There is no known medical cure for ulcerative colitis. Inducing and maintaining clinical remission in these patients is the ultimate goal of treatment (1). Management of inflammation in patients with ulcerative colitis will include a plan to induce and maintain remission by reducing or eliminating intestinal inflammation, limit side effects of medications, modify the pattern of the disease, and avoid disease complications (2). The decision regarding treatment of ulcerative colitis will depend upon the anatomic extent of the inflammatory process in the colon ("distal" versus "extensive"), the clinical severity of an attack, and the degree of inflammatory activity and risks of available interventions (1, 3).
Medical management of ulcerative colitis may include the following classes of medications: aminosalicylates (sulfasalazine, mesalamine, olsalazine, balsalazide), corticosteroids, immunosuppressants (azathioprine, 6-MP, methotrexate, cyclosporine), antibiotics, and biologic therapy (1, 3). The safety, convenience, and practicality of these options must be considered along with the potential efficacy of these treatments.
Despite available pharmacologic therapies, hospitalization will be required in approximately 15% of patients at some point in their lives to treat an acute flare of ulcerative colitis (5). When medical management of ulcerative colitis is not completely successful or when complications arise, surgery may be required and, unlike Crohn's disease, surgery may offer a cure for the disease. Complications that require surgery include colonic perforation, massive hemorrhage, fulminant severe ulcerative colitis, and toxic megacolon (5). Approximately 25%-40% of patients will eventually require surgery (6).
Although some patients may still require proctocolectomy with ileostomy, the optimal surgical procedure for patients with ulcerative colitis is pouch anal anastomosis (IPAA) or restorative proctocolectomy, because it preserves the anal sphincter and maintains continence (4, 7, 8). Ongoing post-surgical management of patients with ulcerative colitis is essential to ensure patients continue to benefit from the best treatments available for their condition or to monitor for a recurrence of symptoms.
The unmet needs in the treatment of ulcerative colitis are induction and maintenance of remission in refractory patients with moderate disease, and induction of remission in severe disease (alternative for colectomy) (9). Sustaining a therapeutic response over time in these patients is particularly challenging. Because of the nature of the disease, which is characterized by alternating periods of flare-ups and periods of remission, there is a need to maintain constant vigilance in monitoring symptoms that may indicate active disease.
- Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 2004;99:1371-1385
- Travis S. Advances in therapeutic approaches to ulcerative colitis and Crohn's disease. Curr Gastroenterol Rep 2005;7:475-84.
- Steinhart AH. Induction of remission in ulcerative colitis. In Satsangi J, Sutherland LR, eds. Inflammatory Bowel Diseases. London: Churchill Livingstone. Elsevier Limited, 2003: 383-401.
- Steinhart AH. The management of fulminant ulcerative colitis. In Satsangi J, Sutherland LR, eds. Inflammatory Bowel Diseases. London: Churchill Livingstone. Elsevier Limited, 2003: 403-417.
- Ford D. Ulcerative Colitis. American Society of Colon and Rectal Surgeons. Available at: http://www.fascrs.org/displaycommon.cfm?an=1&subarticlenbr=314. Accessed July 21, 2006.
- Surgery. Crohn's and Colitis Foundation of America. Available at: http://www.ccfa.org/info/treatment/medications. Accessed July 21, 2006.
- Sagar PM, Pemberton JH. Surgical treatment of chronic ulcerative colitis. In Satsangi J, Sutherland LR, eds. Inflammatory Bowel Diseases. London: Churchill Livingstone. Elsevier Limited, 2003: 491-511.
- Friedman S, Blumberg RS. Inflammatory Bowel Disease. In: Harrison's Internal Medicine. McGraw-Hill Access Medicine. 2006. The McGraw-Hill Companies. Available at: http://www.accessmedicine.com/content.aspx?aID=90472. Accessed July 21, 2006.
- Van Assche G. Medical treatment of inflammatory bowel diseases. Curr Opin Gastroenterol 2005;21:443-447.