Gut reaction: a pharmacist’s approach to supporting patients with ulcerative colitis


Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD), which can have an enormous impact on a patient’s quality of life. It affects mainly young people at a time when they are establishing their careers and relationships (30–39 years), and can cause them great concern due to having an unpredictable clinical course.1 Australia has one of the highest reported incidence of IBD worldwide, and approximately 846 new cases of UC are diagnosed every year.1,2

UC is characterised by chronic inflammation of the colon and rectum, which causes ulcers to form in the bowel lining.1 The most common symptoms are diarrhoea (often bloody), abdominal pain, urgency to empty the bowel and weight loss.1 UC will progress over time in about one-third of patients, even when initial disease is restricted to the rectum and mild in severity, with 10–20% developing extensive colitis.3

Possible medications for UC1

Disease-modifying and supportive treatment options

  • Aminosalicylates (5-ASAs) e.g. sulfasalazine, mesalamine
  • Corticosteroids e.g. prednisolone, budesonide (oral or rectal)
  • Immunomodulators e.g. thiopurines
  • Antibiotics e.g. metronidazole, ciprofloxacin
  • Biologics e.g. TNF inhibitors

Possible over-the-counter medications1,6,7

  • Antidiarrhoeals (use with caution)
  • Antibiotic creams
  • Pain relief
  • Dietary supplements
    (e.g. iron, vitamins A,D E,K, B-12, calcium, folic acid, zinc)
  • Peppermint oil

Unmet needs for patients with UC

One study found that 90% of patients with UC did not have their condition under control using their current medication (no patients surveyed were using biologic therapy, n=256).4 And almost half (48%) of the respondents were unhappy with the current conventional treatment they were receiving.4

Without effective maintenance therapy and adequate inflammation control, one in two UC patients will experience a relapse, which can be disabling.1,5 As many as one in three patients could eventually progress to requiring a colectomy.5 Symptom flares despite treatment, and unexplained anaemia and lethargy should prompt referral to an IBD specialist.1

UC PRO: engaging with the healthcare community to help manage patients with UC

UC PRO is a professional support initiative being run by AbbVie Australia. It is designed to engage healthcare professionals in the proactive management of patients who have been diagnosed with UC. UC PRO aims to encourage patients experiencing moderate-to-severe UC to take steps to identify the right disease management mechanisms to keep their disease under control. Importantly, this may help them reduce their risk of experiencing future complications associated with UC.3

As a Pharmacist, you may be contacted by an AbbVie Representative to discuss the challenges faced by UC patients in more detail. UC PRO activities are also being directed at GPs, who will receive information on how to council UC patients to recognise a disease flare. They will be shown how to discuss symptoms with their patients who have UC and recognise when they should refer to an IBD specialist.

To further help patients recognise when their symptoms need more attention, a leaflet emphasising the importance of addressing flare ups has been produced for patients that encourages them to seek advice from an IBD specialist when their symptoms are uncontrolled.

What can you do?

Patients with UC need to understand that ‘putting up’ with symptom flares (rectal bleeding, abdominal pain, increase in stool frequency) is not the best course of action for them.1 People using steroids plus ASAs are possibly UC patients. Pharmacists are ideally placed to recognise those patients who are experiencing a flare up despite medication and encourage them to seek help from an IBD specialist. Consider the full picture for the patient, and enquire about flare frequency and time on medication. Patients experiencing frequent flares should be referred to their specialist.

Proactive contact with the patient’s prescriber can also be helpful in managing their adherence to disease-modifying medications and ensuring an appropriate selection of supplements and over-the-counter products can be offered for overall wellness support and symptom relief.

All UC patients should be encouraged to adhere to a regular follow-up schedule (every 3–6 months),1 as those who are not seen regularly are more likely to encounter worsening of disease.1 Advise patients that contacting their GP or specialist when flare ups become a problem is key to their ongoing health.

Counselling patients with UC

  • Patients diagnosed with UC but not experiencing a flare: Encourage them to keep up with their follow-up appointments with their IBD specialist.
  • Patients diagnosed with UC and experiencing a flare: Advise them to seek a referral to manage their flares e.g.

UC is a chronic, progressive condition, symptom control alone may not help.
See an IBD specialist to discuss your flares
.

Want to know more?

For further information or to access the patient leaflet, please contact AbbVie Medical Information.
Phone: 1800 043 460
Email: medinfoanz@abbvie.com


References:

  1. Gastroenterological Society of Australia (GESA). Inflammatory Bowel Disease. Updated 2018. Available at: http://www.gesa.org.au/ resources/clinical-guidelines-and-updates/inflammatory-bowel-disease/ [Accessed July 2018].
  2. Wilson J et al. Inflamm Bowel Dis 16(9):1550–1556.
  3. Panés J (Chairperson). Eur Med J Gastroenterol 2015;4(1):58–64.
  4. Peyrin-Biroulet L et al. Dig Liver Dis 2016;48(6):601–607.
  5. Blonski W et al. Gastroenterol Clin N Am 2012;41:443–462.
  6. Crohn’s and colitis foundation. Vitamin and mineral supplementation. Available at http://www.crohnscolitisfoundation.org/what-are-crohns-and-colitis/diet-and-nutrition/supplementation.html accessed March 2019.
  7. Mayo Clinic. Ulcerative colitis. Diagnosis and treatment. Updated March 2018. Available at https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/diagnosis-treatment/drc-20353331 accessed March 2019.

This article is an AbbVie sponsored article.
AbbVie® is a registered trademark of AbbVie Inc. AbbVie Pty Ltd, ABN 48 156 384 262, Mascot NSW 2020.
AbbVie Medical Information phone: 1800 043 460. www.abbvie.com.au.
AU-IMMG-190004. Date of preparation: February 2018.

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