Ulcerative Colitis
Treatment Overview
Treatment for ulcerative colitis depends mainly on the severity of the disease and usually includes medicines to control symptoms, such as diarrhea, and changes in diet. A few people have symptoms that are persistent and severe, in some cases requiring treatment with additional medicines or surgery.
The goals of treatment include:
- Relieving symptoms and ending sudden (acute) attacks as quickly as possible.
- Treating complications, such as anemia or infection. Treatment may include taking nutritional supplements to restore normal growth and sexual development in children and teens.
- Preventing or delaying new attacks.
Initial treatment
If you don't have any symptoms of ulcerative colitis or if your disease is not active (in remission), you may not need treatment. If you do have symptoms, they usually can be managed with medicines to put the disease in remission. It often is easier to keep the disease in remission than to treat a flare-up.
Mild symptoms may respond to antidiarrheal medicines and changes in your diet. Sometimes you may need to use enemas or suppositories. Talk with your doctor before taking antidiarrheals. Prescription medicines may be used to treat mild symptoms and keep the disease in remission. Usually, corticosteroids (such as hydrocortisone or prednisone) are given for a few weeks to control active disease. Aminosalicylates (such as sulfasalazine or mesalamine) will often also be used to reduce or stop symptoms, sometimes at the same time as corticosteroids.
When your symptoms are under control, you may continue to take aminosalicylates to keep the disease in remission. Aminosalicylates relieve inflammation in the intestines.
Moderate to severe symptoms usually require corticosteroids to control inflammation. The required dose of steroids may be higher than that needed to treat mild colitis. When inflammation goes away, you will take aminosalicylates to keep the condition in remission. For more information about making good food choices, see:
Immunomodulator medicines, such as azathioprine (AZA) or 6-mercaptopurine (6-MP), also may be needed for severe cases that cannot be controlled with aminosalicylates alone. These medicines suppress the body's immune system to prevent inflammation. Immunomodulators also may be needed to avoid long-term use of steroids, which can cause side effects such as increased risk of infection and osteoporosis.
For severe ulcerative colitis, when corticosteroids don't work, your doctor may have you try infliximab. Infliximab (Remicade) may work to put you in remission when other medicines don't. Infliximab has also been shown to help heal the lining of the intestine.
Ongoing treatment
The goal of ongoing treatment is to keep ulcerative colitis from causing symptoms (keep it in remission). Most people take aminosalicylates (such as sulfasalazine or mesalamine) to prevent symptoms from recurring. Aminosalicylates relieve inflammation in the intestines. If you do have flare-ups, you may be given corticosteroids (such as hydrocortisone or prednisone) to control the inflammation.
Usually, steroids are given only long enough to control inflammation. If your condition is so severe that aminosalicylates alone cannot keep you in remission and you would need long-term use of steroids, you may take immunomodulator medicines (such as azathioprine [AZA], 6-mercaptopurine [6-MP], or cyclosporine). These strong medicines suppress the immune system to prevent inflammation.
If these medicines don't work, your doctor may have you try infliximab (Remicade). Infliximab also blocks the inflammatory response in your body and helps reduce the inflammation in your colon.
Your doctor will want to see you for a follow-up visit about every 6 months while your condition is stable and more frequently if you are having problems. If you are taking medicines, you may have laboratory tests every 2 to 3 months. Many people who have ulcerative colitis are so familiar with the course of their condition that they can handle minor flare-ups on their own. In some cases, you may be able to consult with your doctor on the phone for minor problems.
Treatment if the condition gets worse
You may have to receive treatment in the hospital if you have severe, persistent ulcerative colitis with symptoms outside the digestive tract, such as fever or anemia. Treatment includes replacing fluids and electrolytes lost because of severe diarrhea.
Your doctor may increase your dose of corticosteroids (such as hydrocortisone or prednisone) to control active disease or may increase your immunomodulator medicines (such as azathioprine [AZA], 6-mercaptopurine [6-MP], or cyclosporine) or infliximab to suppress your immune system. But steroids are usually not used as long-term therapy.
Surgery may be necessary if your symptoms do not improve with medicines or you have complications such as bleeding or perforation of the intestine. Removal of the large intestine (colon)
cures ulcerative colitis. Some people with severe ulcerative colitis need urgent surgery to remove their colon. Several types of surgery can be done. For more information, see the Surgery section of this topic.
Some people who have precancerous changes in their colon may decide to have surgery to prevent cancer even if they have no symptoms. In some cases, people decide to have their colon removed to improve their quality of life and to eliminate the risk of colon cancer.
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| Author: | Monica Rhodes | Last Updated: November 3, 2008 |
| Medical Review: | Kathleen Romito, MD - Family Medicine Arvydas D. Vanagunas, MD - Gastroenterology | |
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