What Is the Best Treatment for Ulcerative Colitis?

Ulcerative colitis is a type of inflammatory bowel disease (IBD) that causes inflamed sores on the colon or large intestine. The best treatment for ulcerative colitis depends on the severity of the condition. Treatment typically includes medications to reduce symptoms. Surgery or surgical removal of the colon is reserved for severe cases and is the only permanent cure for ulcerative colitis.

Ulcerative colitis is a type of inflammatory bowel disease (IBD) in which the large intestine (colon) becomes chronically inflamed with sores. Ulcerative colitis typically affects the lower part of the colon and the rectum, but it can affect the entire colon. 

Another type of IBD is Crohn’s disease, which differs from ulcerative colitis in that it can affect any part of the gastrointestinal tract from the mouth to the anus. 

The best treatment for ulcerative colitis depends on the severity of the condition and how often a patient’s symptoms flare-up (worsen). Treatment is aimed at reducing symptoms, inducing remission (which is a period without symptoms), and maintaining remission.

Medications are usually used to treat ulcerative colitis to induce or maintain remissions and improve quality of life. 

Medications used to treat ulcerative colitis include:

• Anti-inflammatory drugs 
  • Aminosalicylates (also called 5-ASAs) are used help to reduce inflammation and allow damaged tissue to heal
    • 5-ASAs are usually the first treatment option for mild or moderate ulcerative colitis
    • Mesalamine (Asacol, Pentasa, Rowasa, Lialda, Apriso)
    • Olsalazine (Dipentum)
    • Balsalazide (Colazal)
  • Systemic corticosteroids (prednisone, prednisolone, cortisone)
    • Also used to reduce inflammation, corticosteroids are more powerful than 5-ASAs, and may be used with or instead of 5-ASAs to treat flare-ups when 5-ASAs alone are not effective
    • Corticosteroids are not used long-term because they can cause potentially serious side effects
  • Topical corticosteroids
• Immunomodulators
  • This treatment is used for mild or moderate flare-ups, or to maintain remission if symptoms do not respond to other medicines
  • They can be very effective in treating ulcerative colitis, but often take between 2 and 3 months to start working
    • Azathioprine/6-MP (Imuran, Azasan)
    • Methotrexate (Trexall, Otrexup)
    • Tacrolimus (Prograf)
    • Cyclosporine (Sandimmune, Neoral)
      • Cyclosporine is more powerful than the medicines used to treat milder cases of ulcerative colitis and it starts to work much sooner (normally within a few days)
• Biologic therapies
  • May be used to treat adults with moderate to severe ulcerative colitis when other treatments are not suitable or working
    • Infliximab (Remicade) 
    • Adalimumab (Humira)
    • Golimumab (Enbrel)
    • Vedolizumab (Entyvio)
• Janus kinase inhibitors (JAK Inhibitors)
  • Used to treat moderate to severe ulcerative colitis if standard treatments or biologics have not worked or are not suitable
    • Tofacitinib (Xeljanz)

Surgery for ulcerative colitis is a last-resort used for severe cases of inflammation and life-threatening complications. Surgery usually involves removing the entire colon and the rectum, which is the only permanent cure for ulcerative colitis.