How is ulcerative colitis treated?
Treatment for ulcerative colitis usually involves medication and may also require surgery.
When a person with ulcerative colitis experiences symptoms of the disease, it is called a "flare-up." When there are few or no symptoms, ulcerative colitis is said to be "in remission." The first goal of treatment is to reduce or eliminate the symptoms of ulcerative colitis—remission. The second goal is to keep it that way.
For some people with ulcerative colitis, symptoms are in remission for months or even years. However, in most people, the symptoms eventually return (relapse), sometimes because the person has stopped following the doctor's recommendations.
People tend to stop taking their medication when they feel good and their symptoms are under control. One of the most important things that people with ulcerative colitis can do to stay well and keep the disease in remission is to take their medications even when they feel well.
Treatment of ulcerative colitis usually starts with mild medications to treat mild disease. Stronger medications are used for more severe disease.
Because medication must be taken for life, 1 way to choose the best medication for you is to consider the side effects that each type of medication may cause and how convenient the medication is to take. Here's a list of the drugs often used to treat ulcerative colitis.
Antiinflammatory drugs
These drugs are commonly prescribed for ulcerative colitis. They release a medication inside the colon that fights inflammation, just as their name indicates. Most people with mild to moderate ulcerative colitis start by taking an antiinflammatory drug. Antiinflammatories are also useful to ease pain during relapses.
TOPMesalamine-based medications (5-ASAs)
Mesalamine (5-aminosalicylic acid, abbreviated 5-ASA) is related to aspirin. Instead of relieving pain, as aspirin does, 5-ASA reduces swelling in the digestive system.
Sulfasalazine (Azulfidine®) contains both 5-ASA and a sulfa antibiotic. Sulfasalazine was the first 5-ASA to be widely used for ulcerative colitis. This inexpensive pill is effective for many people. Others find it hard to tolerate the sulfa portion of the medication or may be allergic to it.
New pills are available that contain 5-ASA but no sulfa. These pills include mesalamine (Asacol®, Pentasa®), olsalazine (Dipentum®), and balsalazide (Colazal™). The amount (dosage) to take is different for different people. When and where the drug is released in the colon also varies. Unfortunately, the 5-ASAs that are available today require patients to take several pills 2 or 3 times a day.
Enema formulations (Rowasa®) allow mesalamine to be placed directly in the rectum and lower part of the colon. This lets the 5-ASA coat the lining of the intestine and deliver its benefit to the affected area. Rowasa is effective in mild to moderate colitis that affects only the left side of the colon (left-sided colitis). Up to 80% of patients (4 out of 5) with left-sided ulcerative colitis benefit from using this therapy once a day.
Suppositories inserted into the rectum (Canasa®) deliver mesalamine from the rectum up to the sigmoid colon, the lower part of the large intestine. Many people who have ulcerative proctitis—ulcerative colitis that occurs only in the rectum and the lower end of the colon—respond well to mesalamine suppositories.
TOPSteroids
Steroids have been used for many years to reduce inflammation in patients who have not responded well to 5-ASA medications or who have moderate to severe ulcerative colitis. Examples of steroids are prednisone, methylprednisolone, and budesonide.
Steroids can be swallowed in pills or given through an intravenous (IV) line in the arm, through an enema, or in a suppository. The choice will depend on the location of the inflammation.
Patients feel better within days after starting to take steroids. Although steroids are effective for controlling flare-ups, they should not be taken for a long time because of their side effects: weight gain, acne, facial hair, high blood pressure, thinning of the bones (osteoporosis), damage to hip joints, diabetes, mood swings, and an increased risk of getting infections.
Immunomodulators
These drugs maintain remission of ulcerative colitis and make it less necessary to take steroids. Examples of immunomodulators are azathioprine (Imuran®) and 6-mercaptopurine (Purinethol®), abbreviated 6-MP.
Immunomodulators may take as long as 3 to 6 months to be effective. Side effects can include nausea, vomiting, diarrhea, pancreatitis, liver problems, interference with the ability of the bone marrow to make platelets and red and white blood cells, and an increased risk of getting infections.
TOPBiologics
Biologics are the latest form of therapy for treating moderate to severe ulcerative colitis and maintaining remission. Infliximab (Remicade®) neutralizes a protein produced by the immune system before it can cause inflammation in the colon.
Infliximab, which is given through an intravenous (IV) line is very effective for many patients. It has been linked, though, to an increased risk of infection and serious allergic reactions.
Antidiarrheal medications
People whose ulcerative colitis gives them only mild diarrhea may be able to prevent that symptom by taking antidiarrheal drugs. One way to control mild to moderate diarrhea is by taking a fiber supplement, such as psyllium powder (Metamucil®), which adds bulk to the stool, reducing diarrhea. For more severe diarrhea, loperamide (Imodium®) is often prescribed.
Laxatives
In some people with ulcerative colitis, swelling causes the intestines to get narrower, making it harder to have a bowel movement. The result is constipation. Laxatives can help, but because they are hard on the digestive system, they shouldn't be used too often.
Pain relievers
For mild pain, patients often take acetaminophen (Tylenol®). People with ulcerative colitis should not take nonsteroidal antiinflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil®, Motrin®, and others), and naproxen (Aleve®), because these drugs could make the symptoms worse.
Iron supplements
People who have ongoing (chronic) bleeding in the intestine can develop iron deficiency anemia. Taking iron supplements helps to restore iron in the blood to normal levels and reduces this type of anemia after bleeding has slowed or stopped.
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