Ulcerative colitis is a type of inflammatory bowel disease (IBD). People with this condition develop sores in the innermost lining of their colon (large intestine) and rectum. Another type of IBD, Crohn’s disease, affects the entire digestive tract and all the layers of the bowel wall.

Ulcerative colitis symptoms include abdominal pain, stomach cramps, severe diarrhea with blood and mucus, rectal bleeding, rectal pain, problems with defecation such as urgent bowel movements, weight loss, fatigue, and fever. If left untreated, the disease can progress and lead to potentially life-threatening complications. There is no cure for ulcerative colitis, but medications and surgery can be used to treat ulcerative colitis.

Please continue reading to find out some of the best medications for treating ulcerative colitis.

What causes inflammatory bowel disease (IBD)?

Exactly what causes inflammatory bowel disease is not known. Stress and certain foods can make ulcerative colitis symptoms worse, but they do not cause the condition. One hypothesis is that ulcerative colitis occurs due to an immunological malfunction, where the immune system, in addition to fighting bacteria and viruses in the gastrointestinal tract, also attacks healthy cells. Genetics may play a role in the development of ulcerative colitis, and the condition may run in some families, but many people with ulcerative colitis do not have a family history.

Does ulcerative colitis increase the risk of colon cancer?

People with ulcerative colitis or Crohn’s disease are at an increased risk of colon cancer. Therefore, you will need to start getting screening colonoscopies 8 years after your ulcerative colitis diagnosis if the majority of your large intestine is involved or 15 years after your diagnosis if ongoing inflammation affects only the left side (sigmoid colon). Follow-up colonoscopies should be completed every 1 to 3 years, depending on the results of the previous colonoscopy and the risk factors.

How do doctors diagnose ulcerative colitis?

Doctors can diagnose ulcerative diagnosis with:

Blood tests to check for anemia from chronic intestinal bleeding.
Stool tests to check for certain proteins that indicate ulcerative colitis.
Endoscopic procedures (colonoscopy and flexible sigmoidoscopy) to look at the colon with a camera and obtain a tissue sample for examination in the laboratory.
Imaging studies (X-ray, CT scan, enterography) to rule out complications, see how much of the colon is affected by ulcerative colitis, and exclude the presence of inflammation in the small intestine.

How is ulcerative colitis treated?

Medicines and surgery are available to treat ulcerative colitis. The treatment options may differ based on the severity of the disease and how much of the large intestine is affected. The treatment plan for people with ulcerative colitis consists of managing symptoms with one or more of the following:

Anti-inflammatory medications

These medications reduce intestinal inflammation and provide relief from UC symptoms. They are usually the first line of treatment to decrease inflammation in people with mild to moderate ulcerative colitis.

5-aminosalicylates: These can be taken by mouth or used as a suppository or enema to manage mild pain and inflammation. Examples include mesalamine (Rowasa, Delzicol), sulfasalazine (Azulfidine), olsalazine (Dipentum), and balsalazide (Colazal).
Corticosteroids. They are used to treat moderate to severe ulcerative colitis that does not improve with other medications. They work by suppressing the immune system to alleviate the ongoing inflammation caused by the disease. However, steroid medicines are not for long-term use due to the risk of severe side effects. Examples include prednisone and budesonide.

Immunosuppressants

These medications suppress the immune system response and reduce inflammation. Your healthcare provider may give you one medication or a combination of immune system suppressors and biologic agents. Taking this type of ulcerative colitis medication requires close follow-up with your healthcare provider and regular blood tests to check for negative effects on the liver and pancreas. Azathioprine (Imuran, Azasan) and mercaptopurine (Purixan, Purinethol) are the most commonly used immunosuppressants.

Another immunosuppressant, cyclosporine (Neoral, Gengraf, Sandimmune), is typically reserved for severely active ulcerative colitis (flare-ups) that have not responded to other treatment options. It is used to treat severe symptoms but is not for long-term use due to the risk of serious side effects.

Biologic agents

These drugs target specific proteins of the immune system. They are used to treat severe ulcerative colitis that does not respond to other treatments and may be given to people with ulcerative colitis who cannot tolerate other medications. Examples include:

Tumor necrosis factor (TNF) inhibitors: These neutralize an immune system protein. They include adalimumab (Humira), infliximab (Remicade), and golimumab (Simponi).
Vedolizumab (Entyvio): Vedolizumab (Entyvio) is a biologic agent that prevents cells causing inflammation from reaching the site of inflammation in the colon.
Ustekinumab (Stelara): Ustekinumab (Stelara) is a biologic drug that blocks an inflammation-causing protein.
Janus kinase (JAK) inhibitors are the newer medications used to treat severe ulcerative colitis and other chronic inflammatory disorders. More details on JAK inhibitors are discussed below.

Other medications

Your healthcare provider may prescribe other drugs to manage ulcerative colitis symptoms:

Pain relievers: For example, acetaminophen (Tylenol). Do not take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), naproxen sodium (Aleve), or diclofenac sodium because they can worsen your ulcerative colitis symptoms. Talk to your doctor or pharmacist if you’re not sure which type of OTC pain reliever is safe to treat minor pain and aches.
Anti-diarrhea medications: For example, loperamide (Imodium A-D) to manage persistent diarrhea. Do not take over-the-counter anti-diarrheals without talking to your healthcare provider. These medications can increase the risk of serious complications such as toxic megacolon (enlarged colon).
Antispasmodics: For example, hyoscyamine and dicyclomine to ease cramps.
Oral iron supplements: To treat iron deficiency anemia from chronic intestinal bleeding. They are typically only used after you achieve clinical remission because they can worsen colitis.

Surgery for ulcerative colitis

Surgery for ulcerative colitis may involve proctocolectomy (removal of the entire colon and rectum). It is done with a procedure called a J-pouch or ileoanal anastomosis, where the surgeon creates an internal pouch at the end of your small intestine and connects it to your anus so that you can defecate normally and won’t need to wear a bag to collect stool. If a J-pouch is not possible, your surgeon may create an ileal stoma (permanent opening in the abdomen) through which stool collects in an attached bag.

What is the best option for medical treatment of ulcerative colitis?

The best option for medical treatment of ulcerative colitis is the ulcerative colitis medication that works for you and causes the least side effects.

As mentioned above, several medications are used to treat active disease in ulcerative colitis patients. The choice of medicine depends on the severity of your condition. Some medications are used to treat mild disease, while others are used to treat moderate to severe ulcerative colitis. If one medication does not work for you or causes intolerable side effects, your healthcare provider will try other treatments.

What is the most successful treatment for severe ulcerative colitis?

Medications are the first line of treatment for mild, moderate, and severe ulcerative colitis. Surgery is used as a last resort if medications cannot control UC symptoms and complications are causing permanent damage to the colon.

More studies are needed to confirm the safety and efficacy of complementary and alternative medicine therapies, such as Chinese herbal medicine, dietary supplements, probiotics, and acupuncture to treat ulcerative colitis or maintain remission. Always check with your healthcare professional before using a complementary medicine approach.

What is the new treatment for ulcerative colitis?

The new treatment for ulcerative colitis is a group of oral medications called small molecules. They include janus kinase (JAK) inhibitors such as tofacitinib (Xeljanz) and upadacitinib (Rinvoq) and sphingosine 1-phosphate receptor modulators such as ozanimod (Zeposia). These medications are prescribed when other therapies for ulcerative colitis do not work. Side effects include an increased risk of blood clots and shingles infection.

The FDA has issued a boxed warning about the increased risk of serious heart problems and cancer in people taking tofacitinib for ulcerative colitis. If you are on this medication, do not stop taking it before you talk to your doctor about other treatment options.

References:

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