Ulcerative Colitis

Treatments

Treatments for ulcerative colitis include:

• Medicines. Medicine is the best treatment option for ulcerative colitis. The following medicines are the most common, but other medications may be prescribed as needed:
  • Aminosalicylates (5-ASAs). Aminosalicylates are medicines that help control mild to moderate inflammation. Some forms are taken by mouth; others must be given rectally.
  • Corticosteroids. Corticosteroids, including prednisone and methylprednisolone, are used to treat moderate to severe ulcerative colitis. They may be taken by mouth or inserted into the rectum. Entocort (budesonide) is an oral corticosteroid that works on the lining of the lower small intestine and upper colon without much absorption into the bloodstream.
  • Immunomodulators. Immunomodulators, such as azathioprine, 6-mercaptopurine and methotrexate, help reduce the need for corticosteroids and can help heal some fistulas (abnormal connections between organs).
  • Antibiotics. Antibiotics may be prescribed for abscesses (sores) or fistulas.
• Biologic therapy. Biologic therapy is used to treat patients with severe ulcerative colitis that does not respond to any other types of medication. These medicines (called monoclonal antibodies) help block an immune system chemical that promotes inflammation. They include:
  • Infliximab (Remicade)
  • Adalimumab (Humira)
  • Certolizumab (Cimzia)
• Surgery. If medicines do not work, a bowel resection may be needed (colectomy). A bowel resection removes the damaged or diseased part of the intestine. After the resection, your child's surgeon will perform an anastomosis to reconnect the bowel.
• Nutrition. No specific diet has been shown to improve or worsen ulcerative colitis. However, eating a healthy amount of calories, vitamins and protein is important to avoid malnutrition and weight loss. Children with ulcerative colitis frequently lose weight and growth may slow down before they are diagnosed. Our pediatric gastroenterology team believes growth is a critical outcome in treating pediatric patients with IBD. We tailor our treatment with medicines to help children regain lost weight and promote growth. However, many children require more intense nutritional therapy to improve their growth. We regularly examine and meet with you and your child. At each clinic appointment, we measure your child's height and weight. We work carefully with our dieticians to find the most appropriate nutrition plan for our patients with IBD. We help children regain lost weight and begin growing taller with the following nutritional therapies:
  • Oral nutritional supplements. Supplements like Pediasure®, Boost® or Ensure® provide excellent nutrition in addition to a regular diet. Modulen® was designed specifically for patients with IBD. Any of these can be taken once or more daily with meals or as a snack.
  • Calcium and vitamin D. IBD can lead to premature thinning of the bones. This can be worsened by steroids. Patients with ulcerative colitis must receive an adequate amount (above what a normal child would require) of calcium and vitamin D. Your pediatric gastroenterologist will recommend a specific amount of calcium and vitamin D based upon the age of your child. Some children may require a calcium supplement such as Tums®, Viactiv® or Caltrate®.
  • Parenteral nutrition. Parenteral nutrition is sugar, fat and protein given through an IV. This is only rarely required in children with severe ulcerative colitis who are unable to take enough nutrition by eating and drinking or have had severe weight loss prior to their diagnosis. If parenteral nutrition is required, your physician will carefully manage the ingredients in the parenteral nutrition by following the results of several blood tests.
• Coping. Some children may become overwhelmed with the thought of having a lifelong illness. They will need the support of family, friends and, sometimes, a professional counselor.