Ulcerative Colitis Treatment:
Diet, Medications and Surgery

Ulcerative colitis treatment options include non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. Along with proper diet, medication has powerful effects on areas of inflammation in the colon. Colitis treatment also includes dietary changes. In some cases, surgery is necessary. Most patients can control their symptoms through diet and medication to decrease inflammation and diarrhea.

Dietary guidelines for ulcerative colitis include eating low residue, high protein foods. Vegetables and fruits can aggravate an inflamed colon. Vitamin therapy and increased fluid intake, not to include caffeinated beverages, is recommended. Milk, cold foods, smoking and alcoholic beverages may irritate ulcerative colitis symptoms in some individuals.

A custom tailored ulcerative colitis diet is an important aspect of symptom control. A registered dietician who specializes in creating diets for inflammatory bowel diseases is an important resource. He or she can plan a diet that meets the patient's nutritional needs while minimizing ulcerative colitis symptoms.

Of all the ulcerative colitis medications, sulfasalazine is most effective in controlling inflammation in mild to moderate ulcerative colitis. Sulfasalazine is poorly absorbed so that it can have maximum effect in the colon. The drug is split by bacteria in the intestine into two components, 5-aminosalicylate (5-ASA) and sulfapyridine. The 5-ASA portion has an anti-inflammatory effect.

Corticosteroid medications may also be used to decrease inflammation in the colon. Hydrocortisone-containing enemas are sometimes used after remission is achieved. These are often better tolerated than oral corticosteroids like prednisone, which is often used to treat initial symptoms.

Immunosupressive therapy with azathioprine, 6-mercaptopurine and cyclosporin A are sometimes used in more severe cases.

Anticholinergics inhibit a substance called acetylcholine, which is responsible for spasms of the colon. Sedatives and anti-diarrheal medications may help to alleviate some of the uncomfortable side effects of ulcerative colitis, but must be used cautiously as they increase the risk of developing toxic megacolon.

When the patient goes into remission, the dosages of ulcerative colitis medications are tapered off and a long-term maintenance regimen ensues.

Hospitalization is imminent for patients who have over ten bowel movements per day. These patients sometimes suffer from tachycardia (rapid heartbeat), high fever and severe abdominal pain. In the hospital an IV drip with medication in it may be used to help control the symptoms and rehydrate the patient.

An emergency colectomy (removal of all or part of the colon) is necessary when excessive bleeding, toxic colitis or colon perforation occurs. Surgery can also be voluntary, when the mucosal lining is severely affected, or cancer is suspected. It is also an elective treatment option for strictures (narrowed areas of the colon), delayed growth in a child with UC or medication dependence.

Resources

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Beers, M.H. & Berkow, R. (ed). Gastrointestinal disorders, general. TheMerck Manual of Diagnosis and Therapy, 17th Edition. Merck Research Laboratories, NJ, 1999.

Campbell, S. & Ghosh, S. (2002). Ulcerative colitis and colon cancer: Strategies for cancer prevention. Digestive Diseases 20(1), 38-48.

Kamm, M. (2002). Maintenance of remission in ulcerative colitis. Alimentary Pharmacology & Therapeutics,16(suppl. 4), 21-24.

Mayo Foundation for Medical Education and Research. (updated 2004). Colorectal cancer.

Seegers, D., Bouma, G. & Pena, S. (2002). A critical approach to new forms of treatment of Crohn's disease and ulcerative colitis. Alimentary Pharmacology & Therapeutics,16(suppl. 4), 53-58.