Choosing your ulcerative colitis (UC) treatment is a team effort among you, your doctor, and other health care professionals you may consult. Be sure to ask questions and share any concerns you have about treatment. You should also tell your doctor how your ulcerative colitis symptoms have changed your lifestyle, including any emotional effects of these changes. The goal of your treatment plan should be to reach remission and to stay there as long as possible.
Remission is the goal
Doctors now realize that controlling ulcerative colitis symptoms is not enough to induce UC remission. If inflammation is ongoing, symptoms may return. But when inflammation is reduced, you may see a reduction in symptoms.
To be considered in remission, you should have no ulcerative colitis symptoms—not just fewer or milder symptoms. In addition, your doctor should be able to see evidence of healing in the lining of your colon. Only then are you in remission.
The ulcerative colitis treatment pyramid
The right ulcerative colitis treatment for you depends on the severity of your disease, medication side effects, and personal preferences you may want to discuss with your doctor. He or she may use an established UC “treatment pyramid” to guide the choice of medicine.
At the base of the pyramid are effective treatments that are often used first because they are considered safe and effective for a wide range of people. Doctors start people who have mild symptoms lower in the pyramid. If the disease and symptoms worsen, doctors employ more aggressive therapies higher in the pyramid. Each person’s UC is different, so your treatment will be individualized for you. Be sure to ask your doctor where your treatment fits in the UC treatment pyramid.
The following medications help manage the symptoms of UC, according to the American College of Gastroenterology, and can be found at different levels of the treatment pyramid:
- Aminosalicylates: Drugs in this class, including mesalamine (the medication in Lialda®) and sulfasalazine, contain 5-aminosalicylic acid (5-ASA) to help control inflammation. Aminosalicylates are the treatment of choice for mild to moderate UC, and most patients are treated with a drug from this group first. See how Lialda is designed to work.
- Corticosteroids: Steroids suppress the inflammatory process in the colon. They may be used for people with moderate to severe UC who have not responded to 5-ASA treatment. Corticosteroids are not recommended for long-term use because of negative side effects such as weight gain, acne, facial hair, and mood swings.
- Immunomodulators: The medications in this class interrupt the immune system, which plays an important role in the inflammatory symptoms of UC. Immunomodulators are usually prescribed for patients who have not responded to 5-ASAs or steroids. These drugs are slow-acting. It can take up to 6 months for you to get their full benefit.
- Biologic therapies: Biologics interfere with the body's inflammatory response by targeting certain enzymes and proteins that are known to be abnormal in people with inflammatory bowel disease (IBD). The most common side effects of biologics may include respiratory infections (such as sinus infection and sore throat), headache, rash, coughing, and stomach pain. Some rare but serious side effects of these therapies have been reported, including tuberculosis, pneumonia, lymphoma, and heart failure.
When surgery may be appropriate
If drug therapy does not relieve symptoms, surgery to remove all or part of the colon may be considered. Factors such as your age and general health can help you and your doctors determine the appropriate surgical solution. The risks and consequences related to colon surgery make this a decision that should be considered carefully.
If you are faced with this decision, try to get as much information as possible. Talk to your doctors and to the nurses who work with colon surgery patients (called enterostomal therapists). It may also help to consult other people who’ve undergone colon surgery. See a listing of Web sites that can connect you with others in the UC community.
Natural treatments for ulcerative colitis
Nutritional supplements such as fish oil and probiotics (sometimes found in special brands of yogurt) have received attention lately.
However, they have not gone through careful and rigorous scientific testing with large groups of patients and should not be viewed as a substitute for the proven medication your doctor prescribes.
Be sure to check with your doctor before trying any supplements and other natural or over-the-counter treatments for ulcerative colitis symptoms.
