Your Online Health Information Site


Treatment Of Ulcerative Colitis

Part of the treatment of ulcerative colitis is to avoid raw vegetables and fruits (one of the few diseases) as the fiber can be enough mechanical trauma to perpetuate or worsen the symptoms of ulcerative colitis. Notably some patients improve on a milk free diet.

A) Mild to moderate disease

The physician will likely order some mild anti diarrhea drugs. However, this has to be carefully monitored as this would be the wrong thing to order in a patient who is shortly before developing toxic colitis. If the ulcerative colitis is only on the left side (rectum, sigmoid and ascending colon), then corticosteroid enemas for a period of time would be useful until the flare-up is under control.

Mesalamine or 5-amino-salicylic acid (brand names: Rowasa, Asacol, Mesasal, Pentasa, Quintasa and Salofalk) are all useful as either tablets by mouth or given by enema. In essence, this medication tends to get the inflammation under control and helps to tone down the symptoms. More extensive disease may respond to Sulfosalazine (brand names: Salazopyrin, Azulfidine), but in men sperm counts can be affected and other side-effects such as bone marrow toxicity have to be monitored with blood tests. However, if this medication helps to get the disease under control, then long-term lower maintenance would likely be useful.

B) Moderately severe disease

It usually requires oral corticosteroid treatment to control ulcerative colitis of this severity. 40 to 60 mg of oral prednisone is usually required for about 1 or 2 weeks. Then the physician will gradually reduce the dose of prednisone and attempt to switch over to Sulfosalazine as a maintenance.

C) Severe disease

When a person with ulcerative colitis has more than 10 bloody bowel movements per day and this is coupled with abdominal pain, a high temperature and a fast heart beat, the physician will likely eventually decide to hospitalize this patient and get a referral to a gastroenterologist. The amount of blood loss is a danger to the cardiovascular system and also undermines the immune system significantly. High dosages of corticosteroids or ACTH hormone are usually given intravenously. There may be a place of medications that modulate the immune system such as azathioprine(Imuran) or mercaptopurine (brand name: Purinethol). These medications are known to suppress cytotoxic T lymphocytes, which is known to ultimately lead to a response in ulcerative colitis and Crohn’s disease (see Ref.12).

Another such medications is cyclosporine, which can lead to an 80% response rate.

After another 6 months of oral cyclosporine and a switch to azathioprine or mercaptopurine maintenance long term remissions of 50 to 60% in these severe cases can be achieved (Ref. 13). Cases that do not respond have to be carefully monitored in an ICU setting and possible urgent surgery to control the bleeding situation may have to be considered as mentioned under “complications” under the “symptom” heading. Even if these patients who have a more severe form of ulcerative colitis recover and stabilize, a higher percentage of them will likely need an elective total colectomy, because they have more invasive disease with a higher colon cancer rate. Unfortunately at the present time there is no gentler therapy.

 Treatment Of Ulcerative Colitis

Treatment Of Ulcerative Colitis

Future more specific anti-inflammatory medication

Lately there are some specific anti-inflammatory treatment modalities that have been developed. The newest classes that have been tested in Crohn’s and ulcerative colitis are the human cytokines (interleukin-11) and the anti-cytokine antibodies (anti-tumor necrosis factor or anti-TNF). Ref. 22-25 deal with interleukin-11. Ref. 26 describes among other medications the use of infliximab, a chimeric antibody targeting the anti-TNF, which has done very well in preliminary clinical trials and early postmarketing experience. However, additional clinical trials are needed to show long-term safety and adverse effects of the medication.


1. M Frevel Aliment Pharmacol Ther 2000 Sep (9): 1151-1157.

2. M Candelli et al. Panminerva Med 2000 Mar 42(1): 55-59.

3. LA Thomas et al. Gastroenterology 2000 Sep 119(3): 806-815.

4. R Tritapepe et al. Panminerva Med 1999 Sep 41(3): 243-246.

5. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse       Station, N.J., 1999. Chapters 20,23, 26.

6. EJ Simchuk et al. Am J Surg 2000 May 179(5):352-355.

7. G Uomo et al. Ann Ital Chir 2000 Jan/Feb 71(1): 17-21.

8. PG Lankisch et al. Int J Pancreatol 1999 Dec 26(3): 131-136.

9. HB Cook et al. J Gastroenterol Hepatol 2000 Sep 15(9): 1032-1036.

10. W Dickey et al. Am J Gastroenterol 2000 March 95(3): 712-714.

11. M Hummel et al. Diabetologia 2000 Aug 43(8): 1005-1011.

12. DG Bowen et al. Dig Dis Sci 2000 Sep 45(9):1810-1813.

13. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse  Station, N.J., 1999.Chapter 31, page 311.

14. O Punyabati et al. Indian J Gastroenterol 2000 Jul/Sep 19(3):122-125.

15. S Blomhoff et al. Dig Dis Sci 2000 Jun 45(6): 1160-1165.

16. M Camilleri et al. J Am Geriatr Soc 2000 Sep 48(9):1142-1150.

17. MJ Smith et al. J R Coll Physicians Lond 2000 Sep/Oct 34(5): 448-451.

18. YA Saito et al. Am J Gastroenterol 2000 Oct 95(10): 2816-2824.

Further references

19. M Camilleri Am J Med 1999 Nov 107(5A): 27S-32S.

20. CM Prather et al. Gastroenterology 2000 Mar 118(3): 463-468.

21. MJ Farthing : Baillieres Best Pract Res Clin Gastroenterol 1999 Oct 13(3): 461-471.

22. D Heresbach et al. Eur Cytokine Netw 1999 Mar 10(1): 7-15.

23. BE Sands et al. Gastroenterology 1999 Jul 117(1):58-64.

24. B Greenwood-Van Meerveld et al.Lab invest 2000 Aug 80(8):1269-1280.

25. GR Hill et al. Blood 2000 May 1;95(9): 2754-2759.

26. RB Stein et al. Drug Saf 2000 Nov 23(5):429-448.

27. JM Wagner et al. JAMA 1996 Nov 20;276 (19): 1589-1594.

28. James Chin, M.D. Control of Communicable Diseases Manual. 17th ed., American Public Health Association, 2000.

29. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 157, page1181.

30. Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages 976-983: “Chapter 107 – Acute Abdomen and Common Surgical Abdominal Problems”.

31. Marx: Rosen’s Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:”Abdominal pain”.

32. Feldman: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002 Elsevier, p. 71: “Chapter 4 – Abdominal Pain, Including the Acute Abdomen”.

33. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

34. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

35. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008

Last modified: September 1, 2018

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.