In Remission with Ulcerative Colitis? Why Continuing Treatment Is Vital
Remission means no symptoms, not no treatment.
Ulcerative colitis, or UC, cannot be cured, but it can be managed. “When we think about treating ulcerative colitis, our goal now is to get the inflammation itself under control,” says Todd B. Linden, MD, gastroenterologist. When inflammation is lowered, many people will enter a state of remission, or a period with little to no symptoms.
But reaching the point of remission doesn’t mean treatment is over. Remission is a break from symptoms, not treatment. Remission can only occur—and be maintained—by consistent treatment, even when symptoms are mild or not present. Sustained remission means your treatment is doing its job.
It’s tempting for individuals with UC to relax their treatment efforts when they’re not dealing with painful and disruptive UC symptoms, such as frequent diarrhea and abdominal pain. Here are some reasons people cite for not maintaining UC treatment, according to a 2017 study in the journal Patient Preference and Adherence:
- Not seeing the point of taking medications if no symptoms are occurring
- Forgetting to take medications
- Inconvenient medication schedules or pill burden
- Being in denial about having an illness
- And depression.
Treatment to Maintain Remission
Doctors may prescribe different types of medications depending on whether you are in remission or having a flare of UC symptoms. Medications for flare-ups are more potent and aggressive, and they may cause side effects.
To make treatment for UC more sustainable, your doctor will prescribe a medication specifically for remission, known as “maintenance therapies.” These medications cause fewer side effects and better tolerated by the body long-term.
Medications for remission may include:
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5-ASAs, or aminosalicylates: These decrease intestinal inflammation and are available in oral or rectal form.
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Immune modifiers, or immunomodulators: These suppress the immune system to reduce inflammatory attacks. They are available in oral or injection form.
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Biologics: These also suppress the immune system, and are also available in oral and injection form.
In addition to maintenance therapy drugs, lifestyle habits to manage UC are also important to stay in remission.
If you ever think your medications aren’t right for you—whether they don’t seem to be working or you find them hard to stick with—talk to your doctor. Skipping or altering doses without discussing with your doctor could lead to a flare-up, and uncontrolled UC can lead to possible complications of UC.
“Often, we will leave people on whatever agents it took to get them into remission,” says Dr. Linden. “We’ll often leave them on those same agents because we think that’s what they need to keep their disease under control, and that’s probably what’s going to lead to a long-term remission.”
Dr. Linden is a gastroenterologist based in New York City and a clinical instructor in the Department of Medicine at NYU Langone Health.
Sergey KhaitovDr. Khaitov is a surgeon specializing in colon and rectal surgery at Mount Sinai Hospital.
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When we think about treating
ulcerative colitis,
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our goal now is to get
the inflammation itself under control.
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Gastroenterologists will provide
a patient with medications to induce and
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maintain remission of the disease to
keep the patient symptom-free, or
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nearly symptom-free.
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The maintenance medicines are very
similar to the medicines that we use for
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induction.
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In addition, a lot of people
need to add an antimetabolite.
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There's some people who, instead of or
in addition to the antimetabolite,
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will use a biologic therapy.
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Very often ulcerative colitis may have
perfect or near perfect control with
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medications, and those patients will
never require surgery or see a surgeon.
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One of the issues with long-term
remission is after a while people feel
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well and they think, maybe I don't
need to take that medicine anymore.
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But what they don't realize is,
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the treatment is just
controlling their colitis.
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When they stop the treatment,
many people will eventually flare.
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Almost everybody sooner or
later is going to flare again.
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People who have ongoing inflammation in
their colon are at increased risk for
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developing colon cancer.
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Also, they're at an increased risk for
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developing damage to
the lining of their colon.
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We want to prevent all of that from
happening by keeping them in remission.
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And that means achieving not
just their clinical remission,
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meaning that the patient's
symptoms are all in control, but
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also an endoscopic remission, meaning when
we look inside with the colonoscope that
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the lining looks back to normal again.
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And a histologic remission,
which means that when we take biopsies and
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the lab looks at them
under the microscope,
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we get a report back that this looks
like normal, healthy colon now.
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Often we will leave people on whatever
agents it took to get them into remission.
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We'll often leave them
on those same agents,
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because we think that's what they need
to keep their disease under control, and
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that's probably what's going to
lead to a long-term remission.
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They will require routine
colonoscopies to survey their colon,
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to rule out development of cancer, but,
still, they will not need surgery.
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Maintenance therapy. New York, NY: Crohn’s and Colitis Foundation. (Accessed on December 11, 2018 at http://www.crohnscolitisfoundation.org/resources/maintenance-therapy.html.)
Moss AC. Residual inflammation and ulcerative colitis in remission. Gastroenterol Hepatol (NY). 2014 Mar;10(3):181-3.
Patient education: ulcerative colitis (beyond the basics). Waltham, MA; UpToDate, 2018. (Accessed on December 11, 2018 at https://www.uptodate.com/contents/ulcerative-colitis-beyond-the-basics.)
Testa A, Castiglione F, Nardone OM, Colombo GL. Adherence in ulcerative colitis: an overview. Patient Prefer Adherence. 2017;11:297-303.
Ulcerative colitis. Bethesda, MD: American College of Gastroenterology. (Accessed on December 11, 2018 at http://patients.gi.org/topics/ulcerative-colitis/.)
Ulcerative colitis. Washington, DC: MedlinePlus, U.S. National Library of Medicine. (Accessed on December 11, 2018 at https://medlineplus.gov/ulcerativecolitis.html.)