Ulcerative colitis (UC) is an inflammatory bowel disease that mainly affects the lining of the large intestine (colon). This autoimmune disease has a relapsing-remitting course, which means that periods of flare-ups are followed by periods of remission.
Right now, there’s no medical cure for UC. Current medical treatments aim to increase the amount of time between flare-ups and to make flare-ups less severe. This may include a variety of medications or surgeries.
Still, UC research continues to explore other methods to decrease the inflammation associated with this autoimmune disease. Learn more about the new UC treatments that have recently come out on the market, as well as emerging therapies that could be other options in the future.
Two new types of medications for UC have emerged in recent years: biosimilars and Janus kinase (JAK) inhibitors.
Biosimilars are a newer class of UC medications. These are copies of the antibodies used in a common type of UC medication called biologics.
Biologics are protein-based therapies that help moderate to severe UC by using antibodies to try to control the inflammatory process.
Biosimilars work in the same way as biologics. The only difference is that biosimilars are copiesof the antibodies used in biologics, and not the originator drug.
Examples of biosimilars include:
- adalimumab-adbm (Cyltezo)
- adalimumab-atto (Amjevita)
- infliximab-abda (Renflexis)
- infliximab-dyyb (Inflectra)
- infliximab-qbtx (Ixifi)
In 2018, the FDA approved a new type of JAK inhibitor for severe UC called tofacitinib (Xeljanz). Tofacitinib is the first oral medication used for the treatment of severe UC. It was previously approved for the treatment of rheumatoid and psoriatic arthritis.
Xeljanz works by blocking JAK enzymes to help control inflammation. Unlike other combination therapies, this medication isn’t intended to be used with immunosuppressants or biologics.
Aside from medications, researchers are looking into the possibility of other treatment measures to help prevent and treat gastrointestinal inflammation caused by UC.
Clinical trials are also ongoing in the following emerging treatments:
- stem cell therapy, which may help the immune system reset to decrease inflammation and lead to tissue repair
- stool transplant (also called a fecal transplantation), which involves the implantation of healthy stools from a donor to help restore a healthy gut microbiome
- cannabis, which may help decrease overall body inflammation — including the inflammation associated with UC
Current treatment for UC involves a combination of medications or corrective surgeries. Talk to your doctor about the following options.
Medications for UC
There are a number of medications used for the treatment of UC, each having the goal of controlling inflammation in the colon to stop tissue damage and manage your symptoms.
Established medications tend to be most helpful for mild to moderate UC. Your doctor may recommend one or a combination of the following:
- aminosalicylates (5-ASA)
It’s estimated that up to one-third of people with UC will eventually need surgery. The symptoms typically associated with UC — such as cramping, bloody diarrhea, and inflammation of the bowel — can be stopped with surgery.
The removal of the entire large intestine (total colectomy) will stop the UC colon symptoms completely.
However, a total colectomy is associated with other adverse effects. Because of this, a partial colectomy is sometimes performed instead, where only the diseased part of the colon is removed.
Of course, surgery isn’t for everyone. A partial or total colectomy is usually reserved for those who have severe UC.
Bowel resection surgery may be an option for those who have not responded well to medical therapy for UC. This is typically after years of medical therapy, in which side effects or decreased ability of the medications to control the disease have led to a poor quality of life.
Partial or total colon resection
In a total resection, the entire large intestine is removed. While this is the only true cure for UC, it can reduce quality of life.
In a partial resection, colorectal surgeons remove the diseased region of the colon with a margin of healthy tissue on either side. When possible, the two remaining ends of the large intestine are surgically united, reconnecting the digestive system.
When this can’t be done, the bowel is routed to the abdominal wall and waste exits the body in an ileostomy or colostomy bag.
With modern surgical techniques, it’s potentially possible to reconnect the remaining bowel to the anus, either during the initial resection surgery or after a healing period.
While surgery is often delayed until UC becomes severe or dysplastic changes trending to the point of cancer have occurred, some people may require emergent large bowel removal surgery because the risk of keeping the diseased bowel is too great.
People with UC may need emergent surgery if they experience:
- toxic megacolon (life threatening dilation of the large intestine)
- uncontrolled bleeding within the large intestine
- colon perforation
Having emergency surgery poses a greater number of risks and complications. It’s also more likely that patients undergoing emergency surgery will at least temporarily need an ileostomy or colostomy.
Possible complications from surgery
Part of bowel surgery involves creating a pouch near the anus, which collects waste prior to defecation.
One of the complications of surgery is that the pouch can become inflamed, which causes diarrhea, cramps, and fever. This is called pouchitis, and it can be treated with an extended course of antibiotics.
The other main complication of bowel resection is small bowel obstruction. A small bowel obstruction is first treated with intravenous fluid and bowel rest (and possibly nasogastric tube suction for decompression). However, a severe small bowel obstruction may need to be treated with surgery.
Although surgery may cure the gastrointestinal symptoms of UC, it may not always cure other affected sites. Occasionally, people with UC have inflammation of the eyes, skin, or joints.
These types of inflammation may persist even after the bowel has been totally removed. While this is uncommon, it is something to consider before getting surgery.
While there’s no medical cure for UC, new medications may help decrease the number of flare-ups while increasing your overall quality of life.
When UC is overly active, surgery may be required to help correct the underlying inflammation. This is the only way that UC may be “cured.”
At the same time, alternate facets of UC treatment are continually being studied for possible cures. This includes other types of surgery, as well as alternative therapies, like cannabis.
Until there is a medical cure, it’s important to be aggressive with preventing your flare-ups so you can prevent tissue damage. Talk to your doctor about your options to see what can work best for you.