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Ulcerative Colitis (cont.)

Ulcerative Colitis Medical Treatment

The patient's health care professional will consider the possible causes of colitis, and any complications that need urgent treatment. The treatment goal of active ulcerative colitis is to relieve the inflammation and replace nutritional losses and loss of fluid due to diarrhea. About 80% of people improve with this approach.

  • Drugs to control mild diarrhea, for example, diphenoxylate (Lofene, Lomotil), loperamide (Imodium, Kaopectate), codeine, and anticholinergics (Anaspaz, Cystospaz, Bentyl) may help to reduce the number of bowel movements and relieve the feeling of bowel urgency. However, you should avoid these drugs if you have severe diarrhea because of inflammatory bowel disease. They should not be used if a fever is present.
  • Cholestyramine (Questran), an agent that binds bile salts, helps to control diarrhea associated with Crohn's disease, particularly in people who have had a portion of their small intestine removed. Dicyclomine (Bentyl) may relieve intestinal spasms.
  • Severe attacks of inflammatory bowel disease require hospital admission and supportive care including bowel rest, IV fluids, and correction of any electrolyte imbalance.
  • The patient will likely be given a restricted diet.

Ulcerative Colitis Medications

Medications that are used in the treatment of ulcerative colitis may divided into two groups, anti-inflammatory and immune suppressive agents. The decision as to which medication regimen should be used will depend upon the severity of the ulcerative colitis. Physicians and patients need to discuss the benefits and risks of recommended treatments.

If the patient has mild or moderate colitis, the first line of treatment is the use of 5-ASA agents-a combination of two drugs sulfonamide (sulfapyridine) and salicylate that helps to control the inflammation. Sulfasalazine (Azulfidine) is the most commonly used of these drugs. Sulfasalazine can be used for as long as needed and can be given along with other drugs. If the patient does not do well on sulfasalazine, they may respond to the newer 5-ASA agents. The side effects of 5-ASA preparations include nausea, vomiting, heartburn, diarrhea, and headache.

Drug therapy for active inflammatory bowel disease includes the following:

  • Mesalamine-derivatives (Asacol, Pentasa): These are used for Crohn's colitis and ulcerative colitis.
  • Antibiotics: Clotrimazole (Lotrimin) and ciprofloxacin (Cipro, Ciloxan) are prescribed for Crohn's disease of the rectum and anus.
  • Predigested (elemental or polymeric) diet for small bowel Crohn's disease

If the patient has severe colitis or does not respond to mesalamine preparations, they may be treated with corticosteroids. Prednisone (Deltasone, Orasone, Prednicen-M, Liquid Prep), methylprednisolone (Medrol, Depo-Medrol), budesonide (Entocort EC) and golimumab (Simponi) are used to reduce inflammation. These drugs are taken during a flare-up, but are not used for maintenance when the ulcerative colitis is in remission. Corticosteroids can be taken by mouth, IV infusion, through an enema, or as a suppository, depending upon the location and severity of the inflammation.

Long term use of corticosteroids (may cause side effects including weight gain, acne, facial hair, high blood pressure, mood swings, and increased risk of infection.

A doctor will monitor the patient closely while taking these drugs. The idea is to take corticosteroids only for flare-ups for a short period of time. They do not stop the condition from coming back.

If the patient responds only partially to these treatments or have early relapse, the doctor may consider aggressive therapy. Aggressive therapy may include the following steps:

  • Hospital admission
  • IV steroids instead of oral steroids
  • Increasing the steroid dose
  • Use of antibiotics (imidazole or ciprofloxacin or both) for Crohn's disease of the rectum and anus

Suppressing the immune system may help to control the symptoms of ulcerative colitis in patients who have failed first line drug treatment or whose disease is advanced. Medications use for this purpose include:

These medications have significant side effects and need close monitoring. The decision to use them as part of the treatment regimen often requires long discussion between patient and doctor.

If these aggressive measures do not work, surgery may be an option to remove the colon.

Medically Reviewed by a Doctor on 4/7/2016
Medical Editor:

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Ulcerative colitis (UC)is an idiopathic chronicinflammatory disorder limited to the colon.

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