Ulcerative Colitis (cont.)
What are the Treatments for Ulcerative Colitis?
Both medications and surgery have been used to treat
ulcerative colitis. However, surgery is reserved for those with severe
inflammation and life-threatening complications. There is no medication that can
cure ulcerative colitis. Patients with ulcerative colitis will typically
experience periods of relapse (worsening of inflammation) followed by periods of
remission (resolution of inflammation) lasting months to years. During relapses,
symptoms of abdominal pain, diarrhea, and rectal bleeding worsen. During
remissions, these symptoms subside. Remissions usually occur because of
treatment with medications or surgery, but occasionally they occur
spontaneously, that is, without any treatment.
Medications
Since ulcerative colitis cannot be cured by medication, the goals of treatment with medication are to 1)
induce remissions, 2) maintain remissions, 3) minimize side effects of treatment,
and 4) improve the quality of life. Treatment of ulcerative
colitis with medications is similar, though not always identical, to treatment
of Crohn's disease.
Medications treating
ulcerative colitis include 1) anti-inflammatory agents such as 5-ASA compounds,
systemic corticosteroids, topical corticosteroids, and
2) immunomodulators.
Anti-inflammatory
medications that decrease intestinal inflammation are analogous to arthritis
medications that decrease joint inflammation (arthritis).
The anti-inflammatory medications that are used in the treatment of ulcerative
colitis are:
- Topical 5-ASA compounds such as sulfasalazine (Azulfidine), olsalazine
(Dipentum), and mesalamine (Pentasa, Asacol, Rowasa enema) that need direct
contact with the inflamed tissue in order to be effective.
- Systemic anti-inflammatory medications such as corticosteroids that
decrease inflammation throughout the body without direct contact with the
inflamed tissue. Systemic corticosteroids have predictable side effects with
long term use.
Immunomodulators are
medications that
suppress the body's immune system either by reducing the cells that are responsible for immunity, or by interfering with proteins that are important in promoting inflammation. Immunomodulators increasingly are becoming important treatments
for patients with severe ulcerative colitis who do not respond adequately to
anti-inflammatory agents. Examples of immunomodulators include 6-mercaptopurine (6-MP), azathioprine
(Imuran), methotrexate
(Rheumatrex, Trexall), cyclosporine
(Gengraf, Neoral).
It has long been observed that the risk of ulcerative colitis appears to be higher in nonsmokers and in ex-smokers. In certain circumstances, patients improve when treated with nicotine.
Next: 5-ASA compounds (Azulfidine, Asacol, Pentasa, Dipentum) »
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