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The Two Goals of Treatment
Once you have been diagnosed with ulcerative colitis (UC), your doctor will recommend treatment depending on the extent and severity of your symptoms. "There are two goals of treatment for ulcerative colitis," says Deborah Proctor, M.D., professor of medicine and medical director of the Inflammatory Bowel Disease Program at Yale University. "The first is to get you feeling better as soon as possible, and the second is to keep you feeling well through a maintenance plan." Following is a breakdown of some treatments shown to work for UC.
Certain prescription medicines can work to turn around flare-ups of UC and put you in remission, but when taken as part of a maintenance plan, they may actually help stave off future flare-ups:
- Aminosalicylates (ASAs) are usually the first line of treatment for people with mild or moderate UC. These oral or rectal medications contain 5-aminosalicylic acid (5-ASA), a substance that helps control inflammation, and include sulfasalazine, mesalamine, olsalazine, and balsalazide.
- Corticosteroids, such as prednisone, prednisolone, or hydrocortisone, are anti-inflammatory medications that may be given for a short term to turn around flare-ups in people with moderate to severe UC. They can be taken orally, rectally or intravenously.
- Immunomodulators, or oral medications that suppress the immune system, are sometimes given to people who haven't responded well to corticosteroids or aminosalicylates, or as a way to decrease one's need for steroids. The most common ones for UC are azathioprine and its metabolite, 6-mercaptopurine (or 6-MP for short). These drugs can take three months or longer to work effectively. Cyclosporine, another immunosuppressive drug given intravenously, may be used in very severe cases of UC to produce remission, but is not usually used for maintenance treatment of UC.
- Biologics, or "biologic response modifiers," are a fairly new class of drugs that reduce symptoms by interfering with pathways involved in inflammation. The biologic therapy used most often for UC is infliximab (Remicade), which is given intravenously to patients with moderate to severe UC for whom other medications have not worked. More biologic drugs for treating UC are in development.
- Antibiotics, such as metronidazole or ciprofloxacin, are sometimes given by pill or by injection for treating infections that can arise in the colon of UC patients.
Side effects from UC medications can range from headaches, stomach cramping and nausea (from the ASAs) to potentially serious rises in blood sugar and blood pressure (from steroids) and inflammation of the liver and pancreas (from immunomodulators). It's important to work closely with your doctor to not only monitor how well your medication is working, but to report side effects as soon as possible and take action to minimize their risks.
There are currently more than 80 experimental treatments for inflammatory bowel disease being researched in clinical trials, according to the Crohn's & Colitis Foundation of America (CCFA). As new medications are approved and become available for use, it will be more likely than ever that people with UC will be able to find a treatment that really works and helps to live a normal life.
Up to one-third of UC patients ultimately have their colons removed (a procedure called a colectomy), according to the CCFA. Surgery may be needed because treatment with medicines either didn't work, caused side effects that were too severe, or because of excessive bleeding, severe illness, rupture of the colon, or risk of cancer. A colectomy usually results in one of two possibilities: an ileostomy, a surgery which results in a small external pouch that is emptied manually; or, if the outer muscles of the rectum and anus are preserved in the original surgery, an ileoanal pouch anal anastomosis (IPAA), which creates an internal pouch.
Sometimes people who have a colectomy are initially left with an ileostomy, but after recovering from the initial surgery may be able to have an IPAA. UC is considered to be "cured" once the colon has been surgically removed.
Reviewed by: Vikram Tarugu, M.D.