Ulcerative colitis treatment: What to know

UC is a form of IBD. It causes inflammation and ulcers to form in a person’s colon. Symptoms of UC can vary, and around half of the people with the condition experience only mild symptoms.

Common digestive symptoms of UC include:

• the urge to have a bowel movement even when the bowel is empty
• loose bowel movements
• bloody stools
• abdominal cramps
• abdominal pain
• diarrhea

A person with UC will often experience symptoms during flare-ups. These flare-ups often occur between periods of remission where the person can experience very few symptoms or none at all.

UC may also affect a person’s general health and quality of life, such as:

• lack of appetite
• weight loss
• nausea
• fatigue
• fever
• low red blood cell count (anemia)
• delayed growth and development in children

UC is not curable. However, several treatment options are available to help a person manage their symptoms and improve their quality of life.

These treatments may help a person regulate their immune system better to reduce symptoms. Treatments vary and can include medications, alterations to diet and nutrition, and in some cases, surgery to repair or remove parts of the colon.

Below are some common treatment options for people with UC.

Biologics

Biologics are medications that come from living cells. Doctors often refer to this medication as “targeted therapy”.

These drugs target cells and proteins in the immune system that are responsible for UC.

Biologic medications attack these cells to reduce their immune response. This helps reduce UC symptoms as it prevents the immune system from being overactive and attacking the body’s own cells.

Doctors often prescribe biologics to people with moderate to severe UC. These drugs can help a person achieve remission and increase their length of time in remission.

Common biologic therapies include:

People take biologics via an injection or intravenous infusion.

Biosimilars

Biosimilars are a newer treatment for UC. These drugs resemble biologics and use natural proteins to target the immune system.

Biosimilars use copies of antibodies to control a person’s immune response. They can help prevent the inflammation that UC causes, which can reduce the symptoms of UC.

Medical professionals can use biosimilars to treat both UC and Crohn’s disease.

People take biosimilars via an injection or intravenous infusion.

JAK inhibitors

Another new treatment for UC is the use of JAK inhibitors. Medical professionals can use these drugs to treat a number of inflammatory diseases, including rheumatoid arthritis, atopic dermatitis, and IBD.

JAK inhibitors are small molecule compounds that break down in the gastrointestinal tract after a person ingests them. Once these compounds break down, the bloodstream absorbs them via the intestines.

Once in a person’s bloodstream, the compounds work directly on the immune system.

The molecules work by attaching themselves to receptors on immune cells to block messaging pathways. This can reduce a person’s immune response, which can ease the symptoms of UC.

In 2018, the Food and Drug Administration (FDA) approved a new type of JAK inhibitor called tofacitinib (Xeljanz) for use in the treatment of UC.

Studies show that tofacitinib is an effective treatment for UC, playing a positive role in inducing and maintaining remission in people with UC.

Corticosteroids

Medical professionals may also use corticosteroids to treat UC. These drugs lower the activity of the immune system. This helps reduce inflammation in the colon and reduces the symptoms of UC.

A person takes corticosteroids orally, as a suppository, via an injection, or via an enema.

Medical professionals often use these drugs as a short-term treatment for UC flare-ups. This is because they act quickly and can work within a few days.

Corticosteroids are not a long-term treatment option for people with UC due to the various side effects they can cause.

Possible side effects of long-term corticosteroid treatment include:

Aminosalicylates

Aminosalicylates are compounds that contain 5-aminosalicylic acid (5-ASA). These drugs can control the symptoms of IBD by reducing inflammation in the gastrointestinal tract.

Medical professionals often use aminosalicylates to treat mild to moderate UC.

Along with corticosteroids, aminosalicylates are often the first-line treatment for UC. People can take these drugs orally, via a suppository, or via an enema.

According to the Chron’s and Colitis Foundation, these drugs are very safe, and people tend to tolerate them very well. However, some common side effects include:

• headaches
• nausea and vomiting
• abdominal pain and cramps
• loss of appetite
• rashes
• fever

Surgery

In some cases, a person with UC may require surgery. Surgery is often a good option for people who no longer respond to medication.

Some people choose to undergo surgery to improve their quality of life. In some rare cases, people may become dangerously ill and need emergency surgery.

Common UC surgery includes removing the entire colon during a colectomy, or removing the colon and the rectum in a proctocolectomy.

These surgeries can prevent the symptoms of UC from arising as the person no longer has a colon that can become inflamed.

After these surgeries, some people may require something doctors call an ileal pouch anal-anastomosis. Surgeons will pull part of the small bowel down and connect it to the anus to replicate some function of the colon.

Some people may need a temporary ostomy before the final anastomosis. An ostomy is a bag that sits on the outside of a person’s body near their stomach. The bag collects waste from the body through a hole called a stoma.

Colectomies can cause various side effects, including infections, pouchitis, fecal incontinence, and small bowel obstruction.

Adjustments to diet and nutrition

It is important that a person with UC eats a healthy, balanced diet. This is because good nutrition can affect a person’s UC symptoms as well as their general well-being.

UC may also cause a person to lose their appetite, which can mean they eat less food. This may lead to a lack of nutrients, which can negatively impact their overall health and well-being.

The Chron’s and Colitis Foundation offers a variety of dietary tips that a person with UC can follow to help manage their symptoms and achieve good nutrition. These tips include:

• eating four to six small meals a day
• remaining well-hydrated and drinking plenty of water
• drinking slowly and avoiding using a straw to prevent ingesting air
• preparing meals in advance
• keeping the kitchen well-stocked with foods they can easily tolerate
• using a food journal to keep track of what foods a person eats and how they affect their symptoms

During a flare-up, a person with UC may wish to avoid certain foods that can trigger UC symptoms, such as bloating, cramping, and diarrhea.

These foods include:

• Insoluble fiber foods: These foods can be hard to digest. They include fruits with skin and seeds, raw vegetables such as broccoli or cauliflower, whole nuts, and whole grains.
• Lactose: This includes dairy products such as milk, cream, and cheese.
• Non-absorbable sugars: These sugars are often in sugar-free gum, candy, ice cream, and some fruits and fruit juices such as pear, peach, and prune.
• Sugary food: This includes pastries, candy, and juices.
• High fat foods: This includes butter, coconut, margarine, and cream, as well as fried, fatty, or greasy foods.
• Alcohol: Including beer, wine, and liquor.
• Caffeine: Including some sodas, coffee, and teas.
• Spicy food: People should avoid eating hot, spicy food during a flare-up as it can worsen symptoms.

When a person is in remission, they may also want to adjust their diet to help them remain healthy and hydrated. This means they may wish to consider eating some of the following foods:

• Fiber-rich foods: These include beans, nuts, whole grains, oat bran, and barley. If a person has an ostomy or an intestinal narrowing, they may wish to avoid these high-fiber foods.
• High-protein foods: These include lean meats, fish, eggs, nuts, and tofu.
• Fruits and vegetables: A person should ensure they are eating as much fruit and vegetables as possible.
• Probiotics: Probiotics can help a person with UC improve their quality of life. These foods include yogurt, kimchi, miso, and tempeh.
• Foods high in calcium: These include yogurt, collard greens, and milk. If an individual is lactose intolerant, they may wish to consider lactose-free dairy products.

UC is a form of IBD that causes inflammation and ulcers to form in the colon. Symptoms of UC include an increased urge to have bowel movements, loose bowel movements, bloody stools, abdominal pain and cramps, and diarrhea.

Symptoms of UC often come during flare-ups which happen between periods of remission. When a person is in remission, they can experience very few symptoms or none at all.

UC is a lifelong condition, and there is currently no cure. However, there are a variety of treatment options that can help reduce symptoms and increase remission periods.

These treatments include biologics, biosimilars, JAK inhibitors, corticosteroids, aminosalicylates, and surgery.

The mortality rate for a person with UC is the same as a person without the disease.