There are a variety of treatments available today for ulcerative colitis(UC), and researchers are continuing to develop exciting new options. The location and severity of your disease, accompanying complications, and your response to previous treatment will all influence your gastroenterologist's choice of therapy.
There are several important goals of treatment:
- Control symptoms by reducing inflammation
- Achieve symptom remission
- Heal the intestine, or mucosa
- Reduce or stop steroid use
- Reduce the need for surgery
Currently available treatments for ulcerative colitis include:
- Antidiarrheal Medications: Patients who have mild diarrhea may be prescribed antidiarrheal drugs. Your doctor may prescribe several antidiarrheal agents, including loperamide. In severe cases, your doctor will closely monitor you if you are taking these antidiarrheal drugs to avoid triggering toxic megacolon, a serious complication. If you are dehydrated because of diarrhoea, you will be treated with fluids and electrolytes.
- Anti-inflammatory agents: The most common anti-inflammatory drugs used to treat UC are aminosalicylates, which are aspirin-like drugs that contain 5-aminosalicyclic acid (5-ASA). These drugs can be taken orally or rectally, through an enema or in a suppository. How you take the medication will depend on the location of the inflammation in the colon. Most people with mild or moderate UC are treated with this group of drugs first. Your doctor may prescribe one or more of the following aminosalicylates: mesalamine (Asacol®*, Lialda®*, Pentasa®*), sulfasalazine (Azulfidine®*), olsalazine (Dipentum®*), and balsalazide (Colazal®*).
- Biologics: Biologics such as Infliximab are currently registered in South Africa for the treatment of Ulcerative Colitis. These therapies selectively interact with processes in your body to treat a number of diseases and their symptoms. To date, biologics have been used to successfully treat many people with a variety of inflammatory disorders. Biologics can reduce the signs and symptoms, induce and maintain remission, promote intestinal healing, and reduce or stop the need for steroids in patients with moderate to severe UC who haven't responded well to other therapies.
- Immunomodulators: Drugs such as azathioprine (Imuran®*) and 6-mercaptopurine (Purinethol®*), or 6-MP, have been used to maintain remission of UC and decrease the need for steroids. However, this class of drugs may take up to three to six months to produce maximal effect. Side effects can include nausea, vomiting, diarrhea, pancreatitis, liver problems, interference with the bone marrow’s ability to make platelets and red and white blood cells, and reduced resistance to infection. If you take these drugs, you may need to have your blood count monitored on a regular basis. Cyclosporine has been given to some people who suffer severe flare-ups and have not responded to steroid therapy.
- Steroids: Corticosteroids, such as prednisone, methylprednisolone, and budesonide, 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 UC. Corticosteroids can be given orally, intravenously, through an enema, or in a suppository, depending on the location of the inflammation. Patients often see an improvement in their symptoms within days after starting steroids. While steroids are effective in the short-term control of a flare-up, it is not recommended that they be used for a long time because of side effects. Side effects can include weight gain, acne, facial hair, hypertension, osteoporosis, hip joint damage, diabetes, mood swings, and an increased risk of infection.
Some people may experience periods of remission when they are free of symptoms. However, symptoms usually recur at various times over a person's lifetime. It is not possible to predict when a remission may occur or when symptoms will return. Because of the unpredictability of ulcerative colitis, you may need medical care for as long as your gastroenterologist deems necessary, with regular office visits to monitor your condition.