Medical Management of Ulcerative Colitis

The medical management of ulcerative colitis is dictated by myriad factors that include disease- and patient-specific features. The agents available to treat ulcerative colitis include homeopathic sources, 5-aminosalicylate compounds, glucocorticoids, immunomodulators, and biologic agents/biosimilars. Mild-to-moderate disease is generally managed with topical/oral 5-aminosalicylate compounds according to disease distribution with escalation to topical/oral glucocorticoids depending on initial treatment response. Moderate-to-severe disease is likely to require oral glucocorticoids to induce remission with biologic agents/biosimilars employed when these are ineffective and immunomodulation with Janus kinase enzyme inhibitor reserved for recalcitrant disease. Severe/fulminant disease requires hospitalization, exclusion of infections (i.e., cytomegalovirus, Clostridium difficile), and intravenous glucocorticoid therapy followed by salvage with an immunomodulator (i.e., calcineurin inhibitor), biologic agent/biosimilar (e.g., infliximab), or operation for treatment failure. The choice of medication(s) used to maintain remission depends on the initial severity of the now controlled disease and the agent(s) used to attain remission; 5-aminosalicylate compounds, immunomodulators, and biologic agents/biosimilars are commonly prescribed.