While there is no cure for ulcerative colitis, several treatments can help to reduce symptoms and increase the possibility of long-term remission.
Treatments for ulcerative colitis may include medications, such as anti-inflammatory agents (5-aminosalicylic acid and corticosteroids), immunosuppressive (immunomodulator) drugs, biologics (anti-TNF therapies), anti-diarrheal drugs, diet and nutrition therapy, and surgery, such as ileal pouch anal anastomosis (use of small intestine to replace lower colon and rectum), ileal stoma (permanent opening in abdominal wall), and proctocolectomy (removal of entire colon and rectum).
Anti-inflammatory drugs – Anti-inflammatory drugs are often the first-line treatment for ulcerative colitis, can be administered by mouth, enema, or suppository, and include the medication, 5- aminosalicylic acid (5-ASA), which is also known under drug names such as sulfasalazine (Azulfidine), mesalamine (Asacol HD, Delizicol, and others), baldalazide (Colazol), and olsalazine (Dipentum).
Other anti-inflammatory drugs include corticosteroids, such as budesonide (Uceris) and prednisone, which are usually administered for moderate-to-severe ulcerative colitis.
Immunomodulator drugs – Like anti-inflammatory drugs, immunomodulators also reduce inflammation; however, this is accomplished through the suppression of the immune system response that causes the inflammation and includes the drugs, azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan), cyclosporine (Gengraf, Neoral, Sandimmune), and tofacitinib (Xeljanz).
Biologics (anti-TNF therapies) – Biologic agents target specific proteins in the immune system to stop them from causing inflammation and include infliximab (Remicade), adalimumab (Humira), golimumab (Simponi), and vedolizumab (Entyvio).
Anti-diarrhea drugs – Anti-diarrheal medications, such as loperamide (Imodium A-D) may be recommended to manage cases of severe diarrhea and should be used with caution under the care of a doctor.
Pain medication – Acetaminophen (Tylenol) may be recommended for mild-to-moderate pain associated with ulcerative colitis.
Antibiotics – Antibiotics may be prescribed for ulcerative colitis to treat bacterial infections of the digestive tract.
Diet and nutrition therapy – Changes in diet may be necessary to help reduce and manage the symptoms of ulcerative colitis, such as eating smaller meals more frequently, drinking more liquids, avoiding fizzy drinks, caffeinated beverages, alcohol, fried foods, high-fiber foods (popcorn, nuts, beans, and lentils), high-fat foods, artificial food additives, dyes, and sweeteners, and lactose. Vitamins and other supplements may also be prescribed to counteract nutritional deficiencies.
Surgery – For some patients with severe ulcerative colitis, surgery may be necessary in the case of life-threatening complications, such as bleeding, not improving with medications, severe side effects from medications, long-term dependency on steroids, or the development of precancerous (colon polyps) or cancer of the colon. Removal of the entire colon and rectum can effectively cure ulcerative colitis and involves the following surgical methods:
Ileal pouch anal anastomosis – In this surgery, a pouch is constructed from the small intestine and is used to replace the rectum, allowing for normal passage of waste as well as avoiding having a permanent stoma (opening into abdomen).
Ileal stoma – When an ileal pouch cannot be done, a stoma (permanent opening in abdomen) will be created along with the placement of a stool collection bag.
Proctocolectomy – A proctocolectomy involves the removal of the entire colon and rectum and includes the creation of a stoma (permanent opening in abdomen) along with the placement of a stool collection bag. A proctocolectomy can also be performed in tandem with an ileoanal reservoir, which connects a portion of small intestine (ileum) to the anus, creating an ileal pouch to replace the rectum.