Mild-to-Moderate Ulcerative Colitis - Management Algorithm
Curcumin:
 • Natural phytochemical from turmeric
 • 2g/day divided in 2-3 doses: ↑ induction & maintenance rates with 5ASA vs placebo
 • Potential GI SE, liver injury, inhibit platelet aggregation
Probiotics:
 • VSL#3/Visbiome, Megaspore, E. coli Nissle
 • VSL#3: ↑ clinical response & remission with 5ASA vs placebo
 • RD consult re: diet rich in pre/probiotics
Budesonide and UC:
 • Budesonide-MMX PO (delayed, extended release): controlled delivery to the colon
 • Budesonide Foam PR, Enema PR
 • Caution with long-term dosing given risk for steroid AEs; consider decreased dosing if liver disease
 • 5-ASA = Budesonide to induce remission
Patient Experience
 • >50% combination PO/PR 5-ASA therapy most effective
 • PO 5-ASA more tolerated than PR 5-ASA
 • Ostomy pts: poor release in extended-release 5-ASA formulations
 • Difficult to retain enemas if severe rectal inflammation, elderly ; consider suppository or foam formulations
 • Some notice change in efficacy when switching 5-ASA brands

Algorithm by Dr. Waseem Ahmed @Waseem_AhmedMD

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