NHS Direct Wales – Encyclopaedia : Ulcerative colitis

Treatment for ulcerative colitis depends on how severe the condition is and how often your symptoms flare up.

This willusually involve taking various types of medication, although surgery may sometimes be an option.

Your treatment will normally be provided by a range of healthcare professionals, including specialist doctors (such as gastroenterologists or surgeons), GPs and specialist nurses.

Your care will often be co-ordinated by your specialist nurse and your care team, and they will usually be your main point of contact if you need help and advice.

Treatment options are discussed in more detail below.

Aminosalicylates

Aminosalicylates (5-ASAs), such as sulphasalazineor mesalazine, are medications that help toreduce inflammation. They're usually the first treatment option for mildor moderate ulcerative colitis.

5-ASAs can be used as a short-term treatment for flare-ups. They can also be taken long term, usually for the rest of your life,to maintain remission.

5-ASAscan be taken:

How you take 5-ASAs depends on the severity and extent of your condition.

These medications rarely haveside effects, but some people may experience:

Corticosteroids

Corticosteroids (steroid medication),are amore powerful type of medication used to reduce inflammation. They can be used with or instead of ASAs to treat a flare-upif ASAs alone are not effective.

LikeASAs, steroids can be administered orally, or through a suppository or enema.

However, unlike ASAs, corticosteroids are not used as a long-term treatment to maintain remission because they cancause potentially serious side effects, such as osteoporosis (weakening of the bones) and cataracts (cloudy patches in the lens of the eye) when used for a long time.

Side effects of short-term steroid use can include:

Immunosuppressants

Immunosuppressants, such as tacrolimus and azathioprine,are medications that reduce the activity of the immune system. They are usually given as tablets to treat mild or moderate flare-ups, or maintain remission if your symptoms haven't responded to other medications.

Immunosuppressants can be very effective in treating ulcerative colitis, but they oftentake a while to start working (usually between two and three months).

The medicinescan make you morevulnerable to infection, so it is important to report any signs of infection, such asfever or sickness, promptly to your GP.

They can also lower the production of red blood cells, making you prone to anaemia. You willneed regularblood tests to monitor your blood cell levels and to check for any other problems.

Treating severe flare-ups

While mild or moderate flare-ups can usually be treated at home, more severe flare-upsshould be managedin hospital to minimise the risk of dehydration and potentially fatal complications, such as your colon rupturing.

In hospital, you will be given medication and sometimes fluids intravenously (directly into a vein). The medication you have will usually be a type of corticosteroid or an immunosuppressant medication called infliximab or ciclosporin.

Ciclosporin

Ciclosporin works in the same way as other immunosuppressant medications (see above)by reducing the activity of the immune system. However, it is more powerful than the medications used to treat milder cases of ulcerative colitis and starts to work much sooner (normally withina fewdays).

Ciclosporinis given slowly through a drip in your arm (known as an infusion) and treatment will usually be continuous, for around seven days.

Side effects of intravenous ciclosporin can include:

Ciclosporin can also causemore serious problems such as high blood pressure and reduced kidney and liver function, but you will be monitoredregularlyduring treatment to check for signs of these.

Biologic medications

Infliximab, adalimumab, golimumab and vedolizumab are medications that reduce inflammation of the intestineby targeting proteins which the immune system uses to stimulate inflammation. These medications block these receptors and reduce inflammation.

They may be used to treat adults with moderate to severe ulcerative colitis, if other options aren't suitable or working. Infliximab may also be used to treat children or young people aged 6-17 with severe ulcerative colitis (see below).

The treatment is given for 12 months unless the medication isn't working well.

Read the full NICE guidelines on:

Infliximab

Infliximab is given as an infusion over the course of two hours. You will be given further infusions after two weeks, and again after six weeks. Infusions are then given every eight weeks, if treatment is still required.

Common side effects of infliximab can include:

In most cases,a reaction to the medication occurs in the first two hours after the infusion has finished. However, some people experience delayed reactions days, or even weeks, after an infusion. If you begin to experience the symptoms listed above after having infliximab, seek immediate medical assistance.

You will be carefully monitored after your first infusion and, if necessary, powerful anti-allergy medication, such as epinephrine, may be used.

Infliximab is not usuallysuitable for people with a history oftuberculosis (TB)orhepatitis B and needs to be used with caution in those withHIV or hepatitis C. This isbecause there havebeen a number of cases where infliximab has "reactivated" dormant infections.The medicationis also not recommended for people with a history of heart diseaseor multiple sclerosis.

Surgery

If you have frequent flare-ups that have a significant effect on your quality of life, or you have a particularly severe flare-up that isn't responding to medication, surgery may be an option.

Surgery for ulcerative colitisinvolves permanently removing the colon(known as a colectomy).

During the operation, your small intestine will be used to pass waste products out of your body instead of your colon. Thiscan be achieved by creating:

Ileo-anal pouches are increasingly used because an external bag to collect waste products is not required.

As the colon is removed, ulcerative colitis cannot recur after surgery. However, it's important to consider the risks of surgery and the impact ofhaving a permanent ileostomy or ileo-anal pouch.

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NHS Direct Wales - Encyclopaedia : Ulcerative colitis