European Journal of Molecular & Clinical Medicine

Abstract

Background: Ulcerative colitis, a life-long recurrent relapsing-remitting disorder, is a type of
debilitating chronic IBD of the colon that causes a superficial mucosal inflammation in a
continuous fashion extending from the rectum to the more proximal colon, in varying extents.
The hallmark symptoms of UC include bloody diarrhea with rectal urgency and tenesmus.
Many UC patients experience extra intestinal manifestations (EIM) that involve multiple organs
like erythema nodosum, pyoderma gangrenosum and arthritis. mucosa of the GIT is exposed to
millions of antigens from the food, environment and microbiome. The epithelial barrier,
covered by a mucinous layer, is the first-line defense of the mucosal immune system, because it
provides physical separation between host immune cells and luminal microbes.
Treatment of UC consists mainly of 5-aminosalycilates (5-ASAs), corticosteroids,
immunosuppressive drugs, and monoclonal antibodies to TNF-α. Treatment success is
dependent on several factors, such as use of the right drug for the right indication (induction vs
maintenance), optimization of the dose, and maximization of drug adherence (non-adherence to
mesalazine is associated with increased rates of relapse).Treatment should be tailored to disease
activity (mild, moderate, severe) and the extent of colonic involvement (proctitis, left-sided
colitis, or pancolitis).
Agomelatine is an atypical antidepressant with a unique receptor profile, as a melatonin
receptor (MT1 and MT2) agonist and a 5-HT2C receptor antagonist.