Ulcerative Colitis

There are two main goals of treatment of ulcerative colitis: to control symptoms, and to prevent their return. Your physician will recommend treatments based on how severe your symptoms are and how much of your colon is affected.

Medications

In addition to dietary and other lifestyle changes, your doctor may recommend medications to reduce inflammation in your colon. These may include:

• Aminosalicylates (like 5-ASA): These are aspirin-like anti-inflammatory agents often used as the first drug therapy for people with early-stage ulcerative colitis.
• Antibiotics and probiotics: These may relieve symptoms in some people with ulcerative colitis.
• Steroids such as prednisone: Doctors may use them to treat people with moderate to severe disease who don’t respond to aminosalicylates. They aren’t recommended for long-term use as they often cause side effects.
• Immunomodulators: These help to reduce inflammation and maintain remission by reducing the immune response, which is heightened in people with ulcerative colitis.
• Biologic therapies: They stop certain proteins from causing inflammation and have proven to be effective treatments for people with ulcerative colitis. You may receive infliximab (Remicade), vedolizumab (Entyvio), adalimumab (Humira), or golimumab (Simponi) in one of our modern and comfortable infusion suites, with experienced nurses monitoring your comfort during your treatment.
• Small molecule drugs: Like biologics, they work on the immune system but act differently. They include tofacitinib (Xeljanz) and ozanimod (Zeposia). They generally work within a few weeks and can be used long term.

Minimally invasive ulcerative colitis surgery

If you don’t respond to medication, you may require surgery to treat ulcerative colitis — typically a proctocolectomy to remove the entire colon and rectum. Since ulcerative colitis involves only the large bowel, this operation cures the disease.

NewYork-Presbyterian’s exceptionally skilled colorectal surgeons use minimally invasive laparoscopy or laparoscopic-assisted robotic surgery to perform this surgery whenever possible. You may then need:

• Ileostomy: The surgeon disconnects the end of the small intestine from the large intestine and then uses it to create an opening, or stoma, on the surface of the abdomen, through which waste is emptied into a bag. You’ll receive support and education from ostomy nurses specially trained in the care of people who need to wear an ostomy bag.
• Reconstructive ileoanal pouch procedure (ileoanal anastomosis or “J-pouch”): During ileal pouch-anal anastomosis (IPAA) surgery, the surgeon creates an internal pouch from part of your small intestine to provide a storage place for stool in the absence of the large intestine to prevent a permanent ostomy bag. Some studies suggest that fertility may be decreased after an ileoanal pouch procedure, possibly as a result of internal scarring. However, people of childbearing age have spontaneously conceived and given birth successfully after this procedure. The laparoscopic/robotic techniques used by surgeons at NewYork-Presbyterian reduce the amount of internal scarring.
• Revision surgeries: Some people who had a J-pouch experience bowel function problems and require additional “revision” surgery, such as pouch salvage surgery or changing the J-pouch to a “continent ileostomy” (K-pouch). Our surgeons have extensive experience in these techniques, which may allow for preservation of the anal sphincter and bowel function while improving quality of life.

Fecal transplants

Clostridium difficile (C. difficile) is a common bacterium that can cause infection in the intestines. NewYork-Presbyterian researchers are evaluating fecal transplant, a novel approach to treating people with ulcerative colitis who have C. difficile, which may also prove useful for patients with ulcerative colitis who don’t have this infection.

Studies have shown that introducing bacteria from the stool of a healthy individual into the intestines of someone with ulcerative colitis and C. difficile can restore the normal diversity of “friendly” intestinal bacteria, relieving colitis symptoms and even curing the disease in some patients.

This approach shows great promise and requires further evaluation in clinical trials to see if it can be used to effectively treat inflammatory bowel disease.

Clinical trials

NewYork-Presbyterian investigators are conducting clinical trials to assess innovative therapies for ulcerative colitis. You may have the opportunity to participate in a clinical study evaluating a promising new treatment. If you are interested in learning more about current trials at NewYork-Presbyterian and other facilities across the nation, visit our Clinical Trials section.