Treatment involves medical and surgical treatments, depending on the severity of the disease. Patients would also require lifestyle changes.
Medical treatment:
Most patients require a combination of more than one medication. Medical treatment typically involves medication to suppress and/or modulate the immune system. The medicines are mostly painkillers, antibiotics, antidiarrhea medication, and nutritional supplements.
- Anti-inflammatory drugs: Anti-inflammatory drugs, such as 5-aminosalicylates (Sulfasalazine, Balsalazides, etc.) and corticosteroids (Prednisolone, Budesonide, etc.), suppress the cells causing inflammation. These drugs are usually the first step in the treatment of ulcerative colitis (UC) and are well tolerated by most patients.
- Immune system suppressors: These medications reduce inflammation by suppressing the immune system response that stimulates the process of inflammation. Immunosuppressant drugs include Azasan and Imuran (azathioprine); Purinethol and Purixan (mercaptopurine); Gengraf, Neoral, and Sandimmune (cyclosporine); and Xeljanz (tofacitinib).
- Biologics (monoclonal antibodies): These drugs target the proteins produced by the immune system, neutralizing the proteins. The types of biologics used to treat UC include Remicade (infliximab), Humira (adalimumab), and Simponi (golimumab). Entyvio (vedolizumab) is also a type of biologics, which works by blocking the inflammatory cells from reaching the site of inflammation and is used in patients who are unable to tolerate other biologics.
- Antidiarrheal medications: The doctor may advise medication, such as Imodium A-D (loperamide), for severe diarrhea. Patients should avoid taking over-the-counter (OTC) antidiarrhea medications without consulting with the doctor because they can increase the risk of toxic megacolon (an enlarged colon).
- Painkillers: The doctor may advise Tylenol (acetaminophen), which is safe to be used in UC. Patients should avoid taking other OTC painkillers without consulting with the doctor.
- Antispasmodics: The doctor may prescribe antispasmodic medication to reduce cramps.
- Nutritional supplements: Iron supplements may be advised for iron deficiency anemia because of chronic intestinal bleeding.
Surgery:
Surgery can eliminate UC and involves removing the entire colon and rectum (proctocolectomy) followed by reconstruction.
Lifestyle and dietary modification:
Management of psychological stress and emotional support is important to prevent and reduce flare-ups. Regular exercises and a healthy diet are important as well. A low-fat diet with vitamin B6, sulfur, and milk is advised.
What causes ulcerative colitis?
The exact cause of ulcerative colitis (UC) is unknown; the possible causes are as follows:
- Genetics: This may play a role in the development of this condition.
- Immune reactions: The body’s own antibodies attack the inner lining of the large intestine (an autoimmune disorder).
- Environmental factors:
- A diet that contains high fat, vitamin B6, sulfur, and a high quantity of meat
- Certain medication
- Alcohol and substance abuse
- Psychological stress
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of UC.
- Milk: Its consumption may exacerbate the disease.
What are the signs and symptoms of ulcerative colitis?
Patients may present with the following symptoms:
- Rectal bleeding
- Frequent stools
- Mucous discharge from the rectum
- Tenesmus (constant feeling of the evacuation of the bowels)
- Lower abdominal pain and cramps
- Dehydration
- Severe diarrhea and cramps
- Fever
- Abdominal distention/bloating
- Increased heart rate
- Severe abdominal pain
- Weight loss
- Pus discharge through the anus
Ulcerative colitis (UC) is associated with various extracolonic manifestations, such as inflammation of the eyes, joints, skin, and lungs.
Grading or Staging of UC: The severity of UC can be graded as follows:
- Mild: Bleeding per rectum and fewer than four bowel motions a day.
- Moderate: Bleeding per rectum with more than four bowel motions a day.
- Severe: Bleeding per rectum more than four bowel motions per day and a systemic illness with protein loss.
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References
Basson MD. Ulcerative Colitis Treatment & Management. Medscape. https://emedicine.medscape.com/article/183084-treatment#d8
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