Treatment:

Treatment can help suppress the inflammatory response and manage symptoms. A treatment plan for ulcerative colitis includes:

• Diet and nutrition
• Medications
• Surgery (when necessary)

Diet and Nutrition

Malnutrition may occur in ulcerative colitis, although it tends to be less severe than with Crohn� ' s disease. Patients with ulcerative colitis may experience reduced appetite and weight loss.

Patients should strive to eat a well-balanced healthy diet and focus on getting enough calories, protein, and essential nutrients from a variety of food groups. These include protein sources such as meat, chicken, fish or soy; dairy products such as milk, yogurt, and cheese (if the patient is not lactose-intolerant); and fruits and vegetables.

Depending on your nutritional status, your doctor may recommend that you take a multivitamin or iron supplement. Other types of dietary supplements, such as probiotics (“healthy bacteria” like lactobacilli), are being investigated for ulcerative colitis, Studies suggest that probiotics do not help much for remission, but they may have modest effects for reducing disease activity and improving symptoms in people with mild-to-moderate ulcerative colitis.

Certain types of foods may worsen diarrhea and gas symptoms, especially during times of active disease. While people vary in their individual sensitivity to foods, general guidelines for dietary management during active disease include:

• Eat small amounts of food throughout the day.
• Stay hydrated by drinking lots of water (frequent consumption of small amounts throughout the day).
• Eat soft, bland foods and avoid spicy foods.
• Avoid high-fiber foods (bran, beans, nuts, seeds, and popcorn).
• Avoid fatty greasy or fried foods and sauces (butter, margarine, and heavy cream).
• Limit milk products if you are lactose intolerant (or consider taking a lactase supplement to improve tolerance). Otherwise, dairy products are a good source of protein and calcium.
• Avoid or limit alcohol and caffeine consumption.

Medications

Drug therapies for ulcerative colitis aim to resolve symptoms (induce remission) and prevent flare-ups (maintain remission). The main types of drugs used for treating ulcerative colitis include:

• Aminosalicylates. Mild-to-moderate ulcerative colitis is usually treated with aspirin-like medications called aminosalicylates, or 5-ASAs. These drugs are also used to treat relapses. They may be administered rectally in patients who have mild-to-moderate disease that occurs only in the last portion of the intestine. They may also be taken by mouth.
• Corticosteroids. Corticosteroids (steroids) may be added or used alone to reduce acute inflammation. (Because of their significant side effects, they are not recommended for long-term use and maintenance therapy). Steroids may be administered rectally as an alternative to an aminosalicylate if the disease is limited to the last portion of the intestine. Forms taken by mouth may treat moderate-to-severe cases. People who do not respond to less aggressive treatments may need intravenous steroids.
• Immunosuppressants. Drugs that suppress the immune system (immunosuppressants) are useful, either alone or in combinations, for disease that does not respond to other treatments or for maintenance of remissions.
• Biologic Drugs. Unlike drugs that are made from chemicals, biologic drugs are produced from living organisms. Biologics are designed to stimulate the immune system and interfere with specific proteins (cytokines) involved with the inflammatory response. Infliximab (Remicade) is the only biologic drug approved for ulcerative colitis. It blocks a cytokine called tumor necrosis factor (TNF).

Drug therapy is considered successful if it can push the disease into remission (and keep it there) without causing significant side effects. The patient's condition is generally considered in remission when the intestinal lining has healed and symptoms such as diarrhea, abdominal cramps, and tenesmus (straining painfully or ineffectively to defecate or urinate) are normal or close to normal.

Other types of drugs may also be used to treat specific conditions and symptoms associated with ulcerative colitis. Anti-diarrheal medications such as loperamide (Imodium) may be given to help control diarrhea.

Surgery

Drugs do not help about 25 - 40% of patients with ulcerative colitis. As a result, these people nee surgical treatment. Surgery may also be necessary because of hemorrhage, perforation of the colon, or toxic megacolon.

Total proctocolectomy with ileal pouch anal anastomosis (IPAA), also known as restorative proctolectomy, and total proctocolectomy with ileostomy are the two definitive surgical approaches for widespread ulcerative colitis that cannot be controlled with medications. Other patients may have a colectomy (resection of a portion of the colon) for more limited disease.

Crohn� ' s disease can recur after any attempt at bowel resection, but ulcerative colitis does not recur after total proctocolectomy, which is considered a cure for ulcerative colitis. (See Surgery section for more detailed information.)