Ask the Expert: Can You Cure Ulcerative Colitis?

There is no known medication that can cure ulcerative colitis (UC). The only cure is surgery to remove the colon along its entire length and the rectum.

This surgery can come with risks and is reserved for people who don’t respond to medication.

Other treatments are available to significantly minimize symptoms of the disease and help put UC into remission for the long term. However, they won’t cure the condition.

Researchers are looking at other treatment options and potential cures for UC.

Two of the newest UC medications developed in the last couple of years include biosimilar medications and Janus kinase (JAK) inhibitors.

Biosimilar medications contain copies of the antibodies used in a common type of UC medication referred to as biologics. Those antibodies help the body stop production of some proteins that can cause inflammation.

Severe cases of UC can be treated with a JAK inhibitor called tofacitinib (Xeljanz). It helps block certain enzymes that can trigger inflammation.

Research is ongoing as to whether other therapeutics, such as stem cell therapy and stool transplant, can treat or cure UC.

It is my firm belief that there will be major improvements to UC management within the next decade.

We aren’t quite sure what causes UC. We used to think that diet and stress were possible causes, but now we think of these as triggers that can aggravate symptoms rather than acting as causes.

Immune system dysfunction may be a potential cause of UC. An abnormal immune response against invading pathogens may cause damage to the gut.

Genes may also contribute to the development of UC, as the disease is more common in people with a family history of it.

UC can range from being a debilitating illness to causing fatal complications. The symptoms can vary depending upon the level of inflammation and site of the lesion.

The majority of people with UC tend to develop mild to moderate symptoms such as:

• diarrhea
• rectal pain and bleeding
• abdominal pain
• fatigue
• urgency to defecate

In a small number of cases, people with UC may develop severe complications such as major bleeding, colonic perforation, skin and eye issues, colonic malignancy, and thrombosis.

There are a variety of factors that can determine whether a specific medication can be effective at treating UC. Here are the most common medications for UC:

• 5-amino salicylic acid (5-ASA): This is the first-line treatment for UC. Commonly used medications are sulfasalazine, mesalamine, balsalazide, and olsalazine. The particular 5-ASA medication prescribed to a person with UC depends on the area of the colon that’s affected by the condition.
• Corticosteroids: Corticosteroids, such as prednisone and budesonide, are another treatment for UC. These drugs cause significant side effects when used for longer periods, so they’re used only for moderate to severe illness.
• Immunomodulators: These medications minimize inflammation by controlling the immune response. Some common examples include cyclosporine, which is only used in short durations, as well as azathioprine and mercaptopurine. These two medications can cause side effects in the liver and require close monitoring of the blood by a physician.
• JAK inhibitors: The JAK inhibitor tofacitinib (Xeljanz) was approved recently for use in UC. It blocks an enzyme that can trigger inflammation.
• Biologics: Infliximab, adalimumab (Humira), and golimumab (Simponi) work by neutralizing proteins produced by the immune system. Another biologic, vedolizumab (Entyvio), targets the gut and helps reduce inflammation.

Untreated UC may progress over time, potentially becoming difficult to treat later on.

Treating UC can help minimize the risk of developing serious complications, including:

• severe bleeding
• perforation of the colon
• vision loss
• skin lesions
• dilation of the colon
• colorectal cancer
• thrombosis

UC can lead to life threatening complications. Warning signs that you may need to go to the hospital include:

• severe abdominal pain
• high fever
• abdominal distension
• dehydration
• an abrupt reduction in the frequency of bowel movements

This may require early hospital admission and treatment with fluids and electrolytes, along with nutritional support if required.

Ulcerative colitis can be managed with treatment. It generally won’t alter the life expectancy of most people.

Most people with UC experience acute flares of symptoms during their lifetime. But with treatment, the disease can enter remission, during which symptoms go away.

Remission may last for weeks or even years. The longer the period of remission, the better a person’s general health becomes.

Dr. Saurabh Sethi is a board certified physician specializing in gastroenterology, hepatology, and advanced interventional endoscopy. In 2014, Dr. Sethi completed his gastroenterology and hepatology fellowship at Beth Israel Deaconess Medical Center at Harvard Medical School. Soon after, he completed his advanced endoscopy fellowship at Stanford University in 2015. Dr. Sethi has been involved with multiple books and research publications, including over 30 peer-reviewed publications. Dr. Sethi’s interests include reading, blogging, traveling, and public health advocacy.