Ulcerative colitis is a chronic inflammatory bowel disease. The treatment aims to control inflammation, alleviate symptoms, prevent complications, and improve patients' quality of life. Treatment plans should be tailored based on disease severity, patient age, and overall health, typically combining medication, surgery, and lifestyle modifications. Physicians develop treatment strategies based on two phases: "flare control" and "maintenance of remission," emphasizing the importance of long-term follow-up.
During treatment, doctors regularly assess efficacy and adjust medications or therapies according to disease changes. Patients need to work closely with their healthcare team and proactively report symptom changes to effectively control disease progression. The development of emerging biologics and personalized medicine has significantly improved patient prognosis, but treatment options still require balancing drug side effects and long-term risks.
Current strategies are divided into three main categories: medication, surgery, and adjunct therapies. Pharmacological treatment mainly involves anti-inflammatory drugs, used in a stepwise manner based on disease severity—first-line, second-line, and last-resort options. Surgery is reserved for patients unresponsive to medication or with severe complications; colectomy remains the ultimate solution. Additionally, nutritional support, psychological counseling, and lifestyle adjustments are integral parts of comprehensive treatment plans.
Treatment choices follow the "stepwise therapy principle," prioritizing low-side-effect medications for mild cases and escalating treatment as disease worsens or recurs. This approach minimizes unnecessary side effects while ensuring treatment efficacy. Physicians will dynamically adjust treatment plans based on endoscopic findings, blood indices, and symptom severity.
Drugs such as mesalamine are first-line treatments for mild to moderate ulcerative colitis, acting directly on the intestinal mucosa to suppress inflammation. Oral formulations are suitable for proctitis or left-sided colitis, while suppositories or enemas target rectal or distal colonic lesions. Common side effects include dizziness and diarrhea; long-term use requires monitoring renal function.
Moderate to severe flare-ups are often treated with corticosteroids such as prednisolone to suppress systemic inflammatory responses. However, long-term use is not recommended due to potential side effects like osteoporosis or hyperglycemia. After remission, maintenance therapy is necessary to prevent relapse. Immunosuppressants like 6-Mercaptopurine (6-MP) or azathioprine can modulate the immune system, usually combined with steroids to accelerate remission, with regular blood monitoring.
Newer immunosuppressants such as tocilizumab target specific inflammatory cytokines and are used in refractory cases unresponsive to conventional therapy. During treatment, close monitoring of liver function and infection risk is essential, with dosage adjustments based on response.
Surgical treatment is the final option when medication fails. Total colectomy with ileal pouch-anal anastomosis can definitively resolve intestinal issues, but requires lifelong follow-up for potential complications. Some patients may opt for laparoscopic surgery preserving the anus, weighing surgical risks against quality of life.
Emerging regenerative medicine research explores the potential of mesenchymal stem cell therapy, which has shown promise in repairing intestinal mucosal damage in animal studies, though clinical applications are still experimental. Gene therapy and precision medicine are also hot research topics, with future prospects of developing personalized treatments based on individual genetic profiles.
Nutritional management is a key component during remission, with low-fiber diets reducing intestinal stimulation. Some patients may require low FODMAP diets to control bloating. Dietitians recommend phased dietary adjustments to avoid nutritional imbalances caused by abrupt changes. Exclusive enteral nutrition (EEN) has been proven to induce remission in pediatric patients and can be an adjunct in adults.
Stress management has been shown to reduce flare frequency. Mindfulness meditation, yoga, and other relaxation therapies can modulate the autonomic nervous system. Regular exercise improves intestinal blood flow and immune regulation. It is recommended to engage in 150 minutes of moderate-intensity aerobic activity weekly, but strenuous exercise should be avoided during flare-ups.
Immunomodulatory therapies are rapidly advancing. Monoclonal antibody drugs targeting specific cytokines (e.g., anti-TNF-α agents) are now standard, while newer small-molecule drugs like JAK inhibitors can directly regulate signaling pathways. Gene editing technologies such as CRISPR show potential in repairing inflammatory genes in laboratory studies, but clinical applications require extensive research.
Microbiota therapies are another research focus. Probiotic formulations aimed at correcting gut microbiome imbalances are in clinical trials. Artificial intelligence systems analyzing patient biomarkers can assist in predicting treatment responses, paving the way for personalized medicine. However, all new therapies must undergo rigorous clinical trials to ensure safety.
Seek immediate medical attention if you experience warning signs such as increased blood in stool, persistent high fever over 38.5°C, uncontrollable abdominal pain, or a sudden decrease in medication effectiveness. Doctors may adjust medication doses, perform endoscopy, or order blood tests to evaluate inflammation markers.
Regular follow-up examinations include complete blood counts, C-reactive protein levels, and intestinal endoscopy, recommended every 6-12 months. If medication fails three or more times or if complications like strictures or dysplasia occur, surgical consultation is necessary.
What are the potential side effects of biologic treatments for ulcerative colitis?
Biologics (such as anti-TNF-α drugs) may cause immune-related side effects, including increased infection risk and skin reactions. Patients should have regular blood monitoring, and if symptoms like fever, severe diarrhea, or unexplained fatigue occur, seek medical attention immediately. Doctors will adjust dosages or switch medications based on individual circumstances.
How can patients reduce the risk of flare-ups through diet during remission?
Adopt an anti-inflammatory diet, increasing fiber intake (e.g., oats, cooked vegetables), and consuming high-quality proteins (e.g., fish, tofu). Avoid high-fat, spicy foods, and alcohol. Dietary adjustments should be personalized and assessed by a nutritionist, as responses to foods vary among individuals.
When is surgery indicated for ulcerative colitis?
Surgery may be necessary when medication fails, in cases of severe complications (e.g., significant bleeding, bowel obstruction), or suspicion of precancerous lesions. Total colectomy can definitively resolve intestinal damage but results in a permanent stoma. It is considered a last resort but may be life-saving.
Can long-term ulcerative colitis lead to psychological issues?
Yes, chronic pain, frequent bowel movements, and social stigma can induce anxiety or depression. Patients should communicate emotional changes with their healthcare providers and seek psychological support if needed. Studies show that positive psychological interventions can improve treatment adherence.
Can patients receiving biologic therapy receive vaccinations?
Some live vaccines (e.g., varicella, measles) should be avoided during immunosuppressive therapy. Inactivated vaccines like influenza and pneumococcal vaccines are recommended during treatment intervals. Timing should be coordinated with healthcare providers to ensure vaccine efficacy and safety.
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