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The goals of treatment are to control inflammation, replace nutritional losses and blood volume, and prevent complications. Supportive treatment includes bed rest, I.V. fluid replacement, and a clear-liquid diet. For patients awaiting surgery or showing signs of dehydration and debilitation from excessive diarrhea, total parenteral nutrition (TPN) rests the intestinal tract, decreases stool volume, and restores positive nitrogen balance. Blood transfusions or iron supplements may be needed to correct anemia.
Immunomodulators or 5-aminosalicylates may be used to decrease the frequency of attacks. Drug therapy to control inflammation includes steroids. Antispasmodics and antidiarrheals are used only in patients whose ulcerative colitis is under control but who have frequent, loose stools.
Surgery is the last resort if the patient has toxic megacolon, fails to respond to drugs and supportive measures, or finds symptoms unbearable. A common surgical technique is proctocolectomy with ileostomy. Another procedure, the ileoanal pull-through, is being performed in more cases. This procedure entails performing a total proctocolectomy and mucosal stripping, creating a pouch from the terminal ileum, and anastomosing the pouch to the anal canal. A temporary ileostomy is created to divert stool and allow the rectal anastomosis to heal. The ileostomy is closed in 2 to 3 months, and the patient can then evacuate stool rectally. This procedure removes all the potentially malignant epithelia of the rectum and colon. Total colectomy and ileorectal anastomosis isn’t as common because of its mortality rate (2% to 5%). This procedure removes the entire colon and anastomoses the terminal ileum to the rectum; it requires observation of the remaining rectal stump for any signs of cancer or colitis.
Pouch ileostomy (Kock pouch or continent ileostomy), in which the surgeon creates a pouch from a small loop of the terminal ileum and a nipple valve from the distal ileum, may be an option. The resulting stoma opens just above the pubic hairline and the pouch is emptied periodically through a catheter inserted in the stoma. In ulcerative colitis, a colectomy may be performed after 10 years of active disease because of the increased incidence of colon cancer in these cases. Performing a partial colectomy to prevent colon cancer is controversial.
Source: Professional Guide to Diseases (Eighth Edition), 2005
The goals of treatment are to relieve symptoms of the acute attack and prevent recurrent attacks, to replace nutritional losses and blood volume, and to prevent complications.
Supportive treatment includes I.V. fluid replacement and a clear-liquid diet. For patients awaiting surgery or showing signs of dehydration and debilitation from excessive diarrhea, total parenteral nutrition rests the intestinal tract, decreases stool volume, and restores positive nitrogen balance. Blood transfusions or iron supplements may be necessary to correct anemia.
Medications to control inflammation include corticotropin and adrenal corticosteroids, such as prednisone, prednisolone, and hydrocortisone; sulfasalazine, which has antiinflammatory and antimicrobial properties, may also be used. Options to decrease attacks include 5-aminosalicylates such as mesalamine and immunomodulators such as azathioprine, 6-mercaptopurine.
UNDER STUDY: Dehydroepiandrosterone is a steroid hormone that’s marketed as an over-the-counter drug in the United States. In pilot studies, it was proven safe to use in patients with ulcerative colitis. Dosage adjustments may further improve treatment outcomes.
Patients with mild to moderate disease may eat a regular diet, excluding caffeinated beverages and gas-producing foods. Anticholinergics and a low-roughage diet without milk or milk products may be used to reduce bowel movement frequency. Fiber supplementation may be used to control diarrhea and rectal symptoms. Antidiarrheal agents should be used only in patients with mild symptoms, not in those with the acute phase of this illness.
Patients with disease primarily affecting the rectum or rectosigmoid should be managed with topical agents such as mesalamine. Topical steroids may be used, but they may be less effective.
Patients with mild to moderate disease extending above the sigmoid colon who fail to improve after 2 to 3 weeks on sulfasalazine or mesalamine should have a corticosteroid added to their regimen.
Severe colitis is usually managed with nothing-by-mouth status and parenteral alimentation. Volumizers and blood should be provided as needed. Surgical consultation should be obtained in all patients with severe disease.
Surgery is recommended for patients who have toxic megacolon or who fail to respond to drugs and supportive measures.
The ileoanal restorative proctocolectomy with ileoanal pouch anastomosis is being performed more frequently. This procedure entails performing a total proctocolectomy, creating a pouch from the terminal ileum, and anastomosing the pouch to the anal canal. A temporary ileostomy is created to divert stools and allow the rectal anastomosis to heal. This technique is now more common than total proctocolectomy with ileostomy. The ileostomy is closed in 2 to 3 months.
Total proctocolectomy (with ileostomy) provides complete cure of disease. However, the patient’s self-image and social interactions may be affected by wearing an external appliance.
Pouch ileostomy (Kock pouch or continent ileostomy), in which the surgeon creates a pouch from a small loop of the terminal ileum and a nipple valve from the distal ileum, may be an option. The resulting stoma opens just above the pubic hairline, and the pouch empties periodically through a catheter inserted in the stoma. Patients may experience six or more bowel movements per day. A low-residue diet should be maintained to promote pouch adaptation. Patients may also need bulking agents or antidiarrheals to slow stool output. This procedure is performed less often now than in the past.
A colectomy may be performed after 10 years of active ulcerative colitis because of the increased incidence of colon cancer in these patients. Performing a partial colectomy to prevent colon cancer is controversial.
Source: Handbook of Diseases, 2003
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