Best prescription treatments for colitis

Introduction

Ulcerative colitis is a chronic inflammatory bowel disease that affects the lining of the large intestine, causing symptoms such as abdominal pain, diarrhea, and rectal bleeding. 1 This condition is difficult to manage, so it’s important to get professional treatment. In this article, we will explore various approaches to managing colitis, including dietary changes, medications, lifestyle changes, alternative therapies, and surgeries.

Dietary Management for Colitis

Diet plays an important role in managing colitis symptoms. While there is no one-size-fits-all diet for people with colitis, certain dietary changes can help reduce inflammation and improve symptoms. Some foods to avoid include high-fiber foods, spicy foods, and dairy products, as they may make symptoms worse. 2 On the other hand, foods rich in omega-3 fatty acids, such as fatty fish, and probiotic-rich foods like yogurt and kefir may help reduce inflammation. 3

Specific diets, such as the low-FODMAP diet and the Mediterranean diet, can help manage colitis symptoms. The low-FODMAP diet limits fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are short-chain carbohydrates that your gut has a hard time absorbing. 4 The Mediterranean diet, rich in fruits, vegetables, whole grains, and healthy fats, can help reduce inflammation and improve gut health. 1

Medication Options for Colitis Relief

Medications can help you manage colitis symptoms and induce remission. Several classes of medications are used to treat colitis, each targeting different aspects of inflammation.

• Aminosalicylates (5-ASAs) are often used for mild to moderate colitis. These medications reduce inflammation in the lining of the colon and can be taken orally or rectally. 5 Mesalamine and sulfasalazine are both 5-ASAs.
• Corticosteroids, such as prednisone, are powerful anti-inflammatory drugs used to treat moderate to severe colitis flares. While they quickly and reliably reduce inflammation, long-term use of corticosteroids can cause significant side effects. These are mainly used short-term and not for maintenance. 6
• Immunosuppressants, such as azathioprine and 6-mercaptopurine, suppress the immune system's response, reducing inflammation. These medications are often used when 5-ASAs and corticosteroids are ineffective or not well-tolerated. 7
• Biologics are a newer class of medications that target specific proteins involved in inflammation. Examples include infliximab, adalimumab, and vedolizumab. These medications are typically used for moderate to severe colitis that has not responded to other treatments. 8

Lifestyle Changes to Manage Colitis Symptoms

In addition to dietary changes and medication, lifestyle changes can play a significant role in managing colitis symptoms. Stress is a well-known trigger for colitis flares, so stress management techniques, such as deep breathing, meditation, and yoga, are important. 9 Regular exercise and physical activity can also help reduce stress and improve overall well-being.

Avoiding triggers, such as smoking and nonsteroidal anti-inflammatory drugs (NSAIDs), can help manage colitis symptoms. Smoking raises your risk of developing colitis and can worsen symptoms in those already diagnosed. 10 NSAIDs, such as ibuprofen and naproxen, can irritate the lining of the gut and make colitis symptoms worse as well. 11

Alternative Therapies for Colitis Treatment

While conventional medical treatments are the main way to manage colitis, some people may benefit from alternative therapies in addition. Probiotics and prebiotics may promote a healthy gut microbiome and reduce inflammation. Probiotics are live beneficial bacteria that can help restore balance to the gut, while prebiotics are non-digestible fibers that serve as food for these beneficial bacteria. 12

Herbal remedies and supplements, such as aloe vera, curcumin, and boswellia, may help reduce inflammation and improve colitis symptoms. 13 However, it is important to consult with a healthcare provider before using any herbal remedies or supplements, as they may interact with medications or have potential side effects.

Acupuncture and mind-body practices, such as mindfulness and cognitive-behavioral therapy, may help manage stress and improve overall well-being. 14 These practices can be used in conjunction with conventional medical treatments to holistically manage colitis.

Surgical Interventions for Severe Colitis

For people with severe or treatment-resistant colitis, surgery may be needed. Surgery is typically considered when medications aren’t effective or when complications, such as severe bleeding or toxic megacolon, develop. 12

The most common surgical procedure for colitis is a colectomy, which involves removing the entire colon. There are two main types of colectomies. A total colectomy with end ileostomy is where the end of the small intestine is brought through the abdominal wall to create a stoma for waste removal. A restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA), where a pouch is created from the small intestine and connected to the anus, which allows for waste excretion through the anus. 15

While surgery can cure colitis, it comes with risks. Complications can include infection, bleeding, and anastomotic leaks. Recovery from surgery can be lengthy, and people may need to adapt to life with a stoma or a J-pouch. 16

Conclusion

Managing colitis uses a multifaceted approach that includes dietary changes, medication, lifestyle changes, and in some cases, surgical intervention. Working closely with a healthcare team to develop a personalized treatment plan can help you achieve and maintain remission. People living with colitis are encouraged to take an active role in their care, staying informed about their condition and advocating for their needs. With the right combination of treatments and support, it is possible to effectively manage colitis symptoms and improve quality of life.

Citations:

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