Introduction – where do we stand with the therapy?
Ulcerative colitis is – just like Crohn’s disease – a chronic inflammatory bowel disease (CED), which has its peak frequency in young adults between the ages of 20 and 35. The cause of ulcerative colitis is still largely unknown. It is suspected – similar to Crohn’s disease – that it is a genetic predisposition that ultimately leads to a barrier dysfunction in the intestinal mucosa, so that the recognition and control of bacteria cannot proceed smoothly there.
Ulcerative colitis, in which the inflammation of the mucosa is limited to the colon and rectum, is – in contrast to Crohn’s disease (the entire gastrointestinal tract is affected) – in principle curable by surgical removal of the colon (proctocolectomy). However, this procedure is usually only performed as a last resort. Since the disease progresses in relapses, a drug therapy has been established which is adapted to the severity of the respective relapses and in the best case can lead to remission, i.e. a symptom-free interval but no cure.
What can we achieve with the therapies today?
Under a drug therapy, which must be individually adapted to the severity of the respective relapse, the symptoms can ideally subside and even be (temporarily) free of symptoms, so that a so-called remission is achieved. Since ulcerative colitis is a chronic inflammatory bowel disease, i.e. it is persistent, the symptoms may flare up again even after a remission. In order to avoid this, a so-called remission-maintaining therapy is usually continued, even when the symptoms and thus the active phase of the disease are over.
This is intended to prevent the next relapse or to delay it as long as possible. Depending on the severity of the relapses, different medications are used (individually or in combination), all of which have in common that they influence and weaken the immune system locally or systemically. However, a definitive cure for the disease is only possible if the sections of the bowel that may be affected in ulcerative colitis are surgically removed.
However, since this is a major operation, this procedure is only considered in cases of very severe disease progression. Ulcerative colitis is treated in a so-called step-by-step therapy, which means that the medication used is adapted to the severity of the symptoms. In the case of mild relapses, it has been shown that local application of the drug mesalazine (5-ASA preparation) as a suppository or rectal foam is sufficient, whereas moderate relapses require additional oral mesalazine administration or a combination of local mesalazine and cortisone administration.
In severe relapses, systemic administration of cortisone as shock therapy is promising, but if this is not sufficient, it is possible to switch to other immunosuppressive drugs such as ciclosporin A, infliximab or azathioprine. Once the relapse has been combated and a temporary absence of symptoms has been established, a remission is usually maintained with the local or oral administration of mesalazine (the administration of azatioprine and infliximab is also possible). Remission maintenance with cortisone should not be performed due to the side effects.
In most cases, the disease progresses chronically intermittently with this therapy approach, i.e. relapses and symptom-free phases alternate. More rarely, a chronic-continuous course occurs despite therapy, i.e. a course that does not show symptom-free intervals. The intensity of the symptoms can vary individually.
The drugs currently used in existing ulcerative colitis do not have any influence on the healing process as such. The drugs used are usually so-called immunosuppressants, which modulate, influence or inhibit the immune system, which in ulcerative colitis is locally dysfunctional in the area of the colon, with the aim of minimising or even preventing the symptoms. However, a definitive cure cannot yet be achieved with them. What is possible, however, is to achieve a remission in which the affected patients can live completely free of symptoms, but the duration of the next relapse varies from individual to individual. or Mesalazine
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