From the Guidelines
Treatment options for colitis include medical therapy, such as aminosalicylates, corticosteroids, and biologic agents, as well as surgical interventions, like subtotal colectomy with ileostomy.
Medical Therapy
- Conventional treatments include aminosalicylates, corticosteroids, and thiopurines (e.g., azathioprine, 6-mercaptopurine) 1
- Biologic agents, such as tumour necrosis factor (TNF) inhibitors, integrin inhibitors, and interleukin 12/23 inhibitors, have revolutionized the treatment of moderately to severely active ulcerative colitis 1
- Small molecule therapies, like Janus kinase (JAK) inhibitors (e.g., tofacitinib, upadacitinib, filgotinib) and sphingosine 1-phosphate receptor modulators (e.g., ozanimod), offer advantages, including oral administration and reduced risk of immunogenicity 1
Surgical Interventions
- Subtotal colectomy with ileostomy is a recommended surgical treatment for acute severe ulcerative colitis, particularly in patients who are hemodynamically unstable or have massive colorectal hemorrhage 1
- A staged procedure, initially with subtotal colectomy, is recommended in acute colitis in patients taking ≥ 20 mg prednisolone daily for more than 6 weeks, or in those treated with anti-TNF 1
- Laparoscopic surgery may be preferred if the appropriate skills are available, as it results in less wound infections and intra-abdominal abscesses, and a shorter hospital stay 1
Considerations
- Delay in surgery is associated with an increased risk of surgical complications, and joint care, including senior surgeons and senior gastroenterologists, is essential for the safe management of acute severe colitis 1
- Patient education and monitoring are crucial when using novel oral small molecule therapies, like ozanimod, to ensure safe and effective treatment 1
- Alternative diagnoses and differential diagnoses should be considered in cases of incomplete response to treatment or flare, including infection, proximal constipation, Crohn's disease, and co-existent irritable bowel syndrome 1
From the Research
Treatment Options for Colitis
The treatment options for colitis depend on the severity, localization, and course of the disease. The following are some of the treatment options available:
- Topical therapy with 5-aminosalicylic acid (5-ASA) compounds for proctitis 2
- Oral and local 5-ASA compounds and corticosteroids to induce remission for more extensive or severe disease 2
- Intravenous steroids or calcineurin inhibitors (cyclosporine, tacrolimus) for patients who do not respond to initial treatment 2
- Tumor necrosis factor-α antibodies (infliximab) or immunomodulators (azathioprine, 6-mercaptopurine) for refractory cases 2
- Alternative therapies such as probiotics, nicotine, and fish oil 3
- Biologic agents such as golimumab, vedolizumab, and tofacitinib 4
- Herbal medicine such as Qing-Dai for active UC 4
- Surgery for refractory toxic megacolon, perforation, and continuous severe colorectal bleeding 2
Treatment Algorithms
Treatment algorithms for ulcerative colitis have been developed based on published guidelines and current literature 5. These algorithms take into account the endoscopic extent of inflammation, disease severity, and prognostic factors of poor outcome. The goal of treatment is to achieve complete remission, defined as durable symptomatic and endoscopic remission without corticosteroid therapy 5.
Medical Treatment Options
Medical treatment options for ulcerative colitis continue to evolve, with new biologic agents and small molecules being developed 6. The selection of appropriate medical therapies should be based on individual patient and disease characteristics. Biologics and small molecules play a significant role in the treatment of ulcerative colitis, and their use should be guided by evidence-based recommendations 6.