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Ulcerative Colitis (cont.)

Medical Author:
Adam Schoenfeld, MD
Medical Author:
George Y. Wu, MD, PhD
Medical Editor:
Jay W. Marks, MD
Jay W. Marks, MD
Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Summary of Medication Treatment

  • Azulfidine, Asacol, Pentasa, Dipentum, Colazal, and Rowasa all contain 5-ASA compounds which are topical anti-inflammatory ingredients. These medications are effective in inducing remission among patients with mild to moderate ulcerative colitis. They also are safe and effective in maintaining remission.
  • Pentasa is more commonly used in treating Crohn's ileitis because the Pentasa capsules release more 5-ASA compounds into the small intestine than the Asacol tablets. Pentasa also can be used for treating mild to moderate ulcerative colitis.
  • Rowasa enemas are safe and effective in treating ulcerative proctitis and proctosigmoiditis.
  • The sulfa-free 5-ASA compounds (Asacol, Pentasa, Dipentum, Colazal, Rowasa) have fewer side effects than Azulfidine, which contains sulfa.
  • Newer formulations of 5-ASA products (Lialda, Apriso) allow for higher doses to be taken less frequently throughout the day.
  • In ulcerative colitis patients with moderate to severe disease and in patients who fail to respond to 5-ASA compounds, systemic (oral) corticosteroids can be used. Systemic corticosteroids (prednisone, prednisolone, cortisone, etc.) are potent and fast-acting anti-inflammatory agents for treating Crohn's ileitis, ileocolitis, and ulcerative colitis.
  • Systemic corticosteroids are not effective in maintaining remission in patients with ulcerative colitis. Serious side effects can result from prolonged corticosteroid treatment.
  • To minimize side effects, corticosteroids should be gradually reduced as soon as disease remission is achieved. In patients who become corticosteroid dependent or are unresponsive to corticosteroid treatment, surgery or immunomodulator treatments are considered.
  • Immunomodulators used for treating severe ulcerative colitis include azathioprine/6-MP, methotrexate, and cyclosporine.
  • Infliximab (Remicade) may be beneficial in controlling moderate to severe ulcerative colitis and in decreasing the need for urgent removal of the colon.
  • Other biological agents are currently being studied, and with more research, might be approved for use in the future.

Reviewed by Jay W. Marks, MD on 5/16/2013

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