Ulcerative Colitis: Treatment
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Treatment for ulcerative colitis addresses the under-lying inflammation, as well as the problems occurring due to continued diarrhea and blood loss.
Inflammation is treated with a drug called sulfasalazine, Sulfasalazine is made up of two parts. One part is related to the sulfa antibiotics; the other part is a form of the anti-inflammatory chemical salicylic acid (related to aspirin). Sulfasalazine is not well-absorbed from the intestine, so it stays mostly within the intestine, where it is broken down into its components. It is believed to be primarily the salicylic acid component that is active in treating ulcerative colitis, by fighting inflammation. For patients who do not respond to sulfasalazine, steroid medications (such as prednisone) are the next choice.
Depending on the degree of blood loss, a patient with ulcerative colitis may require blood transfusions and fluid replacement through a needle in the vein (intra-venous or IV). Medications that can slow diarrhea must be used with great care, because they may actually cause the development of toxic megacolon.
A patient with toxic megacolon requires close monitoring and care in the hospital. He or she will usually be given steroid medications through an IV, and may be put on antibiotics. If these measures do not improve the situation, the patient will have to undergo surgery to remove the colon. This is done because the risk of death after perforation of toxic megacolon is greater than 50%.
Similarly, a patient with proven cancer of the colon, or even a patient who shows certain signs thought to indicate a precancerous condition, will need his or her colon removed. Removal of the colon is called a colectomy. When a colectomy is performed, a piece of the small intestine (ileum) is pulled through an opening in the abdomen. This bit of intestine is fashioned surgically to allow a special bag to be placed over it, in order to catch the body's waste (feces) which no longer can be passed through the large intestine and out of the anus. This opening, which will remain for the duration of the patient's life, is called an ileostomy.
— Rosalyn Carson-DeWitt, MD
