Treatment of Ulcerative colitis

Management of ulcerative colitis depends on the extent of the large intestine affected and the severity of the inflammation. Unfortunately, there is no known cure for ulcerative colitis other than surgical removal of the colon, though surgery is only indicated when medication can no longer control the symptoms that prevent a person from leading a fulfilling life. However, treatments do exist that can relieve symptoms, reduce inflammation, heal the intestinal lining (mucosal healing) and thus reduce the need for hospitalisation and surgery. Your doctor will work with you to decide which treatments are most suitable for you.

For people with ulcerative colitis, the goal of medication is to induce and maintain remission and to improve quality of life. Several drug types, such as anti-inflammatory drugs, corticosteroids, immunosuppressants, antibiotics or biologics, for single or combination therapy are available for the treatment of ulcerative colitis. Other drug classes may also be given to help you relax or to relieve pain, diarrhoea or infection.

When treating mild to moderate inflammation, doctors often prescribe anti-inflammatory drugs known as aminosalicylates, which contain 5-aminosalicyclic acid (5-ASA). Corticosteroids, also known as steroids, may be used to treat moderate to severe ulcerative colitis or to treat patients who do not respond to 5-ASA drugs.

For patients with extensive disease who are in disease remission or who suffer from more than one relapse per year, lifelong therapy is recommended to reduce the chance of relapse (a return of the disease symptoms). Immunosuppressants (or immunomodulators) are generally prescribed when 5-ASAs or corticosteroids have failed and for patients with more moderate to severe disease. Another treatment option is biologics, which work by targeting specific biological proteins involved in chronic inflammation. In ulcerative colitis, biologics such as the antibodies against tumour necrosis factor (TNF-α) work by blocking the immune system’s production of TNF-α, a cytokine, which intensifies inflammation. They can only be prescribed by a gastroenterologist, are administered intravenously or subcutaneously and are generally only offered once a patient has failed to improve on standard therapy.

Occasionally, symptoms may be severe enough that a person requires hospitalisation. In people with severe ulcerative colitis that is not responding adequately to medication or in those who are at higher risk of colorectal cancer (disease duration of more than 10 years), surgical removal of the large intestine and rectum, known as proctocolectomy, may be the most appropriate long-term solution.

If you have any further questions about your treatment options, please contact your doctor.