What is the best treatment for ulcerative colitis?

Question

Hi doctor,

I am 30 years old and have been dealing with bloody diarrhea and stomach cramps for the past two years. A recent colonoscopy confirmed that I have ulcerative colitis. I am currently taking Mesalamine, but my symptoms keep flaring up.

Sometimes, I have to go to the bathroom ten times a day, often with a sense of urgency, which makes it nearly impossible to work. I have also lost weight in the last six months. My doctor mentioned that biologic injections could be an option, but they are quite costly.

Are they safe for long-term use?
Is surgery, such as a colectomy, considered a last resort?
Additionally, are there any specific foods that might help reduce my flare-ups?

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concern.

I understand how difficult this must be for you, and I want to reassure you that you are not alone. Ulcerative colitis (UC) is a chronic condition, but effective long-term treatments are available to help you regain your quality of life.

The treatment options for UC are:

Mesalamine is typically the first-line medication. If flares persist, we consider step-up therapy.
Biologic injections or infusions (such as Infliximab, Adalimumab, Vedolizumab, Ustekinumab) are widely used, with long-term safety data being reassuring. Regular monitoring and ruling out infections are essential before starting.
Immunomodulators (e.g., Azathioprine) may be used for maintenance if biologics are not immediately started.
Corticosteroids are prescribed only for short-term flare control and not for long-term use.
Surgery (colectomy) is a last resort, typically considered if medications fail or complications arise, such as uncontrolled bleeding, severe inflammation, or precancerous changes. Many patients tolerate advanced therapies well and avoid surgery.

No single diet suits everyone, but some patients find relief by avoiding dairy, fatty or fried foods, caffeine, alcohol, spicy foods, and high-fiber foods during flares.

During remission, aim for a balanced, nutrient-rich diet including lean protein, soft fruits, cooked vegetables, rice, and oats.

Probiotics and omega-3 fatty acids may be beneficial for some individuals. Staying hydrated is crucial, especially with frequent diarrhea.

Stress and lack of sleep can trigger flares, so relaxation techniques and gentle exercise may help.

Regular blood tests (complete blood count, C-reactive protein, and liver function tests) and fecal calprotectin can help track inflammation.

Surveillance colonoscopy is recommended after 8 years from diagnosis, then every one to three years, depending on risk.

Biologics are safe and effective when monitored properly, surgery is a backup plan, and diet, along with good disease monitoring, can aid in reducing symptoms.

I hope this information is helpful.

Please let me know if you have any further questions, and I would be happy to assist you.

Thank you.