Ulcerative colitis is a long-term condition that causes inflammation of the large intestine (colon) and rectum. Small ulcers that bleed and produce pus can develop on the mucous membrane of the colon. Treatment of ulcerative colitis usually involves medication or surgery.
Drug Treatment of Ulcerative Colitis
Different classes of medications can be effective in treating ulcerative colitis. The type you choose depends on the severity of your condition. It may take some time to find a medication that works for you, as what works for one person may not work for another. Also, some medications have serious side effects, so the benefits and risks of treatment must be weighed.
Anti-inflammatory medications are often the first step in treating ulcerative colitis and are suitable for most people with this disease. These drugs include:
- 5-Aminosalicylate. Examples of these types of drugs include sulfasalazine (Azulfidine), mesalamine (such as Asacol HD, Delzicol), valsalazide (Colazal), and olsalazine (Dipentum). Which one to take orally, as an enema, or as a suppository depends on the area of the colon affected
- Corticosteroids. These drugs, which include prednisone and budesonide, are usually used for moderate to severe ulcerative colitis that is unresponsive to other treatments. Because of side effects, they are not usually prescribed long-term.
These drugs also reduce inflammation, but they suppress the immune system response that initiates the inflammatory process. Immunosuppressive drugs include:
- Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). They are the most commonly used immunosuppressants for the treatment of inflammatory bowel diseases. Its use requires you to stay in close contact with your doctor and have your blood checked regularly for side effects, including effects on the liver and pancreas.
- Cyclosporine (Gengraf, Neoral, Sandimony). This medication is usually for people who do not respond to other medications. Cyclosporine has the potential to cause serious side effects and should not be used for long periods of time.
- Tofacitinib (Xeljanz). These are called “small molecules” and they block the inflammatory process. Tofacitinib is effective when other treatments do not work. Common side effects include an increased risk of shingles infection and blood clots. The U.S. Food and Drug Administration (FDA) recently issued a warning about tofacitinib, saying preliminary studies have shown that taking the drug increases the risk of serious heart problems and cancer. If you are taking tofacitinib for ulcerative colitis, do not stop taking it without talking to your doctor first.
This class of drugs targets proteins produced by the immune system. Biologic drugs used to treat ulcerative colitis include:
- Infliximab (Remicade), adalimumab (Humira), and golimumab (Simponi). Known as tumour necrosis factor inhibitors (TNF inhibitors) or biologics, these drugs function by blocking a protein released by your immune system. It is intended for people with severe ulcerative colitis who do not respond to or tolerate other treatments.
- Vedolizumab (Ntivio). This drug is approved for the treatment of ulcerative colitis in people who do not respond to or cannot tolerate other treatments. It works by blocking inflammatory cells from reaching the site of inflammation.
- Ustekinumab (Stelara). This medicine is approved for the treatment of ulcerative colitis in people who are unresponsive or cannot tolerate other treatments. The drug works by blocking one of the proteins that cause inflammation.
Additional medications may be needed to treat certain symptoms of ulcerative colitis. There may be a need for one or more of the following over-the-counter medications:
- Antidiarrheal drugs. In cases of severe diarrhoea, loperamide (Imodium A-D) may be helpful. Use antidiarrheal medications very carefully and only after consulting your doctor, as they may increase the risk of an enlarged colon (toxic megacolon).
- Analgesics. For mild pain, your doctor may recommend acetaminophen (such as Tylenol), but not ibuprofen (such as Advil and Motrin IB), naproxen sodium (Aleve), and diclofenac sodium.
- Antispasmodics. Doctors may prescribe antispasmodics to help with spasms.
- Iron supplements. If you have chronic intestinal bleeding, you may develop iron-deficiency anaemia and receive iron supplements.
Surgical Treatment of Ulcerative Colitis
Surgery can be used to eradicate ulcerative colitis by removing the entire colon and rectum.
Most commonly, this involves a procedure called ileal anal (J-pocket) anastomosis surgery. This process eliminates the need to carry bags to collect stool. The surgeon will make a pouch from the end of the small intestine. The sac then attaches directly to the anus, allowing you to expel waste relatively normally.
In some cases, a pocket is not possible. Instead, surgeons create a permanent opening in the abdomen (ileostomy) through which stool is passed to be collected in an attached external pouch.
Complications of Ulcerative Colitis
Complications of ulcerative colitis include:
- primary sclerosing cholangitis – where the bile ducts within the liver become damaged
- Increased risk of bowel cancer
- Inadequate growth and development in children and adolescents
- In addition, some medications used to treat ulcerative colitis can cause weak bones (osteoporosis) as a side effect.
More frequent screenings for colon cancer will be required due to your increased risk. The recommended schedule will depend on the location of your illness and how long you’ve had it. People with proctitis are not more likely to develop colon cancer. If your disease has spread beyond the rectum, a colonoscopy should be performed every 1 to 2 years. It begins 8 years after diagnosis, when most of the colon is affected, and 15 years after that, only the left side of the colon is affected.