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What Are the Different Types of Ulcerative Colitis Treatments?

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If you’re confused about all the treatments available to manage ulcerative colitis (UC), you are not alone. Whether you have just received a diagnosis or are looking to switch treatment plans, we’re here to help you understand the options currently available to treat UC. 

Ulcerative colitis is a relapsing and remitting condition, which means that there may be periods of time when your symptoms are worse and others when your symptoms seem to disappear. It’s important to manage UC not only when you are experiencing symptoms, but to continue managing the condition when you’re feeling better to prevent a relapse. 

While it’s important to discuss your individual treatment goals with your health care team, the primary goals of treatment are to control ulcerative colitis symptoms and decrease the frequency of symptom flare ups. Here are some treatment options that may be included in an ulcerative colitis treatment plan. 

Medication for UC

Medications used for ulcerative colitis fall into several categories, sometimes called drug classes. While several types of medication are being used to treat UC today, your health care provider may recommend a specific type based upon the severity of your symptoms. Here are some medications types that could help someone with UC: 

  • Aminosalicylates (5-ASAs): Aminosalicylates are a class of drug that contain 5-aminosalicylic acid (5-ASA) which reduces inflammation in the lining of the intestine. Aminosalicylates come in a variety of forms (such as oral pills, liquid or foam enemas, or suppositories) and the type you are prescribed usually depends on the location of inflammation within your intestine.
  • Antibiotics: Unlike other medications used to treat ulcerative colitis, antibiotics do not counteract inflammation directly, but decrease and prevent infections that are caused by severe inflammation. Antibiotics can sometimes be used to induce remission in active UC. 
  • Biologics: Biologics are a newer class of drugs used to treat UC. Biologics target specific immune proteins within the immune system that contribute to inflammation. Biologics are most commonly used to treat moderate to severe UC. 
  • Corticosteroids (steroids): Corticosteroids are sometimes referred to as anti-inflammatories and are frequently prescribed to treat symptom flare ups. Because corticosteroids can have serious side effects, your health care provider may only recommend them for short term usage. 
  • JAK inhibitors: Sometimes grouped with another drug class called target synthetic small molecules, JAK inhibitors are small molecule compounds that are broken down by the body and absorbed into the bloodstream through the intestines after ingestion. Once absorbed, they can block the enzymes in the body that trigger inflammation.
  • Immunomodulators: Immunomodulators, also called immunosuppressants, slow or suppress the immune system to reduce inflammation of the colon and rectum caused by UC. Certain immunomodulators have been shown to induce remission in active ulcerative colitis, while others may prevent relapse in inactive UC.
  • Targeted Synthetic Small Molecules: Targeted synthetic small molecules target specific parts of the immune system to reduce inflammation in the intestine. Targeted synthetic small molecules are often prescribed to treat adults with moderate to severe ulcerative colitis. 

In some instances, your health care provider may recommend adding another medication to your treatment plan to increase the effectiveness of your initial medication. This is commonly referred to as combination therapy. Combining medications can increase their effectiveness, but there may also be an increased risk of additional side effects so it’s important to discuss your treatment plan with your health care provider before starting a new medication.

Surgery for UC

Research shows that approximately 20 to 30 percent of people living with ulcerative colitis will require surgery at some point during their lives. Although medication is often the first treatment option for ulcerative colitis, surgery should not be regarded as a last resort, but as just another treatment option available to you. There are two common surgical procedures available to those diagnosed with UC. These include: 

  • Proctocolectomy with ileostomy: In this procedure, the colon and rectum, collectively referred to as the large intestine, are removed and the small intestine is diverted through a hole made in the stomach. An ostomy bag is placed over the opening and attached to the skin with adhesive. Waste is collected in the ostomy bag and should be emptied several times a day. 
  • Proctocolectomy with ileal pouch anal anastomosis (IPAA): In this procedure, the colon and rectum are removed and the end of the small intestine is used to form an internal pouch, often shaped like the letter J, which is attached to the anus. The internal pouch collects waste and allows stool to pass through your anus in a bowel movement.

To learn more about the differences between these two surgical approaches, check out this article.

Diet and Nutrition for UC

While ulcerative colitis is not caused by the foods you eat, you may find that particular foods can trigger your symptoms. As a result, diet and nutrition can be an important part of managing your symptoms. There is no single diet that works best for everyone so you should work with your health care provider or dietitian to develop a personalized meal plan. 

A note from The Mighty: No matter which treatment options you and your health care provider decide to try, it’s important to discuss the risks and benefits of different options with your health care team. You know yourself best so remember to share what is most important to you, including your specific treatment goals, with your doctor!

Originally published: February 13, 2023
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