Ulcerative colitis treatments: Medications and other options

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There is currently no cure for UC, but medications can help manage the condition. Current guidelines recommend long-term treatments that change the way that the immune system works.

There are several options, and each can reduce the risk of a flare-up and lessen the severity of symptoms. They include:

• TNF-α antagonists, such as infliximab (Remicade) or adalimumab (Humira)
• anti-integrin agents, such as vedolizumab (Entyvio)
• Janus kinase inhibitors, such as tofacitinib (Xeljanz)
• interleukin-12/23 antagonists, such as ustekinumab (Stelara)
• immunomodulators, such as thiopurines and methotrexate

It is important to note that these drugs can have adverse effects. Speaking with a healthcare professional about the benefits and risks can be a helpful step. They will take various factors into consideration, including other ongoing medications, and create a treatment plan based on your needs.

Other drug options

Aminosalicylates, such as 5-aminosalicylates (5-ASAs), can help reduce inflammation and may be useful in treating UC symptoms.

Examples include:

• balsalazide (Giazo)
• mesalamine (Azacol)
• olsalazine (Dipentum)
• sulfasalazine (Azulfidine)

If 5-ASAs do not work, a healthcare professional may prescribe corticosteroids to help reduce inflammation. However, long-term corticosteroid use can lead to severe adverse effects, and doctors try to avoid this whenever possible.

Experts currently recommend focusing on long-term treatment to reduce the need for steroids.

Some people with UC require surgery. This usually resolves the condition because surgical options involve removing the colon.

Surgery may be the best option if the person:

• has colon cancer
• has precancerous cells in their colon
• has serious UC complications
• finds that medication does not improve their symptoms

There are two types of UC surgical treatments.

Proctocolectomy with ileostomy

A proctocolectomy involves removing the entire colon, including the rectum.

Doctors sometimes refer to an ileostomy as a stoma. It involves repositioning the end of the small intestine through an opening in the outside of the person’s stomach, just above the waistline.

The surgeon then connects an ostomy pouch, or stoma bag, to the opening. The contents of the small intestine collect in the bag, which is removable, rather than passing out through the anus. This is a permanent procedure.

Proctocolectomy with ileoanal reservoir

This procedure also involves removing the colon and rectum. The surgeon then creates an ileoanal reservoir, which some call a J-pouch, at the end of the small intestine and connects it to the anus.

Waste then collects in the reservoir before passing through the anus. People who have this operation do not require a stoma.

Possible side effects of an ileoanal reservoir include:

• more frequent, watery stools
• fecal incontinence
• infertility in females

Some people who have undergone the procedure develop pouchitis, which involves an infection developing in the lining of the ileoanal reservoir that leads to irritation or inflammation. Doctors usually treat the infection with antibiotics.

Some people with UC find the following supplements and home care strategies effective.

Nutrition

While poor nutrition does not cause UC, it can affect symptoms.

Certain foods and drinks can also be triggers, meaning that they worsen UC symptoms. Triggers are different for everyone. Keeping a food diary can help a person identify theirs.

A doctor may recommend switching to a low fiber eating plan while symptoms flare up. Suitable foods may include:

• refined grains, such as white bread and cornflakes
• white rice or pasta
• cooked vegetables without the peels, seeds, or stalks
• lean meats and fish
• eggs

For someone with UC, soft, bland foods may be easier to eat than spicy foods. However, it is still important to aim for a varied diet that includes all food groups.

Probiotics

People commonly refer to probiotics as “friendly” or “good” bacteria. They boost the levels of beneficial gut bacteria. For example, a person may prefer probiotic supplements, yogurts, or drinks.

There is growing interest in using probiotics to treat or help ease UC symptoms. However, there are many types of probiotics, and it is still unclear regarding which are most likely to help and how effective these might be.

Nevertheless, probiotics are likely safe to take, although they may cause mild side effects, such as gas or bloating, in some people.

Vitamins

Some people with UC may benefit from taking certain vitamins and minerals. For example, typically, anyone who takes steroids for UC for long periods may develop poor bone health, which may make calcium a beneficial mineral supplement.

People with UC may also be at risk of developing anemia, so doctors may recommend iron supplements.

If a person is considering adding vitamin or mineral supplements to their treatment plan, it is important that they talk with a healthcare professional first.

Aloe vera

Typically, people use aloe vera to help wounds heal and relieve pain, but some people also believe that it can reduce inflammation internally.

For example, some people with mild to moderate UC report that drinking aloe vera juice helps their symptoms. However, there is no scientific evidence for this.

It is also worth noting that aloe vera can have a laxative effect when consumed.

UC is a long-term condition that affects the colon. It causes inflammation and ulcers, leading to symptoms such as diarrhea, abdominal pain, and fatigue.

Various medications and self-care strategies can help manage the condition, as can surgery. The best approach will depend on the severity of the condition.

It is recommended that individuals discuss their circumstances and symptoms with a healthcare professional before making changes to their UC treatment plan.

Read the article in Spanish.