For UC treatments, you’ve got options.
Though there may not be a cure for moderate to severe ulcerative colitis (UC), there are several types of prescription treatment options available to help treat it. Finding the right treatment option can take time, but setting treatment goals can help you stay on track. Understanding the severity of your ulcerative colitis and the treatment options available can help you and your gastroenterologist work toward your treatment goals.
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A good prescription for success: Setting goals.
Before you and your gastroenterologist discuss treatment plans, it’s important to discuss treatment goals. And there’s a valid reason why: there’s more to a treatment plan than managing symptoms.
Treat UC symptoms at the source
You might remember that ulcerative colitis symptoms are linked to excess inflammation that causes damage to the colon lining. Controlling inflammation can help reduce ulcerative colitis symptoms and allow the colon lining to heal over time.
So, with controlling inflammation in mind, what goals should you and your doctor try to achieve with a treatment? Consider the following:
GET SYMPTOM RELIEF
Controlling inflammation can help you achieve clinical remission. This means you are experiencing little to no UC symptoms such as urgent bowel movements, bloody stools, and abdominal pain.
VISIBLY IMPROVE YOUR COLON LINING
When inflammation is reduced in the colon lining, your tissue will show it during a colonoscopy. You’ll have achieved endoscopic remission when there’s little to no damage, or you have mild or inactive disease that’s visible in your colon.
ACHIEVE LONG-TERM REMISSION
Research suggests that there is a link between seeing improvement in inflammation and maintaining clinical remission —meaning you have achieved longer-term symptom relief.
Let’s dive into treatment options
These are some of the most commonly used prescription treatment options for UC.
Aminosalicylates (5-ASAs)
Taken either orally or rectally, these drugs work to decrease inflammation in the lining of the intestines and are usually used to treat mild to moderate ulcerative colitis. Sulfasalazine and mesalamine are examples of 5-ASAs.
Biologics
Biologics are designed to work on targeted parts of the immune system to reduce inflammation. Some biologics work by targeting specific proteins, called cytokines, which play a role in causing inflammation. Other biologics work by preventing certain white blood cells from getting into inflamed tissues. Biologics are usually used for people with moderate to severe ulcerative colitis.
Corticosteroids (steroids)
Prednisone, prednisolone, and budesonide are included in this type of medication. They affect the body’s ability to initiate and maintain an inflammatory process—keeping the immune system in check. While effective for short-term flare-ups, they’re not recommended for long-term use. Prolonged use of corticosteroids could lead to side effects such as osteoporosis, adrenal insufficiency, gastrointestinal issues, and more. It’s important to note that it is possible to relieve symptoms and achieve remission without the use of steroids.
Immune modifiers (immunomodulators)
These modify the body’s immune system activity to stop it from causing ongoing inflammation. These drugs (including azathioprine, 6-mercaptopurine, and methotrexate) are usually used to maintain remission or for people who have only responded to steroids.
Targeted oral small molecules
Targeted oral small molecules, usually pills or capsules, help reduce inflammation by targeting specific parts of the immune system. The different parts that these medications target in the body can play a role in reducing inflammation. They’re taken by mouth and are usually used for people with moderate to severe ulcerative colitis in whom certain treatments did not work well.
Aminosalicylates (5-ASAs)
Taken either orally or rectally, these drugs work to decrease inflammation in the lining of the intestines and are usually used to treat mild to moderate ulcerative colitis. Sulfasalazine and mesalamine are examples of 5-ASA medications.
Biologics
Biologics are designed to work on targeted parts of the immune system to reduce inflammation. Some biologics work by targeting specific proteins, called cytokines, which play a role in causing inflammation. Other biologics work by preventing certain white blood cells from getting into inflamed tissues. Biologics are usually used for people with moderate to severe ulcerative colitis.
Corticosteroids (steroids)
Prednisone, prednisolone, and budesonide are included in this type of medication. They affect the body’s ability to initiate and maintain an inflammatory process—keeping the immune system in check. While effective for short-term flare-ups, they’re not recommended for long-term use. Prolonged use of corticosteroids could lead to side effects such as osteoporosis, adrenal insufficiency, gastrointestinal issues, and more. It’s important to note that it is possible to relieve symptoms and achieve remission without the use of steroids.
Immune modifiers (immunomodulators)
These modify the body’s immune system activity to stop it from causing ongoing inflammation. These drugs (including azathioprine, 6-mercaptopurine, and methotrexate) are usually used to maintain remission or for people who have only responded to steroids.
Targeted oral small molecules
Targeted oral small molecules, usually pills or capsules, help reduce inflammation by targeting specific parts of the immune system. The different parts that these medications target in the body can play a role in reducing inflammation. They're taken by mouth and are usually used for people with moderate to severe ulcerative colitis in whom certain treatments did not work well.
Finding the right treatment plan for you
A treatment plan includes many things to help manage your disease—and can include medications, diet, and healthy lifestyle practices. Everyone’s experience with ulcerative colitis is different. Share your ulcerative colitis symptoms with your gastroenterologist. They can help determine if your treatment plan is meeting your goals.
Talk to your gastroenterologist about your ulcerative colitis symptoms to see what treatment options may be right for you.
What about surgery for UC?
Medication is often the first treatment option for ulcerative colitis, and surgery may be an option of last resort. Doctors generally try to avoid surgery, but it may be needed when there are complications from colon damage over time. Complications can include severe bleeding or rapid enlargement of the colon.
Surgery in ulcerative colitis usually involves removal of the colon and rectum. This is called a proctocolectomy and can take different forms.
Surgery may not be a cure-all for ulcerative colitis symptoms. Some people can still have symptoms that need to be well managed following surgery.
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