Medicines usually are the treatment of choice for ulcerative colitis. They control or prevent inflammation in the intestines and help:

• Relieve symptoms.
• Promote healing of damaged tissues.
• Put the disease into remission and keep it from flaring up again.
• Postpone or prevent the need for surgery.

Medication Choices

The choice of medicine usually depends on the severity of the disease, the part of the colon affected, and whether complications are present.

• Treatment of mild to moderate ulcerative colitis often begins with aminosalicylates (such as sulfasalazine or mesalamine). Aminosalicylates relieve inflammation in the intestines and help the disease go into remission. They may also keep the disease from becoming active again.
• Corticosteroids may be added if symptoms continue. Corticosteroids relieve inflammation in the intestines.
• For severe cases, stronger treatment with medicines that suppress the immune system (such as azathioprine [AZA], 6-mercaptopurine [6-MP], or cyclosporine), infliximab (Remicade), and intravenous (IV) corticosteroids may be needed.

If you are pregnant, talk to your doctor about which medicines are safe for you to take. Usually, aminosalicylates and corticosteroids are safe, especially when your doctor thinks that ulcerative colitis is more dangerous to the fetus than these medicines. Ask your doctor whether you can take medicines that suppress the immune system. These are used only when the benefit outweighs the potential harm to the fetus. A doctor can recommend medicines based on the stage of the pregnancy and the severity of your symptoms.

Several studies have shown that the nicotine patch may help treat active ulcerative colitis. It is not yet known how long the benefits of the nicotine patch last or if the patch can help prevent flare-ups of ulcerative colitis. If the patch works, it most likely benefits people whose symptoms began or became worse after quitting smoking. But due to the addictive power and other harmful effects of nicotine, most doctors still prefer to use traditional medicines to treat ulcerative colitis before trying the nicotine patch.

What To Think About

Aminosalicylates are the most common medicines used to treat ulcerative colitis. Most of the time, these medicines are all a person needs to keep the disease in remission (a period of time with no symptoms). When aminosalicylates do not work, corticosteroids are most often the next medicine tried. Corticosteroids will only be used long enough to stop the inflammation in your colon. After the inflammation goes down, aminosalicylates will most likely be used to maintain remission.

If aminosalicylates are not strong enough to keep you in remission, or if corticosteroids don't work, your doctor may have you try different medicines. These medicines include immunomodulators, cyclosporine, and infliximab. All of these medicines control the immune response in your body and will decrease the amount of inflammation in your intestine. The inflammation is what causes the symptoms of ulcerative colitis.