By Dr Ananya Mandal, MD
After diagnosis ulcerative colitis is treatment is undertaken by a gastroenterologist or a physician who deals with diseases of the gastrointestinal tract.
The severity of the condition determines the plan of treatment. Severe conditions are characterized by increased number of stools, bloody stools, wide ranging symptoms indicating malnutrition and complications of ulcerative colitis and lack of general wellbeing.
Treatment for mild symptoms
Those with mild symptoms may not require specific treatment as the symptoms may go away without treatment in a few days
Treatment for moderately severe ulcerative colitis
Those with moderately severe ulcerative colitis are often treated with a medication called aminosalicylates. Aminosalicylates need to be controlled even after the symptoms are under control. This is known as maintenance therapy.
There are alternatives including corticosteroids that belong to the class of immunosuppressants. Immunosuppressants suppress the overwhelming immune reactions caused by the inflammatory condition.
Aminosalicylates are used both in mild and moderate ulcerative colitis. These can help in reduction of inflammation. They are administered as pills or as a suppository (that is like a capsule that may be inserted into the rectum via the anus) or in form of enema. (Enema involves pumping in the medicated fluid into the rectum via the anus. Common side effects with the use of this agent include diarrhea, nausea, skin rashes and headaches.
Corticosteroids reduce inflammation and are stronger agents than aminosalicylates. These can be given as pills or as suppositories or enemas. Long-term use of steroids has the potential to cause severe side effects including sleep and mood disturbances, osteoporosis, diabetes, cataracts, weight gain etc.
Other immunosuppressants include Azathioprine and 6-mercapto-purine (6-MP) that may be used in ulcerative colitis. Azathioprine is given as an alternative to steroids. These may typically take two to three months to be effective. Azathioprine is not normally recommended for pregnant women.
Treatment for severe flare ups
Those with severe flare ups of the condition need to be admitted to hospital. These patients are administered corticosteroids as injections. These agents help to suppress the immune overreaction to reduce the effects of the flare ups and relieve the symptoms. There may be severe complications like rupture or obstruction of the intestines with life threatening results.
Some patients may also benefit from infliximab. This is a biological agent that acts on the pathology of the disease rather than on the symptoms alone. It works by targeting a protein called TNF-alpha or Tumor necrosis Factor alpha.
Infliximab is given as infusions over two hours. The second dose is given after two weeks and the third after six weeks. Infusions are then given every eight weeks, if treatment is still required. Inflixamab use is associated with side effects like joint pain, itchy skin, rash, swelling of hands and face (Angioedema), difficulty in swallowing etc.
In severe cases with complications within the gut, surgery is recommended. Surgery involves removal of the inflamed section of the digestive system and reattachment of the remaining part. This is called a colectomy.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)