The goal of treatment is to control inflammation and achieve and maintain remission.
Ulcerative colitis (UC) is a chronic inflammatory bowel disease that causes irritation, swelling, and sores (ulcers) on the inner lining of the colon. Each year, 38,000 Americans are diagnosed with ulcerative colitis, according to the Crohn’s and Colitis Foundation of America.
Ulcerative colitis symptoms vary greatly among different individuals. “Some patients may have just mild symptoms … and go on for years,” says Sergey Khaitov, MD, surgeon at Mount Sinai Beth Israel. “Some patients may have such severe disease they may require emergency surgery within days after the disease started.” These symptoms may include:
- Loose and bloody stool
- Frequent diarrhea
- Ulcers (open sores in the colon and rectal lining)
- Abdominal pain
- Weight loss
- Loss of appetite
- Delayed growth
There’s no cure for UC, but a proper treatment plan can help patients manage symptoms and even achieve remission—which is a period of no symptoms—for years. “Primarily the goal of treatment these days is not just to deal with the symptoms, but to really try to get the underlying inflammation under control so that the patients don't have symptoms that need to be treated anymore,” says Todd Linden, MD, a gastroenterologist in New York City.
How Ulcerative Colitis Is Treated
The goal of treatment for UC is to control inflammation, and achieve and maintain remission. Medications to treat UC include: aminosalicylates (5-ASAs), corticosteroids, immune modifiers (immunomodulators), biologics, antibiotics, and OTC medications, such as antidiarrheals and pain relievers.
Aminosalicylates (5-ASAs) decrease inflammation in the intestinal lining and are good for mild to moderate UC symptoms. They are available in oral or rectal form.
Corticosteroids. Steroids suppress the immune system to help reduce inflammation. They are helpful for moderate to severe UC, but are not recommended as a long-term treatment because they can cause a dependence or resistance to steroids. They are available orally, as an injection, rectally, or intravenously.
Immune modifiers (immunomodulators) also suppress the immune system to help reduce inflammation. These medications are available orally or by injection.
Biologics suppress the immune system and reduce inflammation, and are a good option for people who haven’t responded to other medications. Biologic therapies are available orally or by injection.
Antibiotics may be used to help treat infections and complications of UC.
Over-the-counter medications, such as pain killers or antidiarrheals, may be helpful for symptom management, but not so much for treating the disease itself. “The only things that the over-the-counter [medications] help us with is symptomatic treatment for some of the symptoms of colitis, but really in terms of treating the underlying disease process, none of the over-the-counter stuff have really been shown to do very much,” says Dr. Linden.
“For people who are in active disease, if they are not responding to the medicines that we are using for maintenance, then we will probably intensify the regimen,” says Dr. Linden. “We will leave people on whatever agents it took to get them into remission. 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.”
Lifestyle Changes That May Help Ulcerative Colitis
While there are no recommended lifestyle changes to help a patient reduce inflammation or achieve remission with UC, there are a few tweaks that may help with flare management.
Some of these include eating a well-balanced diet and keeping a journal to track foods that may aggravate UC symptoms during flare-ups. “We need people to have good nutrition to be able to heal well,” says Dr. Linden.
Other habits, like not managing stress or following your UC treatment regimen can also affect ulcerative colitis flares.
Skipping or taking the wrong dose of your UC medication can cause inflammation and symptoms to return. During remission, you should continue taking medications at the correct dose and at the scheduled time.
“We really try to encourage people to understand that the treatments have come so far that they will likely have a completely normal life. They will get the illness under control, which is what happens the vast majority of the time,” says Dr. Linden. “The vast majority of people will be totally in remission and happy and healthy and unbothered by this for the rest of their life.”
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Primarily, the goal of treatment
these days is not just to deal with
00:00:07,997 --> 00:00:11,805
the symptoms, but to really try to get
the underlying inflammation to be under
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control, so that the patients don't have
symptoms that need to be treated anymore.
00:00:15,981 --> 00:00:24,215
00:00:24,215 --> 00:00:26,815
When we think about treating
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we think about getting the patient's
inflammation under control.
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We call that induction of remission.
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So we have a whole spectrum
of medical treatments, and
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they start with very simple things
that'll calm the immune system down and
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help you get that colitis
back under control.
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And for many, many people,
that's all that they need.
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Sometimes we'll use steroids, and
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that will help get it under control
often very rapidly, but it has a lot of
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long-term side effects, so you try to
use it for as short a time as possible.
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Another class of drugs
is our immune modifiers.
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These medications help calm down that
inflammatory reaction that's going on.
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And then we have another whole class
of drugs, the biologic therapies, and
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they work on a specific point in the
cascade of signaling proteins that tell
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the immune system what to do.
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The only things that the over-the-counter
helps us with are symptomatic treatment
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for some of the symptoms of colitis.
00:01:22,412 --> 00:01:25,977
But really, in terms of treating
the underlying disease process,
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none of the over-the-counter stuff have
really been shown to do very much.
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Well, with ulcerative colitis there's
not really any cure for the disease,
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except to remove the entire colon.
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In surgical management of ulcerative
colitis, there are three or two steps.
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First step will involve removal
of the large intestines, and
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creation of the temporary ileostomy.
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Then this patient will
undergo second step surgery,
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when we actually remove the rectum,
and create an internal J-pouch.
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Then, once everything is healed, that
will lead the patient to the third stage,
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when we reverse the ileostomy.
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At that point, the patient will start
moving his or her bowels through the anus.
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Sometimes patients hear this
diagnosis of ulcerative colitis, and
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they think this is the end of the world.
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The number of people that
end up have a colectomy or
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something like that is
extraordinarily small these days.
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Things have improved dramatically, and
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the vast majority of people will
be totally in remission and
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happy and healthy and unbothered by
this for the rest of their life.
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Ulcerative Colitis Treatment Options. New York, NY: Crohn’s and Colitis Foundation. (Accessed on December 20, 2018 at http://www.crohnscolitisfoundation.org/what-are-crohns-and-colitis/what-is-ulcerative-colitis/colitis-treatment-options.html)
Current Treatments for Ulcerative Colitis. Berlin, Germany: Johannes Meier, Andreas Sturm, Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, Campus Virchow Clinic. (Accessed on December 20, 2018 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158396)
Ulcerative colitis. Washington, DC: MedlinePlus, U.S. National Library of Medicine. (Accessed on December 11, 2018 at https://medlineplus.gov/ulcerativecolitis.html)Ulcerative Colitis (Beyond the Basics). UpToDate. (Accessed on December 20, 2018 at https://www.uptodate.com/contents/ulcerative-colitis-beyond-the-basics)