Ulcerative Colitis (cont.)

Mild-moderate distal colitis

• Oral aminosalicylates, topical mesalamine, or topical steroids
• Combination of oral and topical aminosalicylates is better than either alone

For refractory cases, oral steroids or IV infliximab can be used (though this is less well studied in distal colitis)

Mild-moderate extensive colitis

• Oral sulfasalazine 4-6 g/day or alternative aminosalicylate 4.8 g/day
• Oral steroids for patients refractory to above therapy + topical therapy
• 6-MP or azathioprine for patients refractory to oral steroids, but not so severe as to require IV therapy
• Infliximab in patients who are steroid refractory/dependant on adequate doses of 6-MP/thiopurine or who are intolerant to these medications

Severe colitis

• Infliximab if urgent hospitalization is not needed
• If patient is toxic, should be admitted to the hospital for IV steroids
  • Failure to improve in 3-5 days is indication for colectomy or IV cyclosporine
• Maintenance 6-MP can also be added in these patients

Indications for Surgery

• Absolute: Hemorrhage, perforation, documented or strongly suspected cancer

Also, surgery is recommended for severe colitis refractory to medical therapy

Although it seems plausible that a specialized diet might benefit patients with ulcerative colitis, there is actually no evidence to support treatment with dietary modification. Despite extensive research, no diet has been found to slow progression, treat, or cure the disease. It is recommended that patients stay on a balanced, healthy diet rich in fruits, vegetables, grains, lean meats, beans, fish, eggs, nuts. Patients should also try to limit foods with saturated fats high cholesterol. During flare-ups, patients should continue to eat as tolerated. The Crohn's and Colitis Foundation of America recommends a bland diet with soft food during a flare including hot cereals, boiled eggs, mashed potatoes, steamed vegetables, canned or cooked vegetables to minimize discomfort.

Source: MedicineNet.com
http://www.medicinenet.com/ulcerative_colitis/article.htm