Ulcerative colitis: Encyclopedia II - Ulcerative colitis - Treatment

Ulcerative colitis - Treatment

Although much progress has been made in the last 20 years, in understanding and treating the disease, a definitive treatment or cure for Ulcerative colitis still eludes modern medicine. Therefore, treatment for Ulcerative colitis actually aims at inducing remission, preventing relapse, improving nutritional deficiency, and ensuring normal growth and development in child patients. This is achieved primarily through medication, and sometimes surgery.

• Anti-inflammatory drugs (such as sulfasalazine or mesalamine) are often used, and in severe cases corticosteroids may be given.
• Immunosuppressive agents such as azathioprine, 6-mercaptopurine (6-MP), and more recently, cyclosporine are also used as effective preventive medications.
• Anti-diarrheal drugs (such as loperamide) should be avoided unless under specific doctors orders, as they can worsen the disease.

Surgery is rarely recommended, except in cases where drug treatment has proven completely ineffective. Since ulcerative colitis affects only the colon, a complete large intestine removal can be considered a cure. However, this leaves the patient with a permanent ileostomy, which can cause further problems in itself. A more aesthetically and functionally pleasing resolution may be a j-pouch surgery, where a part of the terminal ileum is used to create a "pouch" which is then connected to the anus. This preserves the appearance of normal bowel function, although bowel movements are somewhat more frequent.

There is no proven connection between dietary habits and the onset of the disease. Although opinions are somewhat divided on this issue it is safe to say that no particular diet can influence length of remission or cause inflammation if none is present. The usual recommendation for patients is to simply avoid foods that have caused them discomfort in the past, and try to eat as healthy as possible. This does not apply to acute onsets of the disease when a patient should try and maintain a low-fat and generally bland diet to facilitate faster and easier healing.

Ulcerative colitis - Current research and treatment alternatives

Kampo medicine is used in Japan as complementary or alternative medication to sulfasalazine. Oren-gedoku-to is one such traditional herbal medicine being used both in Japan and China since the Han Dynasty (Traditional Chinese Medicine name is Huang-Liang-Jie-Du-Tang and english name Coptis Detoxifying Formula). Another herbal supplement said to help with the bleeding hemorrhoids associated with ulcerative colitis is rutin, sold in most vitamin and supplement stores.

A significantly elevated number of sulfate-reducing bacteria in the colon has been observed in some ulcerative colitis patients, resulting in higher concentrations of the toxic gas hydrogen sulfide. It is has been suggested that this may be a major contributor to the disease, however, it is not completely clear whether this may be considered a cause or a mere side-effect of the disease itself. Further research is underway. [Roedinger 1997, Levine 1998]

Interestingly enough, another unrelated study suggested sulphur contained in red meats and alcohol may lead to an increased risk of relapse for patients in remission.[1]

One controversial theory claims that Mycobacterium paratuberculosis which is responsible for Johne's disease in cows, sheep and goats has many similarities to Crohn's and a lesser extent ulcerative colitis. The M. paratuberculosis bacteria are extremely hardy and may survive normal pasteurization method of milk which is 72 degrees celsius for 15 seconds. The theory is further that the M. paratuberculosis bacteria are only indirectly responsible, since it is the immune system of the person that overreacts in an allergic fashion to this intestinal bacteria. M. paratuberculosis is also probably underreported as the suspect variant grows very slowly in ordinary cultivation tests and recent research indicates only DNA testing will show if it is present in low numbers.[2]

Recently, probiotics have become a powerful alternative treatment for ulcerative colitis. While they do not cure the disease, they have been found to significantly reduce symptons. One probiotic formula known as VSL #3 has shown promise for people with ulcerative colitis. [3]

Another controversial area of probiotic research called Fecal bacteriotherapy involves the infusion of human probiotics through fecal enemas. It suggests that the cause of ulcerative colitis may be a previous infection by a still unknown pathogen (possibly even Mycobacterium paratuberculosis), which resolves itself naturally but somehow damages the bacterial flora of the colon, causing an imbalance, which then proceeds to reinfect and damage the colon in an endless cycle which can be broken by "recolonizing" the colon with bacteria from a healthy bowel. While there are still many questions that remain to be answered, there have been several clinicaly researched cases where people with ulcerative colitis have been "cured" or remain in remission - some of them for more than 13 years to date - without drugs. While the process itself has been used in hospitals to cure pseudomembranous colitis caused by C. difficile infection (which exhibits symptoms remarkably similar to ulcerative colitis), it has yet to be given serious consideration by the scientific community. [4]

Helminthic therapy is another promising new treatment for Ulcerative Colitis and Crohn's disease which has shown great results in clinical trials. It argues that the absence of intestinal worms (due primarily to higher hygiene standards) from the human intestinal tract may cause the immune system, which is not evolutionary adapted to this condition, to over-react causing inflammation and other negative effects, and that reintroducing helminths through ingesting eggs of a certain species (which is not dangerous to humans) can help downregulate and normalize immune responses.

It is interesting to note that both the helminthic therapy and the fecal bacteriotherapy induce a characteristic TH2 white cell response in the diseased areas which seems to be the key in achieving and maintaining remission, and may prove to be of key significance in further research. If the theories behind these new treatments prove correct, they could also very elegantly explain the similarities, differences and reasons behind Crohn's disease and ulcerative colitis (one being induced by lack of certain helminth parasites in the bowel, the other by lack of certain bacteria).

Adapted from the Wikipedia article "Treatment", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki