What is the Latest Treatment for Ulcerative Colitis?

An estimated 3.1 million adults (1.3%) in the United States have been diagnosed with inflammatory bowel disease (IBD). Ulcerative Colitis is a form of chronic IBD that causes sores and irritation in the large intestine.

Suffering from Ulcerative Colitis can be frustrating, especially if treatment options fail. Patients often ask what is the latest treatment for Ulcerative Colitis in an effort to heal. In this article, we will discuss the latest treatment options for Ulcerative Colitis, including oral medications and surgical procedures. Read on to understand the disease better and learn about effective cures.

What is Ulcerative Colitis?

Ulcerative colitis is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. It affects the innermost lining of your large intestine, also called the colon, and rectum.

Types of ulcerative colitis include:

Ulcerative Proctitis: This type causes inflammation around the anus. Rectal bleeding is the most common symptom.
Proctosigmoiditis: Also known as Tenesmus, this type causes bleeding around the rectum and sigmoid colon, the lower end of the colon. Symptoms include bloody diarrhea, abdominal cramps, and pain.
Left-sided Colitis: The inflammation of this type extends from the rectum through the sigmoid and descending colon located in the upper-left abdomen. It causes stomach pain and cramping on the left side, bloody diarrhea, and weight loss.
Pancolitis: This affects the entire colon and causes severe bloody diarrhea, abdominal cramps, fatigue, and significant weight loss.

Symptoms of Ulcerative Colitis

Here are the most common symptoms of ulcerative colitis:

Pain and cramping in the abdomen
A gurgling or splashing sound heard over the intestine
Blood and pus in the stool
Diarrhea
Fever
Feeling that you need to pass stools, even though your bowels are already empty
Weight loss
Joint pain and swelling
Mouth sores (ulcers)
Nausea and vomiting
Skin lumps.

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Causes of Ulcerative Colitis

Although the exact cause behind ulcerative colitis remains unknown, here are some factors that contribute to the disease:

Autoimmune Condition: In ulcerative colitis, the immune system mistakes ‘friendly bacteria’ in the colon, which aid digestion, as a harmful infection. This leads to the colon and rectum becoming inflamed.
Genetics: You are more likely to have ulcerative colitis if you have a family history of the condition.
Environmental Factors: The condition is more common in urban areas of Western Europe and America. Air pollution also contributes to the disease.
Medications: Medicines such as Ibuprofen, Aspirin, Naproxen, and antibiotics worsen the symptoms of ulcerative colitis.
Stress: Chronic psychological stress triggers ulcerative colitis and leads to relapses.

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What is the Latest Treatment for Ulcerative Colitis?

Despite a growing number of available treatment options for ulcerative colitis, up to 50% of patients do not respond to initial treatment. Some new medications have been recently approved by the FDA for the treatment of ulcerative colitis. Here’s all you need to know about these latest treatment options for Ulcerative colitis.

Mirikizumab

Mirikizumab is an antibody that targets the p19 subunit of IL-23, a protein that causes ulcerative colitis-related inflammation. It is an effective drug used to treat moderate to severe ulcerative colitis.

“Mirikizumab is the first antibody targeting p19/interleukin-23 to be approved for the treatment of ulcerative colitis. Its performance in both induction and maintenance phases of the clinical trials is truly impressive,” said Bruce Sands, MD, a subject matter expert.

In a 2019 research study, Mirikizumab was effective in treating patients with ulcerative colitis after a 12-week period. The drug also showed durable efficacy throughout the maintenance period.

Mirikizumab injection comes as a solution to be injected intravenously (into a vein) over at least 30 minutes. Only a licensed doctor or nurse can do the process. Following is the usually prescribed dosage for adult patients:

Induction dose: 300 mg IV over at least 30 minutes at weeks 0, 4, and 8
Maintenance dose: 200 mg at week 12, and every 4 weeks thereafter.

Common side effects of Mirikizumab include:

Body aches
Chills
Cough
Diarrhea
Ear congestion
Fever
Loss of taste or smell
Loss of voice
Nausea or vomiting.

Etrasimod

Etrasimod is a once-daily, oral, sphingosine 1-phosphate (S1P) receptor modulator that has been approved by the FDA for the treatment of ulcerative colitis. It works by decreasing the action of immune cells that cause damage and inflammation of the intestine.

In patients with moderately to severely active ulcerative colitis, 2 mg Etrasimod was effective in producing clinical and endoscopic improvements.

Etrasimod has been recommended as a treatment option for moderately to severely active Ulcerative Colitis in people who:

Are aged 16 and over
Have had to stop conventional or biological treatments because of side effects
Have found that their old treatments have stopped working

Here are some side effects of Etrasimod:

Bladder pain
Bloody or cloudy urine
Blurred vision
Burning or stinging of the skin
Dark urine.

Other Treatment Options for Ulcerative Colitis

Aside from the two recently approved drugs, the following are the most commonly prescribed treatment options for those suffering from ulcerative colitis.

Immunosuppressants

Your immune response is what turns on the inflammation process in your body. When you have ulcerative colitis, that response is overactive. Immunosuppressants work by turning the immune system down. This way, they decrease the inflammation caused by ulcerative colitis.

A recent research study revealed that at six months, 53% of patients on azathioprine were able to stop taking steroids.

“These real-world data provide compelling evidence of the utility of immunosuppressive therapy in ulcerative colitis, specifically of azathioprine”, says Dr. B E Sands.

You may take one immunosuppressant, or a combination of them, as prescribed by your doctor.

Here are the most commonly prescribed immunosuppressants:

Azathioprine: Azathioprine is the most common immunosuppressant treatment for IBD. When you’re on these drugs, you may need to have regular blood tests to check on the health of your liver, kidneys, bone marrow, and pancreas. You take azathioprine in pill form once a day. In severe cases, doctors give azathioprine as a shot in a hospital.
Tofacitinib: This is a type of immunosuppressant called a Janus kinase inhibitor (JAK inhibitor). It works by blocking Janus kinase, which is an enzyme involved in increasing the inflammation process.
Cyclosporine: This is the option doctors typically turn to when you haven’t responded to other medications. It is prescribed to avoid surgery for ulcerative colitis.

Corticosteroids

Corticosteroids lower the activity of your immune system and limit the inflammation in the digestive tract. They are used as short-term treatments for ulcerative colitis flares as they reduce inflammation quickly.

Corticosteroids can be taken orally, rectally, or via an injection depending on which medication you take.

The following are the most common types of corticosteroids used in the treatment of ulcerative colitis:

Prednisone: This is one of the most common corticosteroid choices. It comes in the form of a pill.
Budesonide: This is a modified steroid your body absorbs through the small intestine and colon. Your liver processes it much faster than prednisone, lowering the risk of side effects.
Hydrocortisone: Suppositories of hydrocortisone treat inflammation in the anus and rectum. They are taken by inserting the small, round suppository into the anus, where it dissolves to deliver the drug.
Rectal foams: Rectal foams such as those containing budesonide and acetate can deliver steroids to the rectum and colon. Foams stay in the area longer so the drug has a better chance to absorb.

Because systemic steroids slow down your immune system to reduce inflammation, regular usage increases the risk of infection. Common side effects include:

Urinary tract infection
Vaginal yeast infection
Acne
Cataracts (cloudy patches in the eye)
High blood pressure
High blood sugar
Increased facial hair.

Biologics

Biologics are derived from human or animal genes. They are designed to reduce inflammation by acting on the immune system. Many biologics work by targeting a protein called tumor necrosis factor-alpha (TNF-alpha), which contributes to inflammation.

Another way biologics target inflammation is by addressing the problem of excessive white blood cells in the GI tract. They block inflammatory cells from getting to the site of inflammation.

“As inflammation is thought to be a cornerstone of ulcerative colitis, they have proved to be very effective as a treatment for certain patients,” says Donald Tsynman, MD.

The biologics that have been approved by the FDA include:

Humira (adalimumab)
Simponi (golimumab)
Remicade (infliximab)
Entyvio (vedolizumab)
Stelara (ustekinumab)

Biologics are derived from natural sources so they do not have serious side effects, such as those caused by corticosteroids.

“Biologics are much safer and stay in remission longer. The serious side effects we see are from steroids or narcotics, not biologics”, says gastroenterologist Laura E. Raffals, a subject matter expert.

However, some potential side effects of biologics include soreness at the injection site, aches and pains, fever, and increased susceptibility to infection.

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Surgical Treatment Options for Ulcerative Colitis

The standard surgical procedure to treat ulcerative colitis is a proctocolectomy. This surgery removes the large intestine.

There are two types of proctocolectomy procedures used to treat ulcerative colitis.

Proctocolectomy With Ileal Pouch-Anal Anastomosis

This procedure is commonly referred to as j-pouch surgery. It is a safe surgical option that allows stool to pass by restoring bowel function.

After the surgical procedure, you will need to wear an external ostomy pouch. The pouch is removed after the recovery period. You may initially have up to 12 bowel movements a day. Your stool may be soft or liquid and you may have a sense of urgency to pass stool. Your anal sphincter muscles will eventually strengthen, resulting in your stools being thicker and less frequent.

Inflammation of the pouch, known as pouchitis, is the most frequent complication following j-pouch surgery. Treatment typically involves the use of antibiotics.

Total Proctocolectomy with End Ileostomy

This proctocolectomy surgical procedure removes the colon, rectum, and anus, and creates an end ileostomy so that waste can exit your body into an ostomy bag.

This procedure is similar to the previous procedure, except that the ostomy bag is to be worn permanently in this case. The pouch must be emptied several times a day.

You should expect an adjustment period of up to one year to get used to the changes in your body after your proctocolectomy. You will likely be on a liquid or soft diet for the first few days after surgery.

Lifestyle Advice and Changes for Ulcerative Colitis

Living a productive life with ulcerative colitis includes some lifestyle changes that limit the symptoms of ulcerative colitis. Here are 5 lifestyle advice for ulcerative colitis.

Stress Management

There is an apparent link between stress levels and ulcerative colitis episodes, which is why regulation is important. There are several effective strategies for minimizing stress:

Meditation: Meditation techniques, such as mindfulness and progressive muscle relaxation, help regulate stress hormones, enhancing the mind-body connection.
Stretching: For those dealing with ulcerative colitis, stretching can help the muscles relax, and allow for pain regulation and proper digestive function.
Physical activity: Regular physical activity in those affected by ulcerative colitis can help regulate immune and digestive function. An NIH study showed a significant link between physical activity and regulating inflammation response.

Diet

Diet plays a key role in digestive and immune response, making it an important factor in managing symptoms of ulcerative colitis. Several dietary elements help patients:

Omega 3 fatty acids

Foods rich in Omega 3 Fatty Acids can help reduce inflammation in the colon, and in some cases, prevent the use of anti-inflammatory drugs. An NIH study confirms that administering fish oil to patients can reduce their need for anti-inflammatory medications in some cases.

Foods such as salmon, trout, chia seeds, and walnuts are rich in omega-3 fatty acids.

Refined grains

Refined grains such as white rice, oatmeal, white pasta, and potatoes should be incorporated into the diet as they are easily digested by the body. This helps patients with ulcerative colitis flares to prevent irritability of the colon.

It is equally important to include other dietary elements in the food plan such as vegetables, fruits, and proteins. This allows patients to maintain a balanced diet.

Foods to Avoid

Carbonated drinks: These irritate the digestive tract and hamper digestive function.
Alcohol: Consumption increases symptoms such as pain in the abdomen and diarrhea.
Dairy: It is difficult for patients to digest the lactose contained in dairy foods such as milk, yogurt, and ice creams.
Processed foods: Ready-to-consume foods contain harmful preservatives and can cause inflammation easily.

Sleep

Ample sleep is necessary for the immune system to work efficiently. Disruption and irregularity in sleep can make patients more susceptible to flare episodes, amongst other infections.

Studies by the NIH have shown a clear connection between sleep deprivation and elevated levels of inflammation-inducing proteins in the body, highlighting the significant relationship between sleep and inflammation.

Quality sleep can diminish stress levels, which are closely correlated to ulcerative colitis symptoms and can trigger flares within patients. The hormones responsible for stress are regulated through a proper night’s sleep.

To enhance sleep quality, patients might use Melatonin and Valerian root supplements, in addition to maintaining a healthy and consistent sleep schedule.

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Herbal Remedies for Ulcerative Colitis

The antioxidant and anti-inflammatory effects of herbal remedies have proven to be effective in treating ulcerative colitis. Here are some effective herbal treatment options.

Ginseng

An NIH study conducted on American Ginseng showed that ginseng extracts prevented colitis, as it prevents inflammation and ulceration. Ginseng extract modulates the immune system, decreases stress levels, and supports cognitive activity, all of which are important in battling IB diseases.

Here are 3 ways to consume ginseng:

Ginseng roots: You can peel and chew raw ginseng roots. You can also boil the root to make tea.
Add ginseng to foods: You can add ginseng to soups, yogurt, oatmeal, stir-fried dishes, and smoothies.
Ginseng supplements: Ginseng supplements are available in the form of pills. The recommended daily dose of ginseng supplements is 200 milligrams.

Boswellia

Boswellia is a natural plant that reduces inflammation and contains key enzymes for those suffering from ulcerative colitis. This resin regulates immune responses within patients and prevents tissue damage and inflammation. This is due to its properties of strengthening the intestinal barriers to keep irritable substances from entering the bloodstream.

A clinical trial by the NCBI linked boswellia use with significant improvement in treating Ulcerative Colitis.

The Arthritis Foundation recommends taking approximately 300–400 milligrams (mg) of boswellia three times per day. It is safe to take capsules that contain 60% boswellic acid as it is the active ingredient.

Common side effects of boswellia include:

Nausea
Acid reflux
Diarrhea
Skin rashes
Increased menstrual flow in women.

Bromelain

Bromelain, an enzyme found in pineapples, can aid with ulcerative colitis symptoms. It is known for being rich in antioxidants. It provides digestive aid and regulation. For those affected by the disease, bromelain might be taken with meals for effective digestion.

A 2009 research study confirmed that oral bromelain can decrease inflammation in ulcerative colitis.

Side effects from bromelain are generally mild and include:

Nausea and vomiting
Diarrhea
Excessive menstrual bleeding

Acupuncture

Acupuncture, a traditional Chinese therapy that involves the insertion of thin needles into pressure points, is an effective remedy to treat inflammatory bowel disease. The improved blood circulation and regulation of immune properties reduce inflammation and prevent the need for surgical intervention.

Different types of acupuncture therapies include:

Auricular acupuncture: This style of acupuncture involves the use of acupuncture points on the ear.
Korean acupuncture: Practitioners of this style use fewer needles.
Cupping therapy: Local suction is created on the skin with the application of heated cups.

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Key Takeaways

Ulcerative colitis is a type of inflammatory bowel disease that causes inflammation and ulcers in the digestive tract, specifically the colon and rectum.
The common types include Ulcerative Proctitis, Proctosigmoiditis, Left-sided Colitis, and Pancolitis.
Symptoms range from abdominal pain and cramping to severe bloody diarrhea and weight loss, significantly impacting quality of life.
Factors like autoimmune reactions, genetics, environmental triggers, and stress can trigger symptoms.
New FDA-approved drugs like Mirikizumab and Etrasimod offer hope by targeting specific inflammatory pathways.
Other treatment options include immunosuppressants, corticosteroids, and biologics.
For severe cases, surgical options like proctocolectomy with ileal pouch-anal anastomosis or end ileostomy are available.
Effective management also involves lifestyle adjustments such as stress management, dietary changes, herbal remedies, or acupuncture.

Frequently Asked Questions

What causes ulcerative colitis to get worse?

Certain triggers can exacerbate ulcerative colitis, including stress, certain medications (like NSAIDs), infections, antibiotics, and consuming foods that irritate the bowel such as dairy, spicy foods, or high-fiber products.

Is there a once-daily pill for ulcerative colitis?

Yes, there are once-daily oral medications available for ulcerative colitis, such as mesalamine, and newer options like Etrasimod, which help manage inflammation and symptoms.

What is the fastest way to calm ulcerative colitis symptoms?

The quickest method to relieve symptoms is through corticosteroids, which reduce inflammation rapidly. For immediate symptom management, rectal forms of steroids like foams or suppositories can act directly on the affected area.

What is the best anti-inflammatory for ulcerative colitis?

Biologics are the most effective anti-inflammatory drugs for ulcerative colitis, targeting specific parts of the immune system to reduce inflammation without the broad side effects of steroids. Examples include infliximab and adalimumab.

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What is the Latest Treatment for Ulcerative Colitis?

Table of Contents

What is Ulcerative Colitis?

Symptoms of Ulcerative Colitis

Causes of Ulcerative Colitis