Treatments for Ulcerative Colitis (UC): What You Need to Know

Ulcerative colitis (UC) is a condition that causes inflammation in the colon (large intestine), which can lead to symptoms such as diarrhea, rectal bleeding, and abdominal pain. While it’s a chronic, or long-term, condition without a cure, many people can manage their symptoms and feel better with the right treatment.

Resource editors spoke with Ronen Arai, M.D., a gastroenterologist who specializes in Inflammatory Bowel disease (IBD). Dr. Arai explained some of the most common – and newest – treatments for UC.

Resource: What are 5-ASAs and how do they help ulcerative colitis?

Dr. Arai: One of the most common treatments for UC is a class of medicines called 5-ASAs, or mesalamine. Approved by the U.S. Food & Drug Administration (FDA) in the 1980s, 5-ASAs are effective in relieving symptoms for people with mild to moderate UC. They reduce symptoms and can help heal the inside lining of the colon.

There are two ways 5-ASAs can be taken – orally, as a pill, or through the rectum, as a suppository or enema. There isn’t one type of 5-ASA that’s better than another. The most important thing is getting the right amount – usually around 4.8 grams a day.

Resource: What happens when ulcerative colitis is more severe?

Dr. Arai: For people with more serious UC, there are several medications available and many of these became available in the last several years. These include:

• TNF inhibitors (Remicade, Humira, Simponi)
• Integrin inhibitors (Entyvio)
• S1P modulators (Zeposia and Velsipity)
• JAK inhibitors (Xeljanz and Rinvoq)
• Interleukin blockers (Stelara, Skyrizi, Tremfya, Omvoh)

These medicines are immune suppressants and they help control the immune system to stop it from attacking the colon. They are used when basic treatments like 5-ASAs aren’t enough.

Resource: When Is surgery needed for ulcerative colitis?

Dr. Arai: Sometimes, medications don’t work, or they stop working, and surgery may be the best option to prevent disease complications. Another indication for surgery is the development of colon cancer, the risk of which is increased in patients who suffer from long-term untreated UC. Surgery usually entails removal of the colon and rectum. This can be considered a cure for UC but it comes with changes. Following surgery, the patient will need a permanent bag outside the body (ileostomy) or a special pouch made inside the body to function as a new rectum.

Resource: What about steroids and older medicines for ulcerative colitis?

Dr. Arai: Doctors may also use steroids such as prednisone to quickly calm UC symptoms. These have been around for a long time and help relieve symptoms while waiting for other medicines to take effect.

Another group of medicines, called immunomodulators, has been used since the 1980s. They take longer to work but help some people reach remission, the point at which symptoms go away. There are no new drugs in this group but they are still helpful in many cases.

Resource: What is your advice to patients with ulcerative colitis?

Dr. Arai: Ulcerative colitis is a tough disease but there are many ways to manage it. Thanks to newer medicines and better treatments, people with UC have more options than ever before. The goal is to help patients feel better, get control of the inflammation in their colon (healing), stay healthy and live full lives.

Ronen Arai, M.D., a gastroenterologist with Baptist Health who specializes in Inflammatory Bowel disease (IBD)