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How Treatment Decisions Are Made for Ulcerative Colitis
Answer each question to learn about ulcerative colitis medications and how your doctor will decide the right course of treatment for you. By Jen Laskey | Medically reviewed by Bret Lashner, MD
RESULT:
Learn more in our ulcerative colitis guide.
Last updated 3/27/14
Have you been diagnosed with
ulcerative colitis?
Are you currently experiencing a flare?
Symptoms of ulcerative colitis include multiple bowel movements each day, abdominal cramping, diarrhea, a constant urge to use the toilet, and blood in the stools. How would you describe your current symptoms?
Moderate
Severe
MILD ULCERATIVE COLITIS WITH FLARE
Recommendations: Oral and topical 5-ASA agents (enemas and suppositories).

The treatment for an ulcerative colitis flare is typically determined by the severity of the symptoms. If the symptoms are mild, the treatment regimen may involve:

Aminosalicylates (5-ASAs).“If the disease is limited to the rectum or rectum and sigmoid colon, we usually start with aminosalicylates (5-ASA agents), both orally and rectally administered,” says Joseph David, MD, of Arizona Digestive Health, in Phoenix. Michael Mills, MD, also of Arizona Digestive Health, explains that 5-ASAs are used both to induce remission, which is when the patient no longer experiences active symptoms of the disease, and to maintain it.

Other medications.In mild cases of ulcerative colitis, antidiarrheals may be used to slow diarrhea. Dr. David says that pain relievers may be used, but usually only for short periods while a flare is being treated with medications meant to induce remission.

The good news, according to Dr. Mills, is that people who are experiencing mild ulcerative colitis flares often respond appropriately to the basic regimen and don’t require additional medications.

if there are any changes in your condition.

MODERATE ULCERATIVE COLITIS WITH FLARE
Recommendations: Corticosteroids, oral and topical 5-ASA agents (enemas and suppositories).

The treatment for an ulcerative colitis flare is typically determined by the severity of the symptoms. If the symptoms are moderate, the treatment regimen may involve:

Initial medications.Aminosalicylates (5-ASAs) may be used first to help control inflammation during a moderate flare. Michael Mills, MD, of Arizona Digestive Health, in Phoenix, explains that 5-ASAs can be used both to induce remission, which is when the patient no longer experiences active symptoms of the disease, and to maintain it.

“If the disease is limited to the rectum or rectum and sigmoid colon, we usually start with 5-ASAs, both orally and rectally administered,” says Joseph David, MD, also of Arizona Digestive Health. Glucocorticoid enemas can also be used, but Dr. David says that research suggests the topical (rectally administered) 5-ASAs are superior.

Other treatment options.“For moderate cases,” says Dr. Mills, “we typically start off with the basics for three to four weeks, and then we may try additional therapies, such as a course of steroids. We may also consider an immunomodulator to help reduce inflammation and get the patient into remission.” Immunomodulators work by weakening or modifying the immune system, but they can take weeks or months to kick in. For this reason, they are often used alongside steroids until symptoms subside.

Pain relievers may be added, but David points out that they're usually only used for short periods while a flare is being treated with other medications meant to induce remission.

if there are any changes in your condition.

In addition to other symptoms, you may experience:
  • Fatigue
  • Dehydration
  • Feeling extremely ill
  • Significant weight loss
  • Severe abdominal pain
  • Fever
Do you have any of these symptoms?
MODERATE TO SEVERE ULCERATIVE COLITIS WITH FLARE
Recommendations: 5-ASAs, corticosteroids, and possibly an immunomodulator. Biologics may be recommended if the patient does not respond to standard therapies.

The treatment for an ulcerative colitis flare is typically determined by the severity of the symptoms, explains Michael Mills, MD, of Arizona Digestive Health, in Phoenix.

Joseph David, MD, also of Arizona Digestive Health, says that the treatment for a moderate to severe condition depends on whether the disease is limited to the rectum or the rectum and sigmoid colon, or if the disease is extensive or involves the entire colon (pancolitis). The treatment may include:

Aminosalicylates (5-ASAs) and corticosteroids.These medications may be used to help control inflammation.

“If the disease is limited to the rectum or rectum and sigmoid colon, we usually start with 5-ASAs, both orally and rectally administered,” Dr. David says. Glucocorticoid enemas can also be used, he says, but adds that research suggests the topical (rectally administered) 5-ASAs are superior.

“When the disease is extensive or involves entire-colon inflammation (pancolitis),” explains David, “oral 5-ASAs are used in conjunction with topical agents. Oral and/or topical glucocorticoids are recommended for nonresponders to induce remission.” (Remissionrefers to a period when the patient no longer experiences active symptoms of the disease.)

What’s next?“For moderate cases, we typically start with the basics for three to four weeks,” says Dr. Mills, “and then we may try additional therapies, such as a course of steroids and an immunomodulator to help reduce inflammation and get the patient into remission.”

Immunomodulators work by weakening or modifying the immune system, but they can take weeks or months to kick in. For this reason, they are often used alongside steroids until symptoms subside.

Pain relievers may be added, but David points out that they're usually only used for short periods while a flare is being treated with other medications meant to induce remission.

Biologics.“If a person with moderate ulcerative colitis doesn’t respond to the standard therapies for treating flares,” says Mills, “we may consider using biologics.” Biologic agents inhibit a specific part of the immune system, such as tumor necrosis factor-alpha (TNF-alpha), a pro-inflammatory protein that circulates in high levels in states of severe inflammation; they are generally reserved for treating severe ulcerative colitis.

if there are any changes in your condition.

FULMINANT COLITIS WITH FLARE
Recommendations: 5-ASAs, corticosteroids, an immunomodulator, biologics, and hospitalization may be used to manage a severe flare.

The treatment for an ulcerative colitis flare is typically determined by the severity of the symptoms. Fulminant colitis, a particularly severe form of ulcerative colitis, is likely to warrant initial strong therapies, such as biologics, to gain control of the disease. These therapies tend to be the most costly and risky medications, and they may have serious side effects.

Corticosteroids and aminosalicylates (5-ASAs).In severe cases, oral steroids — usually in conjunction with oral 5-ASA agents — are used to try to induce remission, the state in which a patient is no longer experiencing active symptoms of the disease. “If these fail,” says Joseph David, MD, of Arizona Digestive Health, in Phoenix, “patients are generally hospitalized for IV steroid therapy.”

Biologics.If there is no response after a week to 10 days of treatment, Dr. David says that patients are likely to be treated with biologics. Biologic agents inhibit a specific part of the immune system, such as tumor necrosis factor-alpha (TNF-alpha), a pro-inflammatory protein that circulates in high levels in states of severe inflammation.

Surgery.“Depending on the degree of severity or the relative risk of a life-threatening circumstance, and in cases of a lack of responsiveness, surgery may be considered on an acute, urgent basis,” says Michael Mills, MD, also of Arizona Digestive Health.

Next steps.Once remission is achieved, people with severe ulcerative colitis, or fulminant colitis, are generally encouraged to stay on medications, like 5-ASAs, immunomodulators, and biologics, to prevent future flares.

if there are any changes in your condition.

Are you satisfied with the control of your symptoms at this time?
Ulcerative colitis symptoms include multiple bowel movements each day, abdominal cramping, diarrhea, a constant urge to use the toilet, and blood in the stools. When you experience a flare, these symptoms are typically:
Moderate
Severe
MILD ULCERATIVE COLITIS IN REMISSION
Recommendations: 5-ASAs.

“When someone with ulcerative colitis is in remission, we put them on maintenance therapy to prevent a recurrence of symptoms,” says Michael Mills, MD, of Arizona Digestive Health, in Phoenix.

“If the disease is limited to the rectum or rectum and sigmoid colon, maintenance therapy usually consists of oral aminosalicylate (5-ASA) agents,” says Joseph David, MD, also of Arizona Digestive Health. “Patients who only have involvement of the rectum may not need 5-ASAs if they flare only once a year or less. Those with disease above the rectum will need 5-ASA maintenance therapy.”

Managing your ulcerative colitis well, along with any additional health conditions you have, can make a difference in how successfully you maintain remission.

if there are any changes in your condition or if you experience a flare.

MODERATE ULCERATIVE COLITIS IN REMISSION
Recommendations: 5-ASAs, and possibly an immunomodulator.

“When someone with ulcerative colitis is in remission, we put them on maintenance therapy to prevent a recurrence of symptoms,” says Michael Mills, MD, of Arizona Digestive Health, in Phoenix.

The treatment for a moderate condition could involve:

Aminosalicylates (5-ASAs).Even during remission, your doctor may prescribe this medication to help control inflammation.

To some extent, the treatment for a moderate condition depends on whether the disease is limited to the rectum or rectum and sigmoid colon, or if it is extensive or involves inflammation of the entire colon, a condition known as pancolitis, explains Joseph David, MD, also of Arizona Digestive Health.

“Maintenance therapy usually consists of oral aminosalicylate (5-ASA) agents,” says Dr. David. “Patients who only have involvement of the rectum may not need 5-ASAs if they flare only once a year or less. Those with disease above the rectum or pancolitis need 5-ASA maintenance therapy.”

Immunomodulators.Depending on a patient’s flare and treatment history, an immunomodulator may also be considered for maintenance. Immunomodulators work by weakening or modifying the immune system and can help prevent an ulcerative colitis flare.

Managing your ulcerative colitis well, along with any additional health conditions, can make a difference in how successfully you maintain remission.

if there are any changes in your condition or if you experience a flare.

FULMINANT COLITIS IN REMISSION
5-ASAs, possibly an immunomodulator, and/or biologics.

“When someone with ulcerative colitis is in remission, we put them on maintenance therapy to prevent a recurrence of symptoms,” says Michael Mills, MD, of Arizona Digestive Health, in Phoenix.

The treatment regimen for a severe condition may involve:

Maintenance drugs.People with severe ulcerative colitis, or fulminant colitis, who are in remission are encouraged to stay on medications, like aminosalicylates (5-ASAs), immunomodulators, and biologics, to prevent future flares. The dosage of 5-ASAs, a type of anti-inflammatory drug, may be reduced to a maintenance level, but Dr. Mills says that immunomodulators and biologics are generally kept at the dose required to induce a remission.

Immunomodulators work by weakening or modifying the immune system to reduce inflammation. Biologics, which are a newer type of ulcerative colitis treatment, target a specific part of the immune system involved in the inflammatory process.

Wean off steroids.Mills points out that steroids, like prednisone, should not be continued for maintenance therapy. Patients should expect their physician to wean them off prednisone once they are in remission. “Prednisone does not prevent a flare,” says Mills, “but is used to treat a moderate to severe flare.”

Managing your ulcerative colitis well, along with any additional health conditions, can make a difference in how successfully you maintain remission.

if there are any changes in your condition or if you experience a flare.

Are you compliant with your prescribed treatment regimen?
If you're experiencing unpleasant side effects or symptoms, or if you’re frustrated with the treatment itself, talk with a gastroenterology specialist to find out if there are any alternative treatments or if any changes in your treatment can be made.
Staying compliant with your prescribed treatment is the best way to reduce the risk of a flare. Talk with a gastroenterology specialist to find out if there are any alternative treatments or if any changes can be made in your treatment to improve your experience.
Are you concerned that you may have ulcerative colitis?
NO CONCERN

This quiz has been designed for people with ulcerative colitis. If you have other digestive concerns, discuss them with your doctor or a gastroenterology specialist.






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Date: 14.12.2018, 10:46 / Views: 44384