Ulcerative Colitis

Ulcerative Colitis Treatment & Surgery

Ulcerative Colitis: Treatment Overview
Diet and Nutrition for Ulcerative Colitis
Medications for Ulcerative Colitis
Surgery for Ulcerative Colitis
Ongoing Monitoring and Prevention
New Therapies in Development for Ulcerative Colitis

Ulcerative Colitis: Treatment Overview

Today’s available medical, nutritional, and surgical treatments can help patients to:

  • Relieve symptoms
  • Make recurrences or flare-ups less frequent
  • Prevent or treat serious complications
  • Correct nutritional deficiencies
  • Feel better overall and get more control over their disease

No one treatment, or combination of treatments, works for all patients. Your therapy will depend on the exact location and severity of your GI inflammation, how often you have flare-ups, and whether or not you are at risk for complications (like anemia, perforations, bowel obstruction or arthritis).

Your specialist will perform a variety of tests to create a unique profile your disease and find the safest and most effective therapy for you. Some very ill or high-risk patients will require powerful or aggressive therapies. Many others may need only mild anti-inflammatory agents to manage their disease.

Your treatment also depends very much on your choices—such as how badly you want to be rid of symptoms, how you feel about needles versus pills, or how much you worry about possible side effects of drugs or surgery. Your doctor will help you weigh all the risks and benefits. In fact, establishing a trusting long-term relationship with an experienced IBD specialist who knows your medical condition and personal history in detail is the best way to keep control over your disease. Chances are, your treatment needs will change over the years. A physician who knows you well can help you adjust therapy and stay ahead of your disease.

No medical cure yet exists for ulcerative colitis. However, today’s newest biological therapies have helped many patients get rid inflammation and slow progression of the disease. This absence of inflammation and symptoms is called “remission.” That is the goal—to induce a remission and maintain it for years. Today, more and more patients are achieving this goal!

Looking ahead, research on new treatments holds the promise of even better long-term results. For young patients struggling with ulcerative colitis, the future is bright.

In this Treatment section, we explain why Temple is a top choice for any patient or family facing IBD and we describe the main medical, nutritional and surgical options available to patients with ulcerative colitis.

Diet and Nutrition for Ulcerative Colitis

Diet is not a direct cause of ulcerative colitis but what you eat can definitely affect how you feel and how healthy you stay. Poor nutrition can have many causes: the GI symptoms of colitis can cause a loss of appetite; the GI inflammation can reduce uptake of nutrients; and the GI bleeding or diarrhea can cause a loss of nutrients and water.

To prevent nutritional problems, all patients with ulcerative colitis should eat a nutritious diet and avoid foods that worsen their symptoms. For example, some patients find that specific foods—like mild products, bulky grains or alcohol—can cause a flare-up. Any IBD treatment program should include education and clear instructions on good food choices, proper nutrition and stress reduction.

To prevent serious problems (like growth delay in children or lack of energy or infections in adults), some patients will require nutritional supplementation with high-calorie or vitamin-fortified liquids. Those who are extremely ill may need to be fed intravenously (through a tube in the arm) for a brief period. This IV feeding, sometimes called total parenteral nutrition (TPN), bypasses normal eating and digestion but allows proper nutrition.

Patients coming to the Temple Inflammatory Bowel Disease Program have access to a full team of nutrition specialists, psychiatrists, counselors, nurse educators and support groups. We are prepared to help patients control their disease with better diet, exercise and relaxation methods. In some cases, special supplements are recommended. Those having a severe bout of disease activity are assisted with temporary intravenous nutrition.

Medications for Ulcerative Colitis

Most medications for ulcerative colitis suppress inflammation. This is the key to reducing symptoms like pain and diarrhea. Reducing inflammation also allows the lining of the large bowel to heal, which can decrease the frequency of flare-ups. The main types of anti-inflammatories are described next, along with a few other medications for specific symptoms or complications.

Some of these medications are pills and others are injections. Some are given only during flare-ups while others are “maintenance” therapies that you take even when you are feeling well to prevent a relapse. Your doctor will explain the full risks and benefits of your recommended medications.

Anti-inflammatory Drugs: Several drugs that contain 5-aminosalicylate acid (5-ASA) are commonly given to treat mild-to-moderate episodes of ulcerative colitis or to prevent a relapse (“maintenance therapy”). Chemical names of these anti-inflammatory agents include: sulfasalazine, mesalamine, olsalazine, and balsalazide. Side effects of these 5-ASA agents may include nausea, vomiting, diarrhea, headache, and heartburn.

Corticosteroids: These medications (sometimes just called cortisone or steroids) can powerfully reduce inflammation. But they have widespread actions that can also cause serious side effects. That’s why they are given only for a short period to treat more severe episodes of ulcerative colitis. Typically, a large dose is given first to get symptoms under control and then the dose is gradually reduced (“tapered”). Prednisone, hydrocortisone and budesonide are common corticosteroids. Side effects of these agents, seen especially with longer-term use, may include: weakening of the bones (osteoporosis), great susceptibility to infection, weight gain and high blood pressure.

Immunomodulators: Also called immune system suppressants, these agents attack the immune cells that stimulate inflammation. They are often given together with corticosteroids. Common immune system suppressors include 6-mercaptopurine, azathioprine, cyclosporine A and methotrexate. Side effects may include nausea, vomiting, diarrhea and increased risk of infection.

Biological Therapies: This is the newest and by far the most effective type of medication to combat ulcerative colitis and to induce remission. They are used mainly for people with moderate-to-severe disease. Several of these therapies (such as infliximab and adalimumab) work by targeting and blocking one natural molecule that is produced by the immune system to incite inflammation. This molecule is called tumor necrosis factor (or TNF) and so the agents are called anti-TNF agents. Blocking TNF reduces inflammation. Although these agents are quite effective, taking them can also lead to serious infections or other side effects such as liver failure, lymphoma (a type of cancer), heart failure or infections. Individuals with tuberculosis, heart failure or multiple sclerosis cannot take the anti-TNF agents.

Antibiotics or Antiviral Agents: Pockets of infection (called abscesses) may develop in areas of severe inflammation, narrowed GI passages or near the rectum. Broad-spectrum antibiotics are often given to treat this bacterial overgrowth. Some patients with viral hepatitis may require treatment with antiviral agents.

Anti-Diarrheal Agents: Most episodes of diarrhea will pass after the inflammation subsides. Drinking plenty of fluids to prevent dehydration is important. To relieve severe abdominal cramping or diarrhea, agents such as loperamide, codeine or diphenoxylate may be prescribed. Prolonged episodes of diarrhea may require intravenous fluid replacement.

Your gastroenterologist can explain the risks associated with the medications used to treat your conditions.

Surgery for Ulcerative Colitis

Despite the improved medications, up to one in every four patients with ulcerative colitis still needs GI surgery at least once during their lives. Surgery can relieve intense symptoms or resolve serious complications such as a severe colitis leading to perforation (leaking), toxic megacolon (dilation), intestinal blockage, severe bleeding or cancer.

At Temple, our experience with minimally invasive (laparoscopic) and robotic surgery allows us to perform precise GI surgery in a way that conserves as much of the colon as possible and that can limit scarring (internal and external) and may allow for less pain and faster healing.

Much less recovery time is typically needed for minimally invasive surgery. Your gastroenterologist and GI surgeon will explain the requirements and benefits and risks for your exact procedure.

Intestinal Resection: In this surgery, the diseased colon is removed. The process of reconnecting the healthy ends of the intestine is called “anastomosis.”

Colectomy: Some patients need to have the entire colon (large intestine) removed. This is called a “colectomy.” An ileostomy or colostomy may be required after a colectomy (see below).

Protocolectomy: In this operation, the rectum and part or all of the colon are removed. This is called a “proctocolectomy.” An ileostomy or colostomy is often required after a protocolectomy (see below).

Ileostomy or Colostomy: In these “-ostomy” procedures, either the ileum (the end of the small intestine) or the remaining end of the colon is brought to the abdominal skin surface to create a “stoma,” or opening. An ostomy pouch covers this opening to collect stool. The patient discards the pouch as needed. In some patients this stoma is temporary, allowing the intestines to rest and heal before being connected again. In other cases, such as after a proctocolectomy with removal of both rectum and anus or with infection or severe disease, the stoma is permanent. Temple has enterostomal therapists who specialize in helping patients take care of the ostomy pouch.

Other procedures: Other surgical or interventional radiological procedures that may help patients with ulcerative colitis, especially in the perianal region (near the anus and rectum), include: repair of fissures (torn tissue); draining of an abscess (pocket of infection); for patients with far advanced IBD who have exhausted all medical and surgical options.

Your gastroenterologist and GI surgeon can explain the risks associated with the surgical procedures needed to treat your conditions.

Ongoing Monitoring and Prevention

Whatever your current treatment, and even if you are feeling well, you should schedule regular meetings with your IBD specialist or your own primary GI specialist to monitor your health. Reasons for these regular check-ins include:

  • To check general GI health (e.g., symptoms, blood test for anemia and infection)
  • To monitor the effectiveness of your therapy (frequency/severity of symptoms)
  • To check for side effects of therapy (e.g., anti-TNF agents have skin reactions, among many other side effects)
  • To ensure proper healing and recovery after surgery and chromoendoscopy to highlight areas of potential early cancer (dysplasia may be used).
  • To administer routine vaccines that will help prevent complications
  • To treat simple health problems (like bronchitis) that can cause complications

New Therapies in Development for Ulcerative Colitis

Hundreds of clinical trials are underway in the U.S. to find safer and more effective tests and treatments for IBD. Your Temple gastroenterologist can help you evaluate all your treatment options including, if needed, participation in clinical trials.

Patients coming to the Temple Inflammatory Bowel Disease Program have access to all the latest medications and advanced surgeries for ulcerative colitis. We are experienced in creating care plans that are customized for the patient’s individual needs and preferences.

To schedule an appointment, click here or call 800-TEMPLE-MED [800-836-7536].