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Ulcerative Colitis:Treatment

Ulcerative Colitis is one of the most prevalent Irritable Bowel Syndromes (or IBSs) diagnosed today amongst adults in the United States.  The disorder occurs when the lining of the colon becomes compromised due to persistent inflammation, thus breaking down the cells in the colon wall and thereby forming lesions or sores in the anus, also known as ulcers.

Ulcerative Colitis affects individuals differently, depending on a variety of considerations, including the status of one’s health, in addition to their family history and hereditary factors.  Because cases are not identical regarding exact causes and symptoms, no two treatments are identical.  However, because causal similarities are consistent amongst sufferers, in addition to the presence of fairly predictable symptoms, remedy options tend to follow certain trends.  Typically drug treatment options are the first measures advised.  Three drugs that are frequently prescribed to help alleviate symptoms are a) Aminosalicylates, b) Corticosteroids, and c) Immunomodulators.  Compounds that include what are called 5-aminosalicylates help to reduce symptoms of inflammation.  An example of a 5-aminosalicylate is a drug composed of two agents, respectively Sulfasalazine and sulfapyridine.  Because one or more of these chemicals is known to induce unpleasant side-effects such as nausea, diarrhea, heartburn, vomiting, indigestion and migraines, 5-ASA compounds will often be augmented with other agents such as olsalazine or balsalazide, which carry fewer side-effects.  5-ASAs can be administered rectally, through an enema or suppositories, or taken orally.  In mild or moderate cases the condition is often first combated with one or more combinations of these of substances.

Ulcerative Colitis treatment also responds favorably to the use of Corticosteroids (or steroids), of which hydrocortisone and prednisone are two examples.  These agents also possess anti-inflammatory properties, and are frequently turned to for relief when individuals with moderate to severe colitis do not respond favorable to 5-ASAs.  Like 5-ASAs, corticosteroids can be taken orally or employed rectally, but can also be administered intravenously.  Side-effects from using steroids can be severe, and may include changes in skin composition resulting in acne, weight gain, in women the development of facial hair, reduction of bone mass, and a heightened vulnerability to infection.  In rarer cases diabetes can develop, which is why the use corticosteroids must be closely supervised by a doctor.  Immunomodulators, of which azathioprine is an example, lessen inflammation by acting on the immune system.  Immunomodulators such as azathioprine and 6-mercapto-purine (or, 6-MP) can be administered in cases where individuals have not responded to either 5-ASAs or to corticosteroids.  Drawbacks of taking Immunomodulators include complications regarding hepatitis, a heightened risk for developing infections, a heightened risk of succumbing to pancreatitis, and also the fact that benefits derived from the drug can take six to nine months to develop.  In addition to these treatment options, one’s physician can also prescribe medications to address issues of infection or nausea, in addition to medications that combat symptoms of diarrhea or pain.

Ulcerative Colitis in very severe and rare cases may require hospitalization.  In the event an individual experiences copious bleeding or diarrhea that is intense enough to generate dehydration, it might become necessary to rehydrate the body of its fluids or undergo transfusion treatment to address the loss of blood.  In these cases dietary needs may necessitate intravenous feeding for a period of time during recovery, administering specific medications or even surgery.  It has been estimated that approximately one quarter to forty percent of individuals suffering from severe and prolonged Ulcerative Colitis will eventually have to undergo surgery to have their colons removed.  If this becomes a necessity it is the result of massive hemorrhaging, rupturing of the colon itself, or in cases where the risk of cancer is either high or malignant polyps have already developed.  There are two procedures that are performed in such cases: an Ileostomy and an Ileoanal Anastomosis.  Respectively, an ileostomy involves making a small incision in the abdomen, through which a small section of the intestine, or ileum, is drawn.  In this way solid waste bypasses the rectum and is eliminated instead into a small pouch to which the section of intestine is fastened, where the stool then collects and can be emptied as necessary.  In contrast to the ileostomy, ileoanal anastomosis provides for the individual to maintain normalized bowel movements.  This procedure involves removal of the colon, while leaving intact the rectal muscles.  The surgeon creates a small pouch with material from the ileum in rectum in which waste is stored, and in this way allows for normal elimination of stool from the body.  Not every surgical procedure or medication regiment is appropriate for every person.  The procedure or drug therapy regiment one opts for should take into account what stage the disease is in, the severity of its symptoms, the individual’s genetic make-up, hereditary factors, and the general state of their health.  If faced with this decision one should acquire as much information as possible by consulting their physicians to best ensure they have explored and decided upon the appropriate treatment course to effectively resolve their specific case of Ulcerative Colitis.

written by David Gilbert

© H.I.C. Digestive Health  2010

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