Treatment for Ulcerative Colitis
The treatment for Ulcerative Colitis, as well as Crohn’s Disease and other IBD conditions, is multifaceted and includes the use of medication, alterations in diet and nutrition, and sometimes surgical procedures to repair or remove affected portions of the GI tract. Medication for Ulcerative Colitis can suppress the inflammation of the colon and allow for tissues to heal. Diarrhea, bleeding, and abdominal pain can be reduced and controlled with effective medication.
In addition to controlling and suppressing symptoms (inducing remission), medication can also be used to decrease the frequency of symptom flare-ups (maintaining remission). With proper treatment over time, periods of remission can be extended, and periods of symptom flare-up can be reduced.
There are five major classes of medication that are used today to treat Ulcerative Colitis:
- Aminosalicylates are given orally or rectally and act to decrease inflammation at the wall of the intestine.
- Corticosteroids affect the body’s ability to begin and maintain an inflammatory process. They are effective for short‐term control of flare-ups but are not recommended for long‐term or maintenance use because of their side effects.
- Immunomodulators are a class of medication that modifies the activity of the immune system so that it cannot cause ongoing inflammation.
- Antibiotics may be used for Ulcerative Colitis when it impacts the colon or the area around the anus.
- Biologic therapies are indicated for people with moderately to severely active disease who have not responded well to conventional therapy.
In some circumstances, a health care provider may recommend adding an additional therapy that will work in combination with the initial therapy to increase its effectiveness. For example, combination therapy could include the addition of a biologic to an immunomodulator. As with all therapy, there are risks and benefits of combination therapy. Combining therapies can increase the effectiveness of IBD treatment, but there may also be an increased risk of additional side effects and toxicity.
With Ulcerative Colitis, one-quarter to one-third of patients may not respond to medical therapy or they may experience complications. Under these circumstances, surgery may be considered. Surgery involves the removal of part of or the entire colon (colectomy).
Depending on a number of factors, including the extent of the disease and the patient's age and overall health, one of two surgical approaches may be recommended. The first involves the removal of the entire colon and rectum, with the creation of an ileostomy or external stoma (an opening on the abdomen through which wastes are emptied into a pouch, which is attached to the skin with adhesive).
Another option also calls for removal of the colon, but it avoids an ileostomy. By creating an internal pouch from the small bowel and attaching it to the anal sphincter muscle, the surgeon can preserve bowel integrity and eliminate the need for the patient to wear an external ostomy appliance.
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