Treatment Options for Ulcerative Colitis

What Are the Goals of Ulcerative Colitis Treatment?

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that causes inflammation and sores, or ulcers, in the inner lining of the large intestine. The goals of treatment are to reduce inflammation, relieve symptoms, achieve remission, and help keep remission over time. Treatment also aims to improve quality of life and lower the risk of complications. Although medicines do not cure UC, they can help control inflammation and reduce flares. Surgery to remove the colon and rectum may be recommended in some cases, such as when medicines do not work well or serious complications occur.

Key treatment goals for ulcerative colitis may include:

Inducing remission, which means getting symptoms under control and reducing active inflammation.
Maintaining remission, which means helping prevent flare-ups and limiting the need for corticosteroids.
Monitoring disease activity using symptoms, physical exams, blood or stool tests, and sometimes endoscopy.
Healing the intestinal lining, sometimes called endoscopic healing or mucosal healing, when this is an appropriate treatment target.
Reducing the chance of complications, such as severe bleeding, hospitalization, surgery, or an increased risk of colorectal cancer in people with long-standing disease.

The right treatment goals and monitoring plan can vary based on the severity and extent of UC, previous treatments, other health conditions, and personal preferences. A healthcare professional can help choose a treatment plan and adjust it over time if symptoms or test results show that inflammation is not well controlled.

What Medicines Are Used for Ulcerative Colitis?

Medicines are a key part of treating ulcerative colitis (UC). They are used to reduce inflammation in the colon, help relieve symptoms, bring on remission, and help maintain remission over time. The medicine a healthcare professional recommends depends on factors such as disease severity, how much of the colon is affected, previous treatment response, other health conditions, and medication safety considerations.

Types of Medicine for Ulcerative Colitis:

Aminosalicylates, also called 5-ASA medicines: These medicines, such as mesalamine, help reduce inflammation in the lining of the colon. They may be taken by mouth or given rectally as an enema or suppository. They are often used for mild to moderate UC and may also help maintain remission.
Corticosteroids: Steroids can reduce inflammation quickly and may be used for short-term treatment of moderate to severe flares or for symptoms that do not respond to 5-ASA medicines. They are not usually used for long-term maintenance because long-term use can cause serious side effects.
Immunomodulators: Medicines such as azathioprine or mercaptopurine may be used in some people to help maintain remission or reduce the need for steroids. Methotrexate is not generally used as a main treatment for UC maintenance. These medicines can take weeks to months to work and require monitoring.
Biologic medicines: Biologics target specific parts of the immune system involved in inflammation. They may be recommended for moderate to severe UC or for UC that has not responded well to other medicines. Examples include anti-TNF medicines, anti-integrin medicines, and medicines that target interleukins.
Targeted small-molecule medicines: These are oral medicines that affect specific inflammation pathways. Examples include JAK inhibitors and S1P receptor modulators. They may be options for some adults with moderate to severe UC, depending on individual risks and prior treatments.

Lifestyle and Supportive Measures:

Lifestyle steps do not replace UC medicines, but they may support overall health and symptom management. A healthcare professional may recommend nutrition guidance, identifying foods that seem to worsen symptoms, staying physically active as tolerated, and avoiding smoking. Alcohol can worsen symptoms for some people, so people with UC may be advised to discuss alcohol use with their healthcare professional.

Smoking cessation: If you smoke, talk with a healthcare professional before making changes. Smoking has complex effects in UC, but smoking is harmful to overall health and is not recommended as a UC treatment.
Alcohol moderation: Alcohol does not cause UC, but it may worsen diarrhea, dehydration, or other symptoms in some people.

Surgery:

Surgery is not a medicine, but it may be considered when UC does not improve with medicines, when long-term steroid use is needed to control symptoms, or when serious complications occur. Surgery for UC typically removes the colon and rectum.

Treatment decisions should be made with a healthcare professional. Do not stop, start, or change UC medicines without medical guidance. Medication dosing, monitoring, and side effects vary by medicine and by each person’s health situation. A healthcare professional or pharmacist can provide medication-specific safety information.