Ulcerative colitis is considered to be related to Crohn’s disease, together, they are frequently referred to as inflammatory bowel disease (IBD).

Ulcerative colitis and Crohn’s diseases are chronic conditions. Crohn’s disease can affect any portion of the gastrointestinal tract, including all layers of the bowel wall. It may not be limited to the GI tract (affecting the liver, skin, eyes, and joints).

Ulcerative colitis only affects the lining of the colon (large bowel). Men and women are affected equally. The most commonly begin during adolescence and early adulthood, but they also can begin during childhood and later in life.

Common symptoms of ulcerative colitis include rectal bleeding, abdominal pain, and diarrhea. Variability of symptoms reflects differences in the extent of disease (the amount of the colon and rectum that are inflamed) and the intensity of inflammation. Generally, patients with inflammation confined to the rectum and a short segment of the colon adjacent to the rectum have milder symptoms and a better prognosis than patients with more widespread inflammation of the colon. The different types of ulcerative colitis are classified according to the location and the extent of inflammation:

1. Ulcerative proctitis – inflammation that is limited to the rectum. In many patients with ulcerative proctitis, mild intermittent rectal bleeding may be the only symptom. Other patients with more severe rectal inflammation may, in addition, experience rectal pain, urgency (sudden feeling of having to defecate and a need to rush to the bathroom for fear of soiling), and tenesmus.
2. Proctosigmoiditis involves inflammation of the rectum and the sigmoid colon. Symptoms of proctosigmoiditis, like that of proctitis, include rectal bleeding, urgency, and tenesmus. Some patients with proctosigmoiditis also develop bloody diarrhea and cramps.
3. Left-sided colitis involves inflammation that starts at the rectum and extends up the left colon (sigmoid colon and descending colon). Symptoms of left-sided colitis include bloody diarrhea, abdominal cramps, weight loss, and left-sided abdominal pain.
4. Pancolitis or universal colitis refers to inflammation affecting the entire colon (right colon, left colon, transverse colon and the rectum). Symptoms of pancolitis include bloody diarrhea, abdominal pain and cramps, weight loss, fatigue, fever, and night sweats. Some patients with pancolitis have low-grade inflammation and mild symptoms. Generally, however, patients with pancolitis suffer more severe disease and are more difficult to treat than those with more limited forms of ulcerative colitis.
5. Fulminant colitis is a rare but severe form of pancolitis. Patients with fulminant colitis are extremely ill with dehydration, severe abdominal pain, protracted diarrhea with bleeding, and even shock. They are at risk of developing toxic megacolon and colonic rupture/perforation. Patients with fulminant colitis and toxic megacolon are treated in the hospital, unless they respond to treatment promptly, surgical removal (allopathic treatment) of the diseased colon is necessary to prevent colonic rupture.

While the intensity of colon inflammation in ulcerative colitis waxes and wanes over time, the location and the extent of disease in a patient generally stays constant. Therefore, when a patient with ulcerative proctitis develops a relapse of disease, the inflammation usually is confined to the rectum. Nevertheless, less than 10% of patients with ulcerative proctitis or proctosigmoiditis can later develop more extensive colitis.

Ulcerative colitis involves abnormal activation of the immune system in the intestines. Alcoholism, unhealthy/nonorganic and/or artificial food, smoking and stress/anxiety/depression and the continued abnormal activation of the immune system causes chronic inflammation and ulceration portions of the large intestine.

The diagnosis of ulcerative colitis is suggested by the symptoms of abdominal pain, rectal bleeding, and diarrhea. There is no gold standard for diagnosis, the ultimate diagnosis relies on a combination of symptoms, the appearance of the colonic lining at the time of endoscopy, histologic features of biopsies of the colonic lining, and studies of stool to exclude the presence of infectious agents that may be causing the inflammation.

• Stool specimens – to exclude infection and parasites, since these conditions can cause colitis that mimics ulcerative colitis.
• Blood tests may show anemia (a low red blood cell count), and an elevated white blood cell count and/or an elevated sedimentation rate (sed rate). An elevated white blood cell counts and sed rate both reflect ongoing inflammation that may be associated with infection or with any type of chronic inflammation including ulcerative colitis and Crohn’s disease. Anemia, especially in a young male with chronic pain and diarrhea should raise the clinician’s suspicion for IBD.
• Other blood tests also may be checked including kidney function, liver function tests, iron studies, and C-reactive protein (another sign of inflammation).
• There is some evidence that a stool test for a protein called calprotectin could be useful in identifying patients who would benefit from colonoscopy. Calprotectin seems to be a sensitive marker of intestinal inflammation meaning that it can be elevated before symptoms become severe and the signs of inflammation are unclear. In the right setting, particularly early in the course of IBD, elevated levels can suggest inflammatory bowel disease. This test alone, however, cannot distinguish between different diseases causing the inflammation so should be used with caution.
• Colonoscopy –  Direct visualization of the inside of the colon to establish the diagnosis and to determine the extent of the colitis. Small tissue samples (biopsies) can be obtained during the procedure to determine the severity.
• A barium enema X-ray – A barium enema is less accurate and useful than direct visualization (sigmoidoscopy or colonoscopy).
• Video capsule endoscopy and CT/MRI enterography – Video capsule endoscopy (VCE) might be useful for detection of small bowel disease in patients with a diagnosis of Ulcerative colitis with atypical features and who might be suspected of actually having Crohn’s disease. With VCE, patients swallow a capsule that contains a camera that takes pictures while it travels through the intestines and sends the pictures wirelessly to a recorder.
• CT and MRI enterography are use oral liquid contrast agents consisting of PEG solutions or low concentration of barium to provide more adequate distension of the colon and small intestine.

These have been reported to be superior to standard imaging techniques in the evaluation of small bowel pathology in patients. They have also been shown to provide adequate estimations of disease severity in ulcerative colitis (with some under- and overestimations).

Blood transfusions, pancolitis, and toxic megacolon

Patients with ulcerative colitis limited to the rectum (proctitis) or colitis limited to the end of the left colon (proctosigmoiditis) usually do quite well. Brief periodic treatments using oral medications or enemas may be sufficient. Serious complications in those with more extensive disease, blood loss from the inflamed intestines can lead to anemia and may require treatment with iron supplements or even blood transfusions (I – Dr Qaisar Ahmed don’t recommend).

Rarely, the colon can acutely dilate to a large size when the inflammation becomes very severe. This condition is called toxic megacolon. Patients with toxic megacolon are extremely ill with fever, abdominal pain and distention, dehydration, and malnutrition. Unless the patient improves rapidly with medication especially Homeopathic medication, with allopathic treatment surgery usually is necessary to prevent colonic rupture.

Cancers

Colon cancer is a recognized complication of chronic ulcerative colitis. The risk for cancer begins to rise after eight to ten years of colitis. Patients with only ulcerative proctitis probably do not have increased risk of colon cancer compared to the general population. Among patients with active pancolitis (involving the entire colon) for 10 years or longer, the risk of colon cancer is increased compared to the general population. In patients with colitis limited to the left side of the colon, the risk of colon cancer is increased but not as high as in patients with chronic pancolitis.

Since these cancers have a more favorable outcome when diagnosed and treated at an earlier stage, yearly colon examinations may be recommended after eight years of known extensive disease. During these examinations, samples of tissue (biopsies) can be taken to search for precancerous changes in the lining cells of the colon. When precancerous changes are found, removal of the colon may be necessary to prevent colon cancer.

Other complications

Complications of ulcerative colitis can involve other parts of the body.

• Inflammation of the joints (arthritis) {10%}.
• Low back pain due to arthritis of the sacroiliac joints.
• Ankylosing spondylitis (AS). There seems to be an increased incidence of ankylosing spondylitis among patients with inflammatory bowel disease.
• Rarely, patients may develop painful, red, skin nodules (erythema nodosum). Others can have painful, red eyes (uveitis, episcleritis). Because these particular complications can risk permanent vision impairment, eye pain or redness are symptoms that require a physician’s evaluation.
• Diseases of the liver and bile ducts also may be associated with ulcerative colitis. For example, in patients with a rare condition called sclerosing cholangitis, repeated infections and inflammation in the bile ducts can lead to recurrent fever, yellowing of skin (jaundice), cirrhosis, and the need for a transplantation of the liver.
• Finally, patients with ulcerative colitis also might have an increased tendency to form blood clots, especially in the setting of active disease.

In allopathy both drugs and surgery have been used to treat ulcerative colitis. However, surgery is reserved for those with severe inflammation and life-threatening complications. There is no allopathic drug that can cure ulcerative colitis (for Homeopathic treatment see lower part of article please).

With allopathic treatment patients with ulcerative colitis will typically experience periods of relapse (worsening of inflammation) followed by periods of remission (resolution of inflammation) lasting months to years. During relapses, symptoms of abdominal pain, diarrhea, and rectal bleeding worsen. During remissions, these symptoms subside.

Since ulcerative colitis cannot be cured with allopathic drugs, the goals of allopathic treatment with drugs are to…

1. induce remissions,
2. maintain remissions,
3. minimize side effects of treatment,
4. improve the quality of life,
5. minimize risk of cancer.

Treatment of ulcerative colitis with allopathic drugs is similar, though not always identical to treatment of Crohn’s disease.

Drugs for treating ulcerative colitis include:

• Anti-inflammatory agents such as 5-ASA compounds, systemic corticosteroids, topical corticosteroids,
• Immunomodulators.

Anti-inflammatory drugs that decrease intestinal inflammation are analogous to arthritis medications that decrease joint inflammation (arthritis). The anti-inflammatory drugs that are used in the allopathic treatment of ulcerative colitis are:

• Topical 5-ASA compounds such as sulfasalazine (Azulfidine), olsalazine (Dipentum), and mesalamine (Pentasa, Asacol, Lialda, Apriso Rowasa enema) that need direct contact with the inflamed tissue in order to be effective.
• Systemic anti-inflammatory medications such as corticosteroids that decrease inflammation throughout the body without direct contact with the inflamed tissue. Systemic corticosteroids have predictable side effects with long term use.

Immunomodulators are drugs that suppress the body’s immune system either by reducing the cells that are responsible for immunity, or by interfering with proteins that are important in promoting inflammation. Immunomodulators increasingly are becoming important treatments for patients with severe ulcerative colitis who do not respond adequately to anti-inflammatory agents. Examples of immunomodulators include 6-mercaptopurine (6 MP), azathioprine, methotrexate, cyclosporine.

It has long been observed that the risk of ulcerative colitis appears to be higher in nonsmokers and in ex-smokers. In certain circumstances, patients improve when treated with nicotine (Homeopathically)

5-ASA (5-aminosalicylic acid), also called mesalamine, is chemically similar to aspirin. 5-ASA can be effective in treating ulcerative colitis if the drug can be delivered directly (topically) onto the inflamed colon lining. For example, Rowasa enema is a 5-ASA solution, effective in treating inflammation in and near the rectum (ulcerative proctitis and ulcerative proctosigmoiditis). However, the enema solution cannot reach high enough to treat inflammation in the upper colon. Therefore, for most patients with ulcerative colitis, 5-ASA must be taken orally. The stomach and upper small intestine absorb most of the drug before it reaches the colon. Therefore, to be effective as an oral agent for ulcerative colitis, 5-ASA has to be modified chemically to escape absorption by the stomach and the upper intestines. These modified 5-ASA compounds are sulfasalazine (Azulfidine), mesalamine (Pentasa, Rowasa, Asacol, Lialda, Apriso), and olsalazine (Dipentum).

Azulfidine

Sulfasalazine (Azulfidine) has been used successfully for among patients with mild to moderate ulcerative colitis. Inducing remission means decreasing intestinal inflammation and relieving symptoms of abdominal pain, diarrhea, and rectal bleeding. Sulfasalazine has also been used for prolonged periods of time to maintain remissions.

Sulfasalazine consists of a 5-ASA molecule linked chemically to a sulfapyridine molecule. (Sulfapyridine is a sulfa antibiotic). Connecting the two molecules together prevents absorption by the stomach and the upper intestines, when sulfasalazine reaches the colon, the bacteria in the colon will break the linkage between the two molecules. After breaking away from 5-ASA, sulfapyridine is absorbed into the body and then excreted in the urine but most of the active 5-ASA drug, however, remains in the colon.

Side effects of sulfasalazine include nausea, heartburn, headache, anemia, skin rashes, hepatitis and kidney inflammation etc. Sulfasalazine can reduce the sperm count.

To minimize stomach upset, sulfasalazine generally is taken after or with meals. Some patients find it easier to take Azulfidine-EN (enteric-coated form of sulfasalazine). Enteric-coating helps decrease stomach upset.

Asacol

Asacol is a tablet consisting of the 5-ASA compound, mesalamine, surrounded by an acrylic resin coating. (Asacol is sulfa free.)

Asacol is effective in inducing remissions in patients with mild to moderate ulcerative colitis. The recommended dose of Asacol to induce remission is two 400-mg tablets three times daily (total of 2.4 grams/day). Two tablets of Asacol twice daily (1.6 grams/day) is recommended for maintaining remission. Occasionally, the maintenance dose is higher. If patients do not respond to 2.4 grams a day of Asacol, the dose frequently is increased to 3.6 grams/day (and sometimes even higher) to induce remission. If patients fail to respond to the higher doses of Asacol, then alternatives, such as corticosteroids, are considered.

Lialda

Lialda (mesalamine multi matrix, MMX) is a 5-ASA medication within an inert matrix (surrounded by a coating). When the capsule reaches the distal ileum, the outer coating dissolves, the intestinal fluid then is absorbed into the matrix forming a gel-like substance which prolongs the contact of the medication with the colonic wall as the mesalamine slowly separates from the matrix. This extended release formulation allows for higher doses to be taken less frequently throughout the day and might and improve compliance.

The most common side effects of Lialda are flatulence, abdominal pain, headache, nausea, and dyspepsia.

Apriso

Apriso is another formulation of 5-ASA that consists of extended-release mesalamine granules encased in microcrystalline cellulose within a capsule. Dissolution of the capsule occurs in the distal ileum, and, since the granules are encased in the cellulose and only slowly separates from the cellulose, there is prolonged delivery of medication as the cellulose and mesalamine travel through the colon.

The most common side effects of this medication are headache, diarrhea, abdominal pain, nausea, nasopharyngitis, influenza-like illness, and sinusitis.

Pentasa

Pentasa capsules – consisting of the 5-ASA compound mesalamine inside controlled-release spheres. It is sulfa free. Unlike Asacol, the mesalamine in Pentasa is released into the small intestine as well as the colon. Therefore, Pentasa can be effective in treating inflammation in the small intestine and the colon. Pentasa is currently the most logical 5-ASA compound for treating mild to moderate ulcerative colitis etc. involving the small intestine. Pentasa also is used to induce remission and maintain remission among patients with mild to moderate ulcerative colitis.

Olsalazine (Dipentum)

Olsalazine (Dipentum) consists of two 5-ASA molecules linked together. It is sulfa-free. The linked 5-ASA molecules travel through the stomach and the small intestine unabsorbed. In the terminal ileum and the colon, the normal bacteria in the intestine break the linkage and release the active drug into the colon and the terminal ileum. Olsalazine has been used in treating ulcerative colitis and in maintaining remissions. A side effect unique to olsalazine is secretory diarrhea (diarrhea resulting from excessive production of fluid in the intestines). This diarrhea sometimes can be severe.

Balsalazide (Colazal)

Balsalazide (Colazal) is a capsule in which the 5-ASA is linked by a chemical bond to another molecule that is inert and prevents the 5-ASA from being absorbed. This drug is able to travel through the intestine unchanged until it reaches the end of the small bowel (terminal ileum) and colon. There, intestinal bacteria break apart the 5-ASA and the inert molecule, releasing the 5-ASA. Colazal is used to treat inflammation predominantly localized to the colon.

More clinical trials are needed to compare the effectiveness of Colazal to the other mesalamine compounds such as Asacol in treating ulcerative colitis.

Side Effects of 5-ASA Compounds

The sulfa-free 5-ASA compounds have fewer side effects than sulfasalazine and also do not impair male fertility.

Patients allergic to aspirin should avoid 5-ASA compounds because they are chemically similar to aspirin.

Kidney inflammation has been reported with the use of 5-ASA compounds (blood tests of kidney function be obtained before starting and periodically during treatment).

Instances of acute worsening of diarrhea, cramps, and abdominal pain may occur which at times may be accompanied by fever, rash, and malaise (allergy to the 5-ASA compound).

Rowasa Enema

Rowasa is the 5-ASA compound mesalamine in enema form and is effective in ulcerative proctitis and ulcerative proctosigmoiditis (two conditions where active 5-ASA drugs taken as enemas can easily reach the inflamed tissues directly). Each Rowasa enema contains 4 grams of mesalamine in 60 cc of fluid. The enema usually is administered at bedtime, and patients are encouraged to retain the enema through the night.

The enema contains sulfite and should not be used by patients with sulfite allergies.

Rowasa also comes in suppository form for treating limited proctitis. Each suppository contains 500 mg of mesalamine and usually is administered twice daily.

The usual course of treatment is three to six weeks or longer courses of treatment for optimal benefit. Some studies have reported increased effectiveness in treating ulcerative proctitis and proctosigmoiditis by combining oral 5-ASA compounds with Rowasa enemas. Oral 5-ASA compounds also are used to maintain remission in ulcerative proctitis and proctosigmoiditis.

Another alternative for patients who fail to respond to Rowasa or who cannot use Rowasa is cortisone enemas (Cortenema – anti-inflammatory agent). Oral corticosteroids are systemic drugs with serious and predictable long-term side effects. Cortenema is a topical corticosteroid that has less absorption into the body than oral corticosteroids.

Unlike the 5-ASA compounds, corticosteroids do not require direct contact with the inflamed intestinal tissues to be effective. After absorption, corticosteroids exert prompt anti-inflammatory action throughout the body. In critically ill patients, intravenous corticosteroids (such as hydrocortisone) can be given in the hospital.

Corticosteroids are faster acting than the 5-ASA compounds, however, do not appear to be useful in maintaining remissions in ulcerative colitis.

Corticosteroid side effects

Corticosteroids usually produce predictable and potentially serious side effects, for example – rounding of the face (moon face), acne, increased body hair, diabetes, weight gain, high blood pressure, cataracts, glaucoma, increased susceptibility to infections, muscle weakness, depression, insomnia, mood swings, personality changes, irritability, and osteoporosis with an accompanying increased risk of compression fractures of the spine. Children on corticosteroids can experience stunted growth.

The most serious complication from long-term corticosteroid use is aseptic necrosis of the hip joints (the death of bone tissue). Aseptic necrosis in knee joints.

Prolonged use of corticosteroids can depress the ability of the body’s adrenal glands to produce cortisol (a natural corticosteroid necessary for the proper functioning of the body). Abruptly discontinuing corticosteroids can cause symptoms due to a lack of natural cortisol (a condition called adrenal insufficiency). Symptoms of adrenal insufficiency include nausea, vomiting, and even shock. Withdrawing corticosteroids too quickly also can produce symptoms of joint aches, fever, and malaise. Therefore, corticosteroids need to be gradually reduced.

Even after the corticosteroids are discontinued, the adrenal glands’ ability to produce cortisol can remain depressed for months to 2 years. The depressed adrenal glands may not be able to produce enough cortisol to help the body handle stress such as accidents, surgery, and infections.

Because corticosteroids are not useful in maintaining remission in ulcerative colitis and Crohn’s disease and because they have predictable and potentially serious side effects, these drugs should be used for the shortest possible length of time.

Preventing Corticosteroid-induced Osteoporosis

Long-term use of corticosteroids such as prednisolone or prednisone can cause osteoporosis. Corticosteroids cause decreased calcium absorption from the intestines and increased loss of calcium from the kidneys and bones.

Immunomodulators weaken the body’s immune system. Activation of the immune system causes inflammation within the tissues where the activation occurs. (Inflammation is, in fact, an important mechanism to defend the body used by the immune system).

Normally, the immune system is activated only when the body is exposed to harmful invaders. In patients with Crohn’s disease and ulcerative colitis, however, the immune system is abnormally and chronically activated in the absence of any known invader. Immunomodulators decrease tissue inflammation by reducing the population of immune cells and/or by interfering with their production of proteins that promote immune activation and inflammation. Generally, the benefits of controlling moderate to severe ulcerative colitis outweigh the risks of infection due to weakened immunity. Examples of immunomodulators include azathioprine (Imuran), 6-mercaptopurine (6-MP, Purinethol), cyclosporine (Sandimmune), and methotrexate (Rheumatrex, Trexall).

Azathioprine (Imuran) and 6-MP (Purinethol)

Azathioprine and 6-mercaptopurine (6-MP) are medications that weaken the body’s immunity by reducing the population of lymphocytes. Azathioprine and 6-MP are related chemically. In high doses, these two drugs have been useful in preventing the rejection of transplanted organs and in treating leukemia. In low doses, to treat patients with moderate to severe Crohn’s disease and ulcerative colitis. One problem with 6-MP and azathioprine is their slow onset of action. Typically, full benefit of these drugs is not realized for three months or longer. During this time, corticosteroids frequently have to be maintained at high levels to control inflammation.

6-MP and azathioprine are used mainly in the following situations:

• Patients with ulcerative colitis and Crohn’s disease not responding to corticosteroids.
• Patients who are experiencing undesirable corticosteroid-related side effects.
• Patients who are dependent on corticosteroids and are unable to discontinue them without developing relapses.

When azathioprine and 6-MP are added to corticosteroids in the treatment of ulcerative colitis patients who do not respond to corticosteroids alone. Some patients can discontinue corticosteroids altogether without experiencing relapses. The ability to reduce corticosteroid requirements has earned 6-MP and azathioprine their reputation as “steroid-sparing” medications.

In patients with severe ulcerative colitis who suffer frequent relapses, 5-ASA may not be sufficient, and more potent azathioprine and 6-MP will be necessary to maintain remissions.

Side Effects of 6-MP and Azathioprine

Side effects of 6-MP and azathioprine include increased vulnerability to infections, inflammation of the liver (hepatitis) and pancreas, (pancreatitis), and bone marrow toxicity (interfering with the formation of cells that circulate in the blood).

The goal of treatment with 6-MP and azathioprine is to weaken the body’s immune system in order to decrease the intensity of inflammation in the intestines; however, weakening the immune system increases the patient’s vulnerability to infections.

Azathioprine and 6-MP-induced inflammation of the liver (hepatitis) and pancreas (pancreatitis). Patients who develop pancreatitis should not receive either of these two medications again.

Azathioprine and 6-MP also suppress the bone marrow.

6-MP can reduce the sperm count in men. When the partners of male patients on 6-MP conceive, there is a higher incidence of miscarriages and vaginal bleeding. There also are respiratory difficulties in the newborn.

Patients on long-term, high dose azathioprine to prevent rejection of the kidney after kidney transplantation have an increased risk of developing lymphoma, a malignant disease of lymphatic cells.

6-MP metabolite levels

In addition to monitoring blood cell counts and liver tests, doctors also may measure blood levels of the chemicals that are formed from 6-MP (6-MP metabolites), which can be helpful in several situations such as:

1. If a patient’s disease is not responding to standard doses of 6-MP or azathioprine and his/her 6-MP blood metabolite levels are low, compliance should be checked, and if satisfactory, the dose of 6-MP or azathioprine may be increased.
2. If a patient’s disease does not respond to treatment and his/her 6-MP blood metabolite levels are very low, it is most likely that he/she is not taking his/her medication. The lack of response in this case is due to patient non-compliance.

Cyclosporine

Cyclosporine (Sandimmune) is a immunosuppressant used in preventing organ rejection after transplantation. It also has been used to treat patients with severe ulcerative colitis and Crohn’s disease. Cyclosporine probably will be used in severe ulcerative colitis. Cyclosporine is useful in fulminant ulcerative colitis and in severely ill patients who are not responding to systemic corticosteroids. Administered intravenously, cyclosporine can be very effective in rapidly controlling severe colitis and avoiding or delaying surgery.

Cyclosporine as an oral medication, the relapse rate with oral cyclosporine is high. Therefore, cyclosporine most useful when administered intravenously in acute situations.

Side effects of cyclosporine include high blood pressure, impairment of kidney function, and tingling sensations in the extremities. More serious side effects include anaphylactic shock and seizures.

Infliximab (Remicade)

Infliximab (Remicade) is an antibody that attaches to a protein called tumor necrosis factor-alpha (TNF-alpha)  (produced by immune cells during activation of the immune system). TNF-alpha, in turn, stimulates other cells of the immune system to produce and release other proteins that promote inflammation. In Crohn’s disease and in ulcerative colitis, there is continued production of TNF-alpha as part of the immune activation. Infliximab, by attaching to TNF-alpha, blocks its activity and in so doing decreases the inflammation.

Infliximab has been used for the treatment of moderate to severe Crohn’s disease that are not responding to corticosteroids or immuno-modulators. Patients experienced improvement within two weeks. Infliximab is typically given to induce remission in three doses – at time zero and then two weeks and four weeks later. After remission is attained, maintenance doses can be given every other month.

Side effects of infliximab

Side effects during infusions, including chest pain, shortness of breath, and nausea. These effects usually resolve spontaneously within minutes if the infusion is stopped. Other commonly reported side effects include headache and upper respiratory tract infections like pneumonia, tuberculosis (TB) etc, some patients also may develop a “delayed allergic reaction” this type of reaction may cause flu-like symptoms with fever, joint pain and swelling, and a worsening of Crohn’s disease symptoms. It can be serious.

There are reports of worsening heart disease in patients after receiving Remicade.

There have been reports of nerve damage e.g optic neuritis and motor neuropathy; and reports of patients developing viral colitis (cytomegalovirus and herpes simplex virus) while on. These viral infections can mimic a flare of ulcerative colitis and mistakenly suggest resistance to therapy. Before increasing the dose or changing the medication being used to treat the ulcerative colitis, patients should have a thorough evaluation including flexible sigmoidoscopy or limited colonoscopy with biopsies to help make the diagnosis of viral colitis.

Adalimumab

Adalimumab is an anti-TNF drug similar to infliximab. It decreases inflammation by blocking tumor necrosis factor (TNF-alpha). In contrast to infliximab, adalimumab is a fully humanized anti-TNF antibody containing no mouse protein and, therefore, might cause less of an immune reaction. Adalimumab is administered subcutaneously (under the skin).

Rheumatologists have been using adalimumab for treating inflammation of the joints in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. It was also approved for the treatment of moderately to severely active Crohn’s disease. Though not approved for treatment of ulcerative colitis, a few studies have shown it to have some efficacy in treating patients with ulcerative colitis who are refractory to or have lost their response to infliximab. More experiments will be required before recommending this as a standard therapy.

Visilizumab (anti-CD3 antibody)

Visilizumab is a humanized antibody that specifically binds to human CD3 expressing T cells, that inhibits the activity of the cells. CD3 expressing T cells are part of the immune system and seem to play an important role in promoting the inflammation of ulcerative colitis. The main side effects are decreased CD4 counts and cytokine release syndromes (flu-like symptoms, etc). More must be learned about this medication before it can be used routinely. This medication is still under experiments for the treatment of ulcerative colitis.

Alpha-4 integrin blockade

Alpha-4 integrins on the surface of cells of the immune system help the cells to leave the blood and travel into the tissues where they promote inflammation. Antibodies against these integrins have been developed, to dampen the inflammatory response. Natalizumab is one such agent, and in studies on patients with ulcerative colitis has been shown to have some efficacy in leading to clinical remission. Another more gut-selective humanized antibody (MLN02) has been evaluated in multi-center trials and has also been found to lead to clinical and endoscopic remission in more patients than placebo. More experiments must be conducted to evaluate long term effectiveness and side effects of these medications.

Removal of the colon and rectum is the only permanent allopathic cure for ulcerative colitis. This procedure eliminates the risk of developing colon cancer. Surgery in ulcerative colitis is reserved for the following patients:

1. Patients with fulminant colitis and toxic megacolon who are not responding readily to medications.
2. Patients with long standing pancolitis or left-sided colitis who are at risk of developing colon cancers. Removal of the colon is important when changes are detected in the colon lining.
3. Patients who have had years of severe colitis which has responded poorly to medications.

Surgery involves the removal of the entire colon, including the rectum. A small opening is made in the abdominal wall and the end of the small intestine is attached to the skin of the abdomen to form an ileostomy. Stool collects in a bag that is attached over the ileostomy. Recent improvements in the construction of ileostomies have allowed for continent ileostomies. A continent ileostomy is a pouch created from the intestine. The pouch serves as a reservoir similar to a rectum, and is emptied on a regular basis with a small tube.

An ileoanal anastomosis allows stool to be passed normally through the anus, in this procedure the large intestine is removed and the small intestine is attached just above the anus. Only the diseased lining of the anus is removed and the muscles of the anus remain intact. In this “pull-through” procedure, the normal route of stool elimination is maintained. This procedure has a relatively good success rate, although pouchitis (inflammation of the distal ileum now acting as the rectum) is a well known complication (that should be confirmed by endoscopy) that is manifested by increased diarrhea, urgency, bleeding, and pain.

Homeopathic Treatment for ulcerative colitis

In my (Dr Qaisar Ahmed) opinion, real treatment – is to cure the disease and/or abnormality. Advising drugs for lifetime or few years or cut it out (surgery), it’s not treatment but addiction & invalidness and could be fatal for other organs.