Treatment of ulcerative colitis
The treatment of ulcerative colitis aims to induction a remission and maintenance of remission. Induction of remission treatment aims to relieve the symptoms and give a chance for the colon to heal from the ulcers. Maintenance remission means the prevention of further relapse.
Treatment of ulcerative colitis includes medications, surgery, and diet modifications. The treatment differs among the cases; thus, your doctor may time to adjust the treatment plan to achieve the goals of treatment. The duration of treatment will depend on the severity of the disease and the response to treatment, but most cases require a long course of treatment that may take many years.
A) Medications for ulcerative colitis include:
Amino salicylates (for example, Sulfasalazine)
It is the first choice in the treatment of ulcerative colitis, especially in mild and moderate cases. It reduces and maintains remission by reduction of the inflammation. Its initial dose is 1 gm per 6 hours to induce a remission, then a maintenance dose 2 gm daily after the remission and for two years. The route of administration depends on the site of the disease; it is available in oral, enema, and suppository forms.
Corticosteroids (for example, Prednisone)
They are potent anti-inflammatory medications, but due to their many side effects, the doctors use them only for short periods as possible. The main indication of corticosteroids is during an active flare-up of the disease if the Amino salicylates can’t control the condition alone. As Aminosalicylates, corticosteroids are available in oral, enema, and suppository forms.
Immunosuppressive drugs (for example, Azathioprine and Cyclosporine)
These drugs act by reducing the inflammation by inhibition of the immune system to make it unable to attack the colon. These drugs may lead to a lot of dangerous side effects, such as recurrent infections and bone marrow depression, which limits their use to the cases that didn’t achieve remission by Amino salicylates or corticosteroids.
Biologic agents (for example, Infliximab and Vedolizumab)
These medications act by inhibiting tumor necrosis factor protein, which is one of the immune system proteins. These medications are powerful, and their response rate is high. But, these medications may lead to dangerous side effects, such as the increased risk of cancers and dangerous infections, heart failure, incoordination, and allergic reaction. Patients who take these medications should undergo a continuous evaluation to assess the effectiveness of the drug and to prevent any dangerous side effects. Doctors may apply these drugs either early in the treatment or after the failure of the previous medications to induce a remission.
Other symptomatic treatments may be useful in ulcerative colitis, such as:
-
- Antibiotics: to prevent infections that may interfere with the healing of the colon
- Antidiarrheal medications: Don’t take these medications without consulting your doctor
- Bacterial recolonization (probiotics): They are beneficial living bacteria that improve the status of the colon by restoring the normal intestinal flora. Probiotics help in the induction and maintenance of remission.
- Iron therapy and blood transfusion: to treat the anemia
Hospitalization of patients with ulcerative colitis
Hospitalization may be necessary for severe cases to correct the dehydration and any electrolyte disturbance that results from severe diarrhea. Also, other complications may require hospitalization as severe bleeding, toxic megacolon, and colon perforation.
