Treatment for ulcerative colitis is different from one child to another. What helps one patient may not help another. Treatment for ulcerative colitis depends upon many things:
- Health of the child
- How much of the colon is inflamed
- Ability of the child to take certain medicines or undergo certain procedures
The goal of treatment is to:
- Control symptoms
- Put the disease into remission (making the disease inactive)
- Help keep the disease in remission
- Improve the quality of life
Some patients go into remission (the symptoms of ulcerative colitis go away). However, it is not uncommon for the symptoms to come back (a "flare").
Several different types of medicines may be used to help control the symptoms of ulcerative colitis. Each helps decrease the swelling in the lining of the colon.
Anti-inflammatory drugs (aminosalicylates or 5-ASA drugs) are usually used to treat mild to medium symptoms. Some examples are Asacol HD, Pentasa, Lialda, Apriso and Colazal.
Corticosteroids, such as prednisone, help to put a patient with medium to severe symptoms into remission. These drugs are not good to use for a long time because of side effects.
Drugs that suppress or quiet the immune system (immunomodulators) are used in medium to severe ulcerative colitis to help patients stay in remission. Some examples are Imuran (azathioprine), purinethol (6-MP) and methotrexate.
Antibiotics may also be used to treat bacteria in the small intestine that can keep the inflammation going. Some examples are Flagyl (metronidazole), Cipro (ciprofloxacin) and Rifaxamin.
Biologics are a newer drug approved by the US Food and Drug Administration for treating medium to severe ulcerative colitis that does not respond to the other medications. This medicine is given through a vein (intravenously) or as an injection.
Seventy to 80 percent of children with ulcerative colitis respond well to medicine and a personalized nutrition plan. The rest may require surgery to relieve their symptoms. The most common type of surgery is called “laparoscopic total proctocolectomy with J-pouch reconstruction.”
- Laparoscopic means that the surgery is minimally invasive − the surgeon makes small incisions in the abdomen, not a large, open incision.
- Total proctocolectomy means that the surgeon completely removes the diseased colon.
- J-pouch reconstruction means that the surgeon uses a small section of the small intestine to create a “J” shaped reservoir, or pouch. This pouch, which remains inside the body, allows the body to store and pass stool through the rectum.
Most patients who undergo laparoscopic total proctocolectomy with J-pouch reconstruction have two separate surgeries. In the first, the surgeon creates a temporary ileostomy, or opening in the abdomen. The surgeon will pass the end of the small intestine through this opening, and feces will collect in a bag outside your child’s body. This gives the J-pouch area time to heal.
Two or three months later, the surgeon will perform a second surgery to remove the temporary ileostomy and “reconnect” the small intestine to the rectum. This allows the child to again have bowel movements in the regular manner.
Laparoscopic total proctocolectomy with J-pouch reconstruction is considered major surgery. Since it involves removing the colon, where ulcerative colitis “lives,” this surgery essentially provides a cure for ulcerative colitis. Patients can live normal and active lives after surgery.