Ulcerative Colitis

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Treatment

There is no cure for ulcerative colitis. The goals of treatment are to reduce or control symptoms and enable patients to live fairly normal lives. Treatment often results in disease remission, which can last for months or even years, although symptoms return eventually.

Women who have ulcerative colitis should inform their physician if they are pregnant, nursing, or are planning to become pregnant. Some medications used to treat ulcerative colitis can cause birth defects or pass through breast milk. Active colitis also increases the risk of fetal complications.

Medications
Aminosalicylates (5-ASA agents) may be used to control inflammation in patients who have mild-to-moderate ulcerative colitis symptoms. These drugs can be given orally, in an enema, or as a suppository. Side effects include nausea, vomiting, heartburn, diarrhea, and headache.

Corticosteroids also may be used to treat colitis. These drugs, which reduce inflammation, are used in patients who have moderate-to-severe colitis and those who have not responded to 5-ASA drugs. Corticosteroids can be given orally, intravenously (through a vein [IV]), in enemas, or as suppositories. These medications may cause severe side effects and are limited to short-term use.

Side effects include the following:

• Acne
• Bone loss
• Diabetes
• Facial hair
• High blood pressure (hypertension)
• Infection
• Mood swings
• Weight gain

Immunomodulators reduce inflammation by suppressing certain aspects of the immune system. These drugs are taken orally; however, they are slow-acting and may take 3-6 months to reduce symptoms. Complications include pancreatitis, hepatitis, reduced white blood cell counts, and an increased risk for infection.

Biologic therapies may be used to treat moderate-to-severe ulcerative colitis cases. This treatment, which uses antibodies to block specific inflammatory processes, may not cause as many side effects as other medications.

Antibiotics and other medications (e.g., pain relievers) may be prescribed to destroy bacteria, control pain, relieve anxiety and tension, reduce diarrhea, or treat iron deficiency. Nicotine patches also may provide short-term relief to ex-smokers; however, the reasons for this remain unclear.

Surgery
If medications combined with diet and lifestyle changes (e.g., stress reduction) are unsuccessful, surgery may be performed. Between 25% and 40% of patients who have ulcerative colitis eventually require surgery, due to massive bleeding, severe illness, rupture of the colon, or the risk for colorectal cancer.

Types of surgery used to treat ulcerative colitis include ileostomy and ileoanal anastomosis. In ileostomy, the rectum and colon are completely removed. To allow for the removal of waste products from the body, the end of the small intestine (ileum) is then attached to an opening (stoma) in the abdomen. A pouch is placed over the stoma, waste products are collected in the pouch, and the pouch is removed and emptied regularly.

In ileoanal anastomosis, the colon is removed, but a portion of the rectum and anus remains. This procedure eliminates the need for a pouch to collect waste materials. The ileum is attached to the inside of the rectum and anus, creating an internal pouch where waste collects until it is eliminated. Bowel movements are made as usual, although they may be more frequent and watery.

Other Treatment
In some cases, patients who have ulcerative colitis require hospitalization to control severe bleeding or diarrhea, or to treat dehydration caused by the loss of body fluids.

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