovde Ø, Høivik ML, Henriksen M, et al. Malignancies in Patients with Inflammatory Bowel Disease: Results from 20 Years of Follow-up in the IBSEN Study. Journal of Crohn's and Colitis, 2017; 11 (5): 571–577. academic.oup.com  
  36. Olén O, Erichsen R, Sachs MC, et al. Colorectal cancer in ulcerative colitis: a Scandinavian population-based cohort study. Lancet 2020. doi:10.1016/S0140-6736(19)32545-0 DOI  
  37. Hovde Ø, Småstuen MC, Høivik ML, et al. Mortality and causes of death in ulcerative colitis: Results from 20 years of follow-up in the IBSEN study. Inflamm Bowel Dis 2016; 22(1):141-145. PubMed  
  38. Grimstad T, Norheim KB, Isaksen K. Fatigue in Newly Diagnosed Inflammatory Bowel Disease. J Crohns Colitis 2015; 9: 725-30. pmid:25994356 PubMed  
  39. Solberg C, Lygren I Jahnsen J, et al. Clinical course during the first 10 years of ulcerative colitis: results from a population-based inception cohort (IBSEN Study). Scand J Gastroenterol 2009; 44(4): 431-40. DOI: 10.1080/00365520802600961. DOI  
  40. Kornbluth A, Marion JF, Salomon P, Janowitz HD. How effective is current medical therapy for severe ulcerative and Crohn's colitis? An analytic review of selected trials. J Clin Gastroenterol 1995; 20: 280-4. PubMed  
  41. Katz J. The course of inflammatory bowel disease. Med Clin North Am 1994; 78: 1275-80. PubMed  
  42. Delco F, Sonnenberg A. A decision analysis of surveillance for colorectal cancer in ulcerative colitis. Gut 2000; 46: 500 - 6. PMID: 10716679. PubMed  
  43. Axon ATR. Cancer surveillance in ulcerative colitis - a time for reappraisal. Gut 1994; 35: 587 - 9. PMID: 8200547. PubMed  
  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet

Tidigare sakkunniga

  • Bjørn Moum, professor i gastroenterologi, Oslo Universitetssykehus