IDDF2020-ABS-0086 Tacrolimus, a boon for elderly-onset ulcerative colitis!. (18th November 2020)

• Record Type: Journal Article
• Authors: Shivam, Shivam; KN, Manohar
• Is Part Of: Gut. Volume 69(2020)Supplement 2
• Page Start: A39
• Page End: A39
• Publication Date: 2020-11-18
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2020-IDDF.70
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Background: Cases of elderly-onset ulcerative colitis (UC) have been growing in number in recent years and currently account for 10–15 percent of all UC cases. While UC care is largely identical between older and younger patients, there is still little evidence of the therapeutic efficacy of tacrolimus in patients with elderly-onset UCs. Here, we detail our attempt to induce remission in a patient with elderly-onset UC using tacrolimus. Tacrolimus was used to treat a 63-year-old Indian man with serious elderly-onset pancolitis-type UC. Medical recovery in the patient succeeded. Methods: A 67-year-old man suffered 3 days of bloody diarrhoea 11 times a day and visited a local hospital. Abdominal CT showed strong oedema in the colon. Treatment with 5-ASA and oral prednisolone at 1 mg/kg/day was started, along with complete parenteral nutrition, under the suspected UC diagnosis. However, the patient was moved to our hospital 1 week after the onset of symptoms, as the symptoms didn't change. Blood test results on admission were as follows: 10.500/cumm WBC count, 2.85 mg/dl serum CRP, and 58 mm/h ESR. Sigmoidoscopy reported acute, persistent and circumferential hemorrhage, mucosal redness, and oedema. The patient had been diagnosed with extreme pancolitis type UC. Prednisolone and 5-ASA were continued, and 0.05 mg/kg/day dose of tacrolimus was introduced. The Clinical Activity Index (CAI) had decreased from 12 to 4, 2 weeks after the initiation of tacrolimus. The dosage of prednisolone was tapered slowly, and azathioprine was started at a dosage of 50 mg; the patient was discharged on day 17 of the hospital. Colonoscopy performed 3 months after tacrolimus initiation showed a clear trend towards improvement Results: Colonoscopy performed 3 months after tacrolimus initiation showed a clear trend towards improvement. The objective findings were concordant with subjective reports of symptomatic relief. There were no major adverse events during therapy with tacrolimus. Conclusions: Tacrolimus provides some signs of effectiveness for treating elderly-onset UC. However, more thorough research is needed to assess the effectiveness and safety of this therapy in this vulnerable population.