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Ulcerative Colitis: What caused it, how is it treated, is there a cure?

Medically reviewed by Asma Khapra, MD, Kevin Tin, MD, Susan Kerrigan, MD and Marianne Madsen on January 23, 2023

What is ulcerative colitis?


Ulcerative colitis is in the category of diseases called Inflammatory bowel disease (IBD) and results in ulcers and inflammation forming on the lining of the large intestine. People with this condition often have a genetic predisposition to IBD and a secondary insult, such as an infection or antibiotics, which alter the microbiome can cause the disease to surface. In general, Ulcerative colitis is thought to be related to the immune system altering the colon. According to the U.S. Department of Health, between 600,000 and 900,000 Americans have the disease, with most cases being people of Jewish descent between the ages of 15-30. It is a chronic condition, with periods of mild to severe flare-ups interspersed with periods of remission. 


As a chronic inflammatory condition, ulcerative colitis has a range of options for chronic therapy. The current goal is a treatment plan that will keep patients in long-term remission. Ultimately if all therapies fail, surgical resection of the colon can be curative, but of course has its own challenges.


Current treatment options for ulcerative colitis


Treatment methods for ulcerative colitis symptoms are typically a combination of one or more medications. 


These may include anti-inflammatory drugs and immune system suppressors to control inflammation for moderate or mild symptoms. Therapies which are topically administered are often used, such as suppositories and enemas. Steroids may be used in more severe cases and to gain immediate control of symptoms.  Also, changes in diet such as not eating dairy products can ease any aggravation of the digestive system while stopping making the symptoms worse. Recent studies are looking at possible diets which could have improvement in symptoms and disease.


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Ulcerative Colitis - Diet

Ulcerative Colitis - Diet

For more severe cases, your doctor may decide you need surgery to remove the colon.


New medical treatment options


Research into new treatment options for ulcerative colitis is ongoing and flourishing. Finding a complete cure still seems to be some way off. In the meantime, new types of medications which are targeting novel pathways are being actively studied. The U.S. Food and Drug Administration (FDA) approved in 2018 the use of Tofacitinib, a new type of JAK inhibitor that also controls inflammation symptoms, as the first oral medicine for severe ulcerative colitis.  There are also new drugs that have developed which keeps lymphocytes in lymph nodes and reduces their movement to the colon.


New therapy options


As well as research into new drugs to help with the symptoms, researchers are also looking at different types of alternative therapy that may help prevent inflammation and tissue damage. 


With many states relaxing their laws regarding cannabis, studies are now being undertaken to see what therapeutic effects the plant may have for specific medical conditions. Some of that research is currently looking at how it can help have an anti-inflammatory effect on the body, especially concerning ulcerative colitis and other IBDs.


Researchers are also examining the benefits of stem cell therapy for Inflammatory Bowel Disease patients. The hope is that it may help decrease colonic inflammation which would help with tissue repair.


There are also ongoing studies into the benefits of stool transplants. In fecal transplantation, healthy stools are implanted into IBD patients to try and restore a healthy gut microbiome. As with stem cell therapy, the intention is that the healthy stool will reduce chronic inflammation levels in the digestive system.


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Ulcerative Colitis - Treatment

Ulcerative Colitis - Treatment

Missing microbes


A 2020 study by Stanford University School of Medicine has found a possible link between ulcerative colitis and a missing gut microbe. The microbe produces metabolites that help keep the gut healthy. The research team at Stanford Medicine is now conducting clinical trials to see if those metabolites effectively treat ulcerative colitis. If the results are positive, it may be that in the future, doctors can supplement patients with these missing metabolites and effectively treat the inflammation.


While research is still ongoing, there is currently no medical cure for ulcerative colitis. The treatment options used can help ease common symptoms of the condition, such as chronic inflammation, but cannot provide a permanent solution. Having a surgical procedure to remove the colon may be the best option at the moment.


The only hope for ulcerative colitis patients is that future research into new, more effective treatment options may find that elusive cure.

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