Ulcerative Colitis Treatment & Medications

When someone is suffering from ulcerative colitis, treatment is focused on reducing the level of inflammation. This is because the inflammation is what causes most of the symptoms of the disease. Ulcerative colitis treatment should provide relief from symptoms, and may also lead into remission. Typically, it’s treated by medications or surgery.

There are a variety of different drugs that doctors use to help reduce inflammation. Because not all people get the same results from the same drugs, there may be a bit of a trial and error process before the doctor finds the ideal medication. Since some medications have strong side effects, you’ll have to look at the pros and cons of any treatment you try.

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Doctors typically begin treatment with anti-inflammatory drugs. They’re effective, and often have less debilitating side effects. Medications used include:

Mesalamine (Lialda, Asacol), Olsalazine (Dipentum, and Balsalazide (Colazal). These drugs can be taken via topical forms like suppositories as well as orally. The form your doctor recommends will depend on the portion of your colon that’s inflamed. In some cases, a combination of both topical and oral treatments may be recommended. These drugs have a high success rate, with more than 90% of people suffering from mild ulcerative colitis reporting relief. They also have the mildest side effects. Common side effects include flatulence, cramping, and mild nausea.

Sulfasalazine (Azulfidine). This medication has great success when it comes to reducing symptoms, but it also has some nasty side effects. These include vomiting, headaches, and diarrhea. A number of people are also allergic to this type of medication.

Corticosteroids. This drug is particularly good at reducing inflammation, but it has some odd and severe side effects. People taking the medication have reported extreme weight gain, mood swings, and excessive growth of facial hair. Studies have also linked it to higher blood pressure, osteoporosis, glaucoma, cataracts, and an increased risk of both type 2 diabetes and infections. Because of the severity of the symptoms, this medication is only used for more severe cases of colitis that haven’t responded to other treatments. Typically, it’s taken in the very short term so that any negative effects will be minimal.

In many cases, these medications are combined with others in order to put colitis into remission. As an example, some doctors use corticosteroids in conjunction with immune system suppressor. As the corticosteroids work to induce remission, the suppressor works to help your body maintain that remission. Some doctors also use steroid enemas alongside anti-inflammatory medications in order to treat the rectum directly. This is another treatment that’s only used in the short term.


Immune system suppressors

There are a variety of drugs that can be used to decrease the inflammation of damaged tissue.  Some target the inflammation itself.  However, in autoimmune disorders the inflammation might not be caused by some external injury to the tissue, but by the body itself.  This occurs when the body’s immune system essentially attacks the body’s own tissues because it becomes too overzealous in responding to an infection or mistakes its own body for a foreign invader.  In such cases, immune system suppressors can also be used to reduce inflammation by preventing the autoimmune response.  Since ulcerative colitis responds to this class of medication, many believe that immune system dysfunction could be part of the underlying pathology.  The following is a list of common immunosuppressant drugs:

Cyclosporin (Gengraf, Neoral, Sandimmune).  This is a very potent immune suppressor commonly used in patients who are undergoing some type of tissue transplant.  It is so strong that it carries with it the risk of causing deadly infections.  It also is known to exhibit severe renal toxicity in some patients.  It that were not enough, it also carries with it an increased risk of certain types of cancers and seizures.  As a result, this drug is not used very often in ulcerative colitis patients and is seen as a drug of last resort with other treatment modalities fail.  The drug can also be used temporarily until less toxic drugs but less potent drugs have had time to become effective.  It can also be used as a temporary stop gap measure to control the disease while awaiting surgical intervention.

Azathioprine (Azasan, Imuran) and mercaptopurine (Purinthol).  These immunosuppressants are much less potent than cyclosporine and are thus much more likely to be used as a first line of therapy.  However, it can take months for these to begin to have an effect, which is one of the reasons cyclosporine is sometimes used as a stop gap measure in severe cases.  In more typical cases a corticosteroid is prescribed concomitantly in the first few months, providing a direct anti-inflammatory effect while waiting for the immunosuppressant to kick in.  At that point, the steroid use can be reduced.  As one would expect, infections do occur as a side effect, along with bone marrow suppression, inflammation of the liver, pancreatitis, and a slightly elevated risk of cancer.  As a result, any patient on these medications should be closely followed by a physician.

-Infliximab (Remicade).  This drug was one of the very first targeted immunosuppressant drugs approved for human use.  It is actually a monoclonal antibody that binds to an important cytokine, TNA-alpha, known to be involved in the inflammatory response.  It is typically used for moderate to severe cases whose condition does not improve when treated with steroids.  While this therapy is more targeted than traditional immunosuppressant, it still has some severe side effects including increase infections, such as tuberculosis and hepatitis B, and increased risk of some cancers.  As a result, tuberculosis skin tests and hepatitis B screening are routine for people considering taking this medication.  It
also can provoke an allergic reaction in some people since the monoclonal antibody used was cloned from mouse tissue which the body can recognize as foreign.

Adalimumab (Humira) is another biologic medication targeted at reducing the concentrations of TNF-alpha.  The monoclonal antibody used in this preparation was actually “humanized” utilizing a proprietary process from Abgenix.  This prevents many of the adverse reactions caused by using mouse antibodies such as with Infliximab.  As a result, this is often used as an alternative to Infliximab.  As one would expect, it carries many similar side effects such as the risk of infection, and many of the same precautions are used prior to taking it.

Other medications

There are other medications that will also help control the inflammation from ulcerative colitis.  These usually target the management of the symptoms.  These can include:

  • Anti-diarrheal. Those with severe diarrhea may be given loperamide (Imodium). These anti-diarrheal drugs may increase the chance of toxi megacolon so use it causiosly.
  • Pain relievers. If you suffer from mild pain, your physician may prescribe acetaminophen (Tylenol, others).  Don’t take ibuprofen (Advil, Motrin, others), naproxen (Aleve) or aspirin. They probably make the symptoms worse.
  • Antibiotics. Those with ulcerative colitis that have fevers will probably be prescribed antibiotics to avoid or stop infection.
  • Iron supplements.  With chronic intestinal bleeding, you have a higher chance of developing iron deficiency anemia. You would need to take iron supplements to get your iron levels to normal and minimize this kind of anemia when your bleeding has stopped.

Surgery

If lifestyle and diet modifications, medications, or other treatment options don’t reduce your symptoms, your physician may suggest surgery.

Surgery usually get rid of ulcerative colitis. However that results in taking out your entire colon and rectum (proctocolectomy). In the past, following this surgery you’d put on a little bag over an opening in your abdomen to accumulate stool. But an operation called ileoanal anastomosis eliminates the bag. As a substitute, your surgeon constructs a sack from the end of your small intestine. The pouch will be connected right to your anus. This lets you discharge waste more normally; however, you might have more-frequent bowel movements which are soft or watery since you no longer have your colon to take in water.

Source – Mayo Clinic


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