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Treatment for ulcerative colitis depends on the severity of the disease.
Each person experiences ulcerative colitis differently, so treatment is
adjusted for each individual.
Drug Therapy
The goal of drug therapy is to induce and maintain remission, and to
improve the quality of life for people with ulcerative colitis. Several types
of drugs are available.
- Aminosalicylates, drugs that contain 5-aminosalicyclic acid
(5-ASA), help control inflammation. Sulfasalazine is a combination of
sulfapyridine and 5-ASA. The sulfapyridine component carries the
anti-inflammatory 5-ASA to the intestine. However, sulfapyridine may lead
to side effects such as nausea, vomiting, heartburn, diarrhea, and
headache. Other 5-ASA agents, such as olsalazine, mesalamine, and
balsalazide, have a different carrier, fewer side effects, and may be used
by people who cannot take sulfasalazine. 5-ASAs are given orally, through
an enema, or in a suppository, depending on the location of the
inflammation in the colon. Most people 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 prednisone, methylprednisone, and
hydrocortisone also reduce inflammation. They may be used by people 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 the
location of the inflammation. These drugs can cause side effects such as
weight gain, acne, facial hair, hypertension, diabetes, mood swings, bone
mass loss, and an increased risk of infection. For this reason, they are
not recommended for long-term use, although they are considered very
effective when prescribed for short-term use.
- Immunomodulators such as azathioprine and 6-mercapto-purine
(6-MP) reduce inflammation by affecting the immune system. These drugs are
used 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 it may take up to 6 months
before the full benefit. Patients taking these drugs are monitored for
complications including pancreatitis, hepatitis, a reduced white blood
cell count, and an increased risk of infection. Cyclosporine A may be used
with 6-MP or azathioprine to treat active, severe ulcerative colitis in
people who do not respond to intravenous corticosteroids.
Other drugs may be given to relax the patient or to relieve pain, diarrhea,
or infection.
Some people have remissions—periods when the symptoms go away—that last
for months or even years. However, most patients' symptoms eventually
return.
Hospitalization
Occasionally, symptoms are severe enough that a person must be
hospitalized. For example, a person may have severe bleeding or severe
diarrhea that causes dehydration. In such cases the doctor will try to stop
diarrhea and loss of blood, fluids, and mineral salts. The patient may need a
special diet, feeding through a vein, medications, or sometimes surgery.
Surgery
About 25 to 40 percent of ulcerative colitis patients must eventually have
their colons removed because of massive bleeding, severe illness, rupture of
the colon, or risk of cancer. Sometimes the doctor will 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, known as proctocolectomy, is
followed by one of the following:
- Ileostomy, in which the surgeon creates a small opening in the
abdomen, called a stoma, and attaches the end of the small intestine,
called the ileum, to it. Waste will travel through the small intestine and
exit the body through the stoma. The stoma is about the size of a quarter
and is usually located in the lower right part of the abdomen near the
beltline. A pouch is worn over the opening to collect waste, and the
patient empties the pouch as needed.
- Ileoanal anastomosis, or pull-through operation, which allows the
patient to have normal bowel movements because it preserves part of the
anus. In this operation, the surgeon removes the colon and the inside of
the rectum, leaving the outer muscles of the rectum. The surgeon then
attaches the ileum to the inside of the rectum and the anus, creating a
pouch. Waste is stored in the pouch and passes through the anus in the
usual manner. Bowel movements may be more frequent and watery than before
the procedure. Inflammation of the pouch (pouchitis) is a possible
complication.
Not every operation is appropriate for every person. Which surgery to have
depends on the severity of the disease and the patient’s needs,
expectations, and lifestyle. People faced with this decision should get 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 can direct people to support
groups and other information resources.
Reference:
National Digestive Diseases Information Clearinghouse, USA.
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