Treatment of particularly severe relapses

If there is an extremely severe relapse, sulfasalazine can be replaced or supplemented with other immunosuppressive drugs (e.g. Azathioprine® or Ciclosporin). In addition, parenteral nutrition must often be administered in such a case, as the patient can no longer take food in the normal way. It must be taken into account that electrolytes, protein or blood may also have to be supplied parenterally. If no or only an unsatisfactory improvement can be achieved after 3 days even after regular treatment of such a relapse, the patient must undergo surgery.

Operative therapy of ulcerative colitis

Indications for surgical treatment are relevant bleeding, perforations (small holes in the intestine), first indications of early stages of colorectal cancer or a so-called toxic megacolon (a dangerous extension of a section of the intestine). In addition, there are some circumstances in which the physician can weigh up with the patient whether surgery is the therapy of choice. These include growth retardation in children or contraindications to the drugs required for long-term therapy.

In contrast to Crohn’s disease, removal of the colon (colectomy) is curative in ulcerative colitis. Surgery is indicated in cases of serious complications such as toxic megacolon, perforation (intestinal rupture), insatiable bleeding, ileus (bowel paralysis) or if the drug therapy does not respond. If surgery is necessary in the context of ulcerative colitis, the surgeon usually removes not only the currently affected bowel segment, but the entire colon.

Thus, the disease is considered cured. However, the operation naturally carries the risk of various complications. It is important to construct a resorvior from the small intestine, which then takes over the storage function for the stool as a replacement for the rectum. In some cases, an artificial bowel outlet is temporarily necessary (stoma, anus praeter), which is later moved back to allow the patient to have a controlled bowel movement (continence) again. A colectomy is also indicated if cancer cells or precancerous lesions (dysplasias) are found in biopsies taken endoscopically.