Ulcerative Colitis Treatment & Surgery
What is ulcerative colitis?
Ulcerative colitis treatment overview
Drug therapy for ulcerative colitis
Hospitalization for ulcerative colitis
Surgery for ulcerative colitis
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Ulcerative colitis treatment overview
Treatment for ulcerative colitis is determined by the severity of the disease. Since each individual experiences ulcerative colitis differently, treatment is customized on a case-by-case basis
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Drug therapy for ulcerative colitis
The goal of drug therapy is to induce and maintain remission, and to enhance the quality of life for individuals with ulcerative colitis. A number of different types of drugs are available:
- Aminosalicylates, drugs that contain 5-aminosalicyclic acid (5-ASA), help control inflammation. Sulfasalazine is composed of a combination of sulfapyridine and 5-ASA. The sulfapyridine component in sulfasalazine carries the anti-inflammatory 5-ASA to the intestine. However, sulfapyridine may cause side effects including heartburn, nausea, headache, vomiting, and diarrhea. Other 5-ASA agents, such as olsalazine, balsalazide, and mesalamine, have a different carrier, fewer side effects, and may be used by individuals who are unable to take sulfasalazine. Depending on the location of the inflammation in the colon, 5-ASAs are given orally, through an enema, or in a suppository. Most individuals with mild or moderate ulcerative colitis are treated with this group of drugs first. This class of drugs is also used in cases of relapse.
- Corticosteroids such as hydrocortisone, prednisone, and methylprednisone also reduce inflammation. They may be prescribed for patients who have moderate to severe ulcerative colitis or who do not respond to 5-ASA drugs. Corticosteroids, also known as steroids, can be given orally, intravenously, through an enema, or in a suppository, depending on where the inflammation is located. Side effects caused by these drugs can include mood swings, weight gain, hypertension, acne, facial hair, diabetes, bone mass loss, and an increased risk of infection. For this reason, corticosteroids are not recommended for long-term use; however, they are considered very effective when prescribed for short-term use.
- Immunomodulators such as 6-mercapto-purine (6-MP) and azathioprine are designed to reduce inflammation by affecting the body's immune system. These drugs are prescribed for patients who have not responded to 5-ASAs or corticosteroids or who are dependent on corticosteroids. Immunomodulators are administered orally; however, they are slow-acting and can take up to six months before the full benefit is achieved. Patients taking immunomodulators are monitored for complications including a reduced white blood cell count, hepatitis, an increased risk of infection, and pancreatitis. Cyclosporine A may be used with 6-MP or azathioprine to treat active, severe ulcerative colitis in patients who do not respond to intravenous corticosteroids.
Additional drugs may be administered to relax the patient or to relieve infection, pain, or diarrhea.
Some patients have remissions – periods with alleviated symptoms – that last for months or even years. However, for most patients with ulcerative colitis, the symptoms will return eventually.
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Hospitalization for ulcerative colitis
Occasionally, ulcerative colitis symptoms are severe enough that an individual must be hospitalized. For example, the individual may experience severe bleeding or severe diarrhea that results in dehydration. In these cases, the doctor attempts to stop the diarrhea and loss of blood, fluids, and mineral salts. The patient may require a special diet, feeding through a vein, medications, or occasionally surgery.
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Surgery for ulcerative colitis
About 25 to 40 percent of ulcerative colitis patients must eventually have their colons removed due to severe illness, massive bleeding, risk of cancer, or rupture of the colon. The doctor will sometimes recommend removing the colon if medical treatment fails or if the side effects of corticosteroids or other drugs threaten the patient’s health.
Surgery to remove the colon and rectum is known as proctocolectomy, and is followed by one of the two procedures listed below:
- Ileostomy is a procedure in which the surgeon creates a small opening in the abdomen (called a stoma) and then attaches the end of the small intestine (called the ileum) to it. Waste travels through the small intestine and exits the body through the stoma. The stoma is approximately the size of a quarter and is typically located in the lower right part of the abdomen near the beltline. The patient wears a pouch over the opening to collect waste, and he or she empties the pouch as needed.
- Ileoanal anastomosis, or pull-through operation, allows the patient to have normal bowel movements because the procedure preserves part of the anus. In this operation, the surgeon removes the colon and the inside of the rectum, and leaves the outer muscles of the rectum. The surgeon then attaches the ileum to the inside of the rectum and the anus, forming a pouch. Waste is stored in the pouch and passes through the anus in the typical manner. The patient's bowel movements may be more frequent and watery than before the procedure. Inflammation of the pouch (pouchitis) is a possible complication of the procedure.
All operations are not appropriate for all individuals. The specific type of ulcerative colitis surgery that a patient undergoes depends on the severity of the disease as well as on the patient's needs, expectations, and lifestyle. Individuals faced with this decision are encouraged to gather as much information as possible by talking to their doctors, to nurses who work with colon surgery patients (enterostomal therapists), and to other colon surgery patients. Patient advocacy organizations are available to direct individuals to support groups and other information resources.
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Schedule an appointment
To schedule an appointment with a Temple Digestive Disease Center Physician, click here or call 1-800-TEMPLE-MED [1-800-836-7536].
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Sources:
National Digestive Diseases Information Clearinghouse (NDDIC), National Institutes of Health (NIH) - NIH Publication No. 06–1597, February 2006
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