Medical treatment of ulcerative colitis

Abstract

Ulcerative colitis is a chronic inflammatory condition characterized by abdominal pain and diarrhea usually with hematochezia. Optimal medical management of ulcerative colitis is aimed at resolving clinical symptoms as well as achieving mucosal healing. Treatments are selected based on several variables including severity of symptoms, overall inflammatory burden, and whether risk factors for poor prognosis are present. Various medications currently approved for use in ulcerative colitis include 5-aminosalicylates, corticosteroids, thiopurines, anti-tumor necrosis factor antagonists, ustekinumab, vedolizumab, and tofacitinib. While the appropriate use of these as solitary drugs or in combination is often straightforward, therapy for particularly complex patients such as those requiring a rapid onset of action, those who are elderly or have significant medical co-morbidities, those with history of or active malignancy, those who are pregnant or breastfeeding, as well as those with extra-intestinal manifestations requires special consideration.