Overview of management of ulcerative colitis in adults

Treatment of ulcerative colitis aims to change the natural history of the disease and its long-term outcomes, rather than simply to control symptoms. This is reflected in the trend towards earlier use of potent immunomodulatory drugs and more frequent endoscopic monitoring, rather than persisting with less potent drugs (ie 5-aminosalicylates, corticosteroids) for patients in whom they have not been effective.

Drug therapy for ulcerative colitis is used to:

• induce remission in active disease (often referred to as clinical remission)—see Acute severe ulcerative colitis in adults, Induction therapy for ulcerative proctitis or distal colitis in adults and Induction therapy for extensive ulcerative colitis in adults
• maintain corticosteroid-free remission and prevent relapse—see Maintenance therapy for ulcerative colitis in adults
• achieve mucosal healing (often referred to as endoscopic remission), defined as the resolution of inflammation on endoscopy—this is associated with improved long-term outcomes (eg reduced need for hospital admission or surgery, reduced risk of colorectal cancer).

The extent and severity of disease and the site(s) of affected colon determine which drugs and route of administration may be used to manage ulcerative colitis. A degree of trial and optimisation is involved—a drug is started and if it is not effective, other therapeutic options are offered as an addition or alternative. A patient’s previous response (or lack of response) can often be used to guide future therapy.

The optimal management of ulcerative colitis commonly requires a multidisciplinary team including surgeons, nurses, pharmacists, dietitians and psychologists.

Patient information about drug therapies for inflammatory bowel disease is available from NPS MedicineWise.