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Overcoming adherence issues in ulcerative colitis.

ABSTRACT: Ulcerative colitis (UC) is a chronic condition requiring lifelong medication to minimize the incidence of symptomatic flares. Nevertheless, studies have shown that a large proportion of patients are nonadherent to their prescribed therapeutic regimen. This review examines studies of patient adherence to 5-aminosalicylic acid (5-ASA) therapy in real world settings and considers the reasons that patients do not adhere to medication. Patients offer numerous reasons for not taking medication as prescribed; however, neither clinical nor community studies have consistently identified the same groups of patients as being high risk for poor adherence. Indeed, the problem of nonadherence is complex and requires a combination of strategies to be improved. Physicians, physician assistants, and nurse practitioners need to take the time to explain the importance of continual therapy, even when patients feel well, and should engage patients in a discussion to aid in the understanding of their nonadherence. Then, healthcare providers can determine how to best amend the regimen to improve adherence. As taking several tablets several times daily may be confusing or difficult for patients, higher strength 5-ASA formulations that require fewer daily doses have the potential to enhance patient adherence as part of an overall management strategy.

SUBMITTER: Kane SV

PROVIDER: S-EPMC3104162 | biostudies-other | 2007 Oct

REPOSITORIES: biostudies-other

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Overcoming adherence issues in ulcerative colitis.

Kane Sunanda V SV

Gastroenterology & hepatology 20071001 10

Ulcerative colitis (UC) is a chronic condition requiring lifelong medication to minimize the incidence of symptomatic flares. Nevertheless, studies have shown that a large proportion of patients are nonadherent to their prescribed therapeutic regimen. This review examines studies of patient adherence to 5-aminosalicylic acid (5-ASA) therapy in real world settings and considers the reasons that patients do not adhere to medication. Patients offer numerous reasons for not taking medication as pres ...[more]

PMID: 21960790

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Project description:BackgroundPrevious studies have indicated that the appendix may be a priming site of ulcerative colitis (UC). Appendectomy is inversely associated with the development of UC, and is suggested to have a beneficial effect on the disease course in patients with refractory disease.ObjectiveThe aim of the current study was to assess histological features of appendices from patients with UC and their clinical relevance.MethodsPatients with UC in remission and active UC (therapy refractory) that underwent appendectomy between 2012 and 2019 were included. Histological features of UC appendices were compared to those of patients with acute appendicitis and colon carcinoma. The Robarts Histopathology Index (RHI) was used to assess appendiceal inflammation. In patients with active UC, histological and clinical characteristics were compared between patients with and without endoscopic response following appendectomy.ResultsIn total, 140 appendix specimens were assessed (n = 35 UC remission, n = 35 active UC, n = 35 acute appendicitis, n = 35 colon carcinoma). Histological features of appendices from UC patients looked like UC rather than acute appendicitis. The presence of active appendiceal inflammation was comparable between patients in remission versus active disease (53.7% vs. 46.3%, p = 0.45) and limited versus extensive disease (58.5% vs. 41.5%, p = 0.50). Endoscopic response (Mayo 0-1) following appendectomy, assessed in 28 therapy refractory patients, was more frequently seen in patients with higher RHI scores (RHI > 6: 81.8% vs. RHI ≤ 6: 9.1%, p = 0.03) and limited disease (proctitis/left sided 63.6% vs. pancolitis 36.4%, p = 0.02).ConclusionThe presence of active appendiceal inflammation is common in UC and does not correlate with colonic disease activity. More than 50% of UC patients in remission showed active histological disease in the appendix. Favorable response to appendectomy for refractory UC was seen in cases with ulcerative appendicitis. These findings might support the role of the appendix as a pivotal organ in UC.

Dataset Information

Overcoming adherence issues in ulcerative colitis.

Publications

Overcoming adherence issues in ulcerative colitis.

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