Treatment
The therapy of the relapse is adapted to how strong the individual relapse is. In the case of a mild relapse with only a few bloody diarrhoea cases and no fever, 5-ASA preparations such as mesalazine are used in acute therapy. These counteract the inflammation in the intestinal tract and trigger a slight immunosuppression.
A moderate relapse is characterised by a distinct feeling of illness with regular bloody diarrhoea and a slight rise in temperature. In this case, in addition to the 5-ASA preparations, glucocorticoids can be given in tablet form only locally for the time being and if there is no improvement. In the severe relapse, which is accompanied by severe feelings of illness, frequent bloody diarrhoea and fever, the therapy must be increased even further.
At first, an attempt is made to start a therapy with glucocorticoids (e.g. prednisolone) via the vein. It is hoped that administration via a venous access will improve the effect of the drug. If there is no improvement, a therapy with immunosuppressive drugs can be considered.
Common drugs are for example Ciclospoprin A, Tacrolimus or Infliximab. However, as these immunosuppressive drugs are not without complications, a surgical therapy should be considered beforehand, as this can cure ulcerative colitis. Cortisone belongs to the drug group of glucocorticoids.
It is identical with cortisone, which is produced by the body itself. Cortisone is used in the therapy of relapses because of its anti-inflammatory and immunosuppressive effect. This is intended to counteract the excessive inflammatory reaction of the body. However, since cortisone also has some relevant side effects, the drug must be used with caution and its dose must always be reduced in slow steps at the end of a therapy. Some of these side effects are, for example, increased blood pressure, edema, bone loss and the development of diabetes.
Duration
The duration of an episode varies with the severity of the episode and depends on the response of the acute medication. A relapse can last from four to eight weeks. However, there are also forms of ulcerative colitis in which there is no inflammation-free interval. This course is called chronic-continuous. The intensity of the continuous inflammation can vary greatly.
Jerkiness during pregnancy
The probability of getting a relapse during pregnancy is about 30%. The course of ulcerative colitis is not negatively influenced by pregnancy. Should a relapse nevertheless occur, it must be treated as quickly as possible, as high inflammatory activity can have negative effects on the unborn child.
The treatment is based on a graduated scheme, which is also used for non-pregnant women. The medication should be given in sufficient dosages, as a long-term inflammation can cause more damage than the side effects of medication. When using cortisone in the last weeks of pregnancy, it must be taken into account that the formation of cortisol in the fetus may be restricted after birth.
The newborn babies are conspicuous by their listlessness and reduced activity. This deficiency can be treated well with a temporary replacement therapy with cortisone. If it is a very severe episode which cannot be treated sufficiently with 5-ASA preparations and glucocorticoids alone, it is possible to administer the immunosuppressive agent azathioprine after a very strict evaluation. However, both mother and child must be closely monitored when taking it. Other medications for the escalation of therapy in severe relapses such as Tacrolimus, Ciclosporin A or the antibody Infliximab should not be given during pregnancy.
