Ulcerative colitis therapy

Medication for ulcerative colitis

Drugs that dampen and contain inflammation are an important pillar in the treatment of ulcerative colitis. The following anti-inflammatory medications, for example, are used during an acute attack:

• Aminosalicylates: Active substances from this group reduce inflammation in the intestine. Doctors mainly use the active ingredient mesalazine. The medication is also suitable for long-term treatment. Mesalazine prevents new relapses or reduces their frequency. The medicines are available in various dosage forms: as tablets, suppositories or foam and enemas for the rectum if the inflammation is located there. Possible side effects include headaches. However, mesalazine is generally very well tolerated and has few side effects. It does not inhibit the immune system
• Probiotics: These contain health-promoting bacteria and can be an alternative to mesalazine – for example, if you cannot tolerate the active ingredient. The bacteria can prevent a further flare-up. Probiotics containing E. coli bacteria of the Nissle 1917 strain are recommended.
• Corticosteroids (“cortisone”): These are immunosuppressants that suppress the immune system. Doctors use it in acute flare-ups when aminosalicylates such as mesalazine have not shown sufficient success. However, drugs containing cortisone are not suitable for long-term treatment of ulcerative colitis due to the side effects. Prednisolone in tablet form is a commonly used active ingredient. Cortisone can also be administered as an infusion in higher doses. Cortisone can lead to sleep disorders, weight gain, acne and an increase in blood sugar. If taken over a longer period of time, it also causes bone loss (“osteoporosis”). Continuous administration of more than 10 mg for more than two months should be avoided if possible.
• Budenoside is a cortisone-like medication that only works in the intestine because it is broken down very quickly by the liver. Despite having a comparable effect to normal cortisone, it therefore has significantly fewer side effects. The medication is available as tablets, enemas, foam or suppositories – it acts directly at the site of inflammation.
• Immunosuppressants of the “thiopurine type”: These are used when mesalazine and cortisone have not produced a sufficient effect. Examples of these active substances are azathioprine and 6-mercaptopurine. These immunosuppressants are not suitable for treating an acute attack of ulcerative colitis, but are suitable for maintaining freedom from symptoms, i.e. for long-term therapy. However, it takes a few months for the medication to take effect. So you need to be a little patient. Possible side effects: Headache, dizziness, inflammation of the liver and pancreas.
• Ciclosporin, methotrexate and tacrolimus are sometimes an option for very severe attacks of ulcerative colitis. It also takes a few months for them to take effect.
• Antibodies (biologicals): These drugs intervene in the inflammatory metabolism and influence the immune system. Active substances for the treatment of ulcerative colitis include (in order of approval) infliximab, adalimumab or golimumab, vedolizumab and ustekinumab. The medication is available as an injection or infusion. They either block inflammatory messengers or, like vedolizumab, prevent inflammatory cells from migrating into the intestine. The time to onset of action varies for the biologics. Infliximab has the fastest effect. Vedolizumab has the slowest effect. However, vedolizumab only works in the intestine and cannot weaken the immune functions in other organs.

Please note the following: Medications that affect the immune system increase susceptibility to infections. Bacteria, viruses or fungi can therefore trigger infections more easily. This increased susceptibility to infections can be a problem, especially for older people or those with other underlying illnesses. Always discuss the benefits and risks of all medications in detail with your doctor.

Surgery for ulcerative colitis

Sometimes medication does not keep ulcerative colitis sufficiently in check – in which case surgery may be necessary. Surgery may also be advisable if the bowel disease is severe, complications develop or doctors have already identified precursors of bowel cancer. In this case, the risk of bowel cancer is increased.

Complete removal of the colon means that ulcerative colitis can in principle be cured. In some patients, however, the inflammation still returns in the artificially created reservoir. The disease is then called pouchitis.

Nutrition as a therapy for ulcerative colitis

Make sure you eat a healthy, balanced and wholesome diet that meets the body’s nutritional requirements and contains few food additives such as emulsifiers. Some tips on nutrition:

• During an acute attack, it is better to avoid foods that are difficult to digest and high in fiber. They would put even more strain on the intestines.
• Some people do better on a dairy-free diet , but colitis does not cause lactose intolerance in the true sense of the word.
• Try out which foods you tolerate well and which you do not. Test this in phases in which you have no symptoms. Many patients do not like the following foods: flatulent fruit, vegetables and pulses, acidic citrus fruits (orange, grapefruit, pomelos, lemons), fruit juices, hot spices or alcohol. But they might be worth testing on a plate.
• Write down in a food diary which foods you have consumed and when. Keep a record of whether any discomfort has set in or whether the food has been good for you. Today, food diaries are also available in digital form, for example as a smartphone app. Otherwise, pen and paper will do.
• If you are unsure about your diet: Consult a nutritionist.

Some people with ulcerative colitis suffer from deficiency symptoms. They lack important vitamins (e.g. vitamin D, vitamin B12) and minerals (e.g. zinc, iron). However, you should not take them as a preventative measure, but only if a doctor has diagnosed a nutrient deficiency. Iron tablets can worsen colitis. You should therefore also not take the frequently used vitamin/iron/trace element combination tablets during pregnancy.

Certain medications that are widely used as painkillers (so-called non-steroidal anti-inflammatory drugs) can trigger an attack of ulcerative colitis. Certain antibiotics are also able to do this. The CCS (Crohn’s and Colitis Switzerland) has a list of these medications on its homepage. If you have any doubts about whether or not you can take a particular medication, it is best to ask your gastroenterologist beforehand.