What is the treatment for UC?
There are several types of medications that are frequently used to treat UC, including Azulfadine (sulfasalazine), mesalamine (Apriso, Asacol, Pentasa, Rowasa), osalazine (Dipentum), Colazal (balsalazide disodium) and corticosteroids (prednisone).
Sulfasalazine (Azulfadine). Sulfasalazine is known as a 5-ASA compound, and is the combination of two drugs: sulfapyridine and an aspirin-like compound. It works to reduce the inflammation in the colon and then as a maintenance therapy to maintain remission. This drug has an extensive history of use for UC, and is considered safe to take for long periods of time. Common side effects -- often caused by sensitivity to the sulfa component -– include nausea, headache, diarrhea and abdominal pain. Sulfasalazine may also cause urine to turn dark yellow or orange in color.
Mesalamine (Asacol, Pentasa, Rowasa), Dipentum (olsalazine), and Colazal (balsalazide disodium). Mesalamine, olsazine, and balaside are the next generation of 5-ASA compounds, and do not contain the sulfa component. Additionally, mesalamine may be given orally (Apriso, Asacol, Pentasa), or in a rectal suppository or foam (Rowasa). The rectally administered form works topically on the inflammation in the last sections of the colon and is useful for ulcerative proctitis, proctosigmoiditis, and left-sided colitis. The newer 5-ASA drugs are as effective as sulfasalazine, but tend to have fewer side effects.
Corticosteroids (prednisone, methylprednisolone). Corticosteroids are similar to cortisol, a steroid the body produces in the adrenal gland. This drug reduces inflammation in the body and is usually prescribed, along with a 5-ASA maintenance drug, to curb an acute flare-up. Because of the incidence of side effects, corticosteroids are usually given in the lowest possible dosage for the shortest amount of time. Care must be taken when lessening the dosage because the body stops or decreases its own production of cortisol during drug therapy. Slowly tapering the amount of the corticosteroids taken daily allows the body to begin producing it again on its own.
Remicade (infliximab). Infliximab is stops tumor necrosis factor alpha (TNF-alpha) from being used by the body. TNF-alpha is found in higher than normal amounts in people with IBD. Side effects include abdominal pain, nausea, fatigue, vomiting and rarely, infection. Initially developed for Crohn’s disease, infliximab is now also approved to treat UC.
Surgery may also be used to treat UC, usually after all available drug treatments have failed. Surgery for UC always involves a total colectomy, or a complete removal of the large intestine (colon). Resection, or removing only the diseased section of the colon, is not an option in UC, because the disease will only re-occur in the portion of the colon that is left.
Ileostomy. An ileostomy is the complete removal of the colon and a creation of a stoma for eliminating waste. A stoma is the opening in the abdomen through which waste can leave the body from the small intestine. After the surgery an ostomy bag must be worn on the abdomen to catch waste materials.
J-pouch. A j-pouch (sometimes also known as an s- or w-pouch), is the last section of the small intestine which is re-constructed to create a reservoir and then connected to the rectum. This allows for a more normal elimination of stool from the body through the anus.
Continent ostomies (Barnett Continent Intestinal Reservoir (BCIR) or Kock Pouch). A continent ostomy is similar to a j-pouch in that an internal pouch is created from a section of small intestine. However, instead of being attached to the rectum, the end of the pouch is connected to the abdomen and a stoma is created. Waste is eliminated through a special tube that is attached to the stoma -an external bag is not necessary.
Are there alternative treatments for UC?
Adjunct treatments for UC can include acupuncture, biofeedback, hypnotherapy and stress reduction. These therapies are often used in conjunction with medical treatments to help with the tension caused by being diagnosed with a chronic disease.
Other experimental treatments including fish oil, butyrate, aloe vera, boswellia, probiotics, antiobiotics, immunosuppressive therapy, and nicotine have not been studied extensively. New therapies for UC may evolve from the ongoing research on these compounds.
