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Ulcerative colitis can be unpredictable, which can make it challenging for physicians to determine whether a particular course of treatment has been effective. The main goal of treatment in UC is to reduce the signs and symptoms by regulating the immune system, and to bring about long-term remission. While there is no cure for UC, treatment can help control symptoms so that patients can lead a fuller life. Treatment may include over-the-counter as well as prescription medications, lifestyle changes in stress management, diet and nutrition, and surgery.
Prescription medications typically include anti-inflammatory drugs, immune suppressants and steroids. If these are not effective, (TNF)-alpha inhibitors, or “biologics,” drugs typically given to treat certain types of arthritis, may be used.
Anti-inflammatory medications are often given first. These include 5-aminosalicylates such as mesalamine and balsalazide that contain 5-aminosalicylate acid (5-ASA). While these drugs are not FDA approved to treat UC, they can help reduce inflammation of the lining of the GI tract. They’re typically used for people with mild-to-moderate episodes of UC and can be useful as a maintenance treatment in preventing relapses. They work best in the colon and are less effective if the UC is in the small intestine.
Corticosteroids such as prednisone and methylprednisolone suppress the immune system and are used to treat moderate to severe active UC. Because they have significant side effects (such as high blood pressure, diabetes and osteoporosis), steroids should not be used long-term. Budesonide is a steroid that is used to treat localized inflammation in UC. Because its systemic exposure is minimal, there is a lower risk of troublesome side effects compared to other steroids.
If aminosalicylates and corticosteroids are not effective, immune suppressants such as azathioprine may be given to suppress the immune system so that it cannot cause ongoing inflammation. Some people taking immune suppressants find that they no longer need steroids. These drugs may also be effective in maintaining remission in people who haven’t responded to other medications designed to achieve remission.
(TNF)-alpha inhibitors, or “biologics,” typically given to people with arthritis, may be used for people with moderate to severe UC who don’t respond to or can’t tolerate the side effects of other treatments. These drugs, such as infliximab and adalimumab, act against a protein produced by the immune system and may be combined with other immunosuppressants.
Antibiotics including metronidazole, ampicillin and ciprofloxacin are typically used when infection is present or when there are fistulas around the anal canal. Additional medications that are sometimes given include anti-diarrheal medications such as loperamide, iron supplements for those with chronic intestinal bleeding who are at risk for anemia, and over-the-counter pain relievers including acetaminophen. Importantly, the pain relievers ibuprofen, naproxen sodium and diclofenac sodium should not be used as they can worsen symptoms and the severity of disease.
Surgery can eliminate UC but it typically means removal of the entire colon or rectum. The surgeon either constructs a pouch at the end of the small intestine to expel waste or the person must get a permanent opening in the abdomen, called a stoma, in which waste is collected into an attached bag.
It’s also important to control stress, as it can worsen symptoms and may trigger flare-ups. Exercise, meditation, yoga and biofeedback, a stress-reduction technique designed to reduce muscle tension and slow heart rate via a feedback machine, are often recommended to help patients reduce stress levels.