Treatment of Ulcerative Colitis

Treatment of Ulcerative Colitis

The aim of medical management of ulcerative colitis is to reduce the symptoms and induce remission. Once remission is accomplished, the goal is to maintain the remission as long as possible. 

Medication of Ulcerative Colitis

Most of the medications used to treat ulcerative colitis are safe for long-term use, and may individuals stay on maintenance doses indefinitely. Medications include : 

5-ASA Compounds : A number of medications used to treat ulcerative colitis have 5 - aminosalicylic acid ( 5-ASA) as their active ingredient. Sulfasalazine is one of them. The sulfapyradine in sulfasalazine causes side-effects such as headache, nausea, and vomiting. Now a number of new 5-ASA medications have been developed which have lesser side-effects. All the new 5-ASA compounds are effective in large doses for treatment of flare-ups, and in lower doses for maintenance therapy. 

Steroids : Steroids are drugs that reduce inflammation and suppress the body's immune system. They can be applied topically by enema for treatment of proctitis, proctosigmoiditis, and left-sided colitis, or taken by mouth for pancolitis or for any type of ulcerative colitis that does not respond to topical steroids. Steroids are used to teat moderate-to-severe symptoms during a flare-up. They have not been shown to be beneficial as a maintenance therapy, and individuals should be weaned off them as quickly as possible. Prednisone and prednisolone are the most commonly used steroids for ulcerative colitis treatment. While they are very useful, they also produce a number of side-effects. 

Immunomodulators : These medications affect the body's natural immune defenses. In high doses they suppress the body's immune response and in low doses they modify the immune response, therefore called ' immunodulators'. One such drug that has proved very effective in helping individuals get off steroids without inducing another flare-up is 6-mercaptopurine. 
Omega-3 fatty acids, short-chain fatty acids ( SCFA) and nicotine gum or patches have also shown benefits to patients of ulcerative colitis. 

Diet 

Taking care of the diet is the most important lifestyle adjustment. Poor nutrition, and even malnutrition, are a constant threat to individuals with ulcerative colitis, as fever and diarrhoa cause loss of appetite. Further, diarrhoea can lead to temporary lactose intolerance ( the inability to digest milk sugars), which leads to calcium deficiency and in turn to osteoporosis ( loss of bone density). This is especially possible in individuals being treated with corticosteroid medications. Nutritional management for ulcerative colitis has two main goals:

1. To increase the intake of calories, proteins, as well as vitamins, minerals, and trace elements. 

2. Change the eating pattern, i.e. to consume smaller, more frequent meals. Last meal preferable should be at least three hours before bedtime 
Surgery 

The surgical treatment for ulcerative colitis is total colectomy, that is removal of the entire colon, regardless of whether all or only a portion of the colon is diseased. Colectomy cures the disease, sine the diseased organ is removed. However, this is used as a last resort as this surgery requires many other adjustments in life. Indications for colectomy are : 

1. Long-standing disease with recurrent flare-ups.
2. Presence of precancerous lesions in the colon
3. As an emergency surgery in complications such as perforation of the colon, severe bleeding, or toxic megacolon. 
4. Fulminant colitis, i.e. persistent severe diarrhoea and bleeding, accompanied by high fever. 

Long-term outlook

After the first attack, less than 10 per cent develop chronic, long-standing, persistent symptoms, while the rest go into complete remission and remain symptom-free. 

Introduction of Ulcerative Colitis
Causes and Types of Ulcerative Colitis
Symptoms of Ulcerative Colitis 
Diagnosis of Ulcerative Colitis
Treatment of Ulcerative Colitis