Can you cure ulcerative colitis?

Introduction - where do we stand with therapy?

Like Crohn's disease, ulcerative colitis is a chronic inflammatory bowel disease (IBD), which has its peak frequency in young adults between the ages of 20 and 35. The cause of ulcerative colitis is still largely unknown, but it is suspected - similar to Crohn's disease - a genetic predisposition that ultimately leads to a barrier function disorder in the intestinal mucosa, so that bacterial detection and control cannot run smoothly there.

Ulcerative colitis, in which the inflammation of the mucous membrane is limited to the large intestine and the rectum, is - unlike Crohn's disease (loss of the entire gastrointestinal tract possible) - a cure through the surgical removal of the large intestine (Proctocolectomy) possible in principle. However, this procedure is usually only performed as a last resort. Since the disease progresses in relapses, a drug therapy has been established that is adapted to the severity of the respective disease relapses and, in the best case, to one Remission, i.e. a symptom-free interval but no cure.

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What can we achieve with the therapies today?

Under drug therapy, which has to be individually adapted to the severity of the respective episode, the symptoms can ideally subside or even (temporary) freedom from symptoms, so that a so-called Remission is achieved.

Since ulcerative colitis is a chronic inflammatory bowel disease, i.e. it persists permanently, symptoms can flare up again even after 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. The next possible episode should be prevented or delayed as long as possible.

Depending on the severity of the relapses, different drugs (individually or in combination) are used, all of which have in common that they are drugs that influence and weaken the immune system on the spot or systemically. A definitive cure of the disease is only possible if the intestinal sections that can be affected in ulcerative colitis are surgically removed. However, since this is a major procedure, this procedure is only considered in the case of very severe disease processes.

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Which treatment approaches are promising from today's perspective?

Ulcerative colitis is treated in a so-called step therapy, which means that the drugs used are used according to the severity of the symptoms.

In the case of minor 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 bouts require additional oral administration of mesalazine or a combination of local administration of mesalazine and cortisone must be used. In severe relapses, systemic administration of cortisone as a shock therapy is promising, but if this is not enough, you can switch to other immunosuppressants such as ciclosporin A, infliximab or azathioprine.

If the relapse has been combated and there is temporary freedom from symptoms, maintenance of remission is usually attempted with local or oral administration of mesalazine (the administration of azatioprine and infliximab is also possible). Remission maintenance with cortisone should not be carried out due to the side effects. In most cases, with this therapeutic approach, the disease is chronically intermittent, i.e. relapses and symptom-free phases alternate. More rarely, despite therapy, a chronic, continuous course occurs, i.e. a course that shows no symptom-free intervals. The intensity of the complaints can vary individually.

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What influence do drugs have on healing today?

The drugs currently used for existing ulcerative colitis do not affect healing as such.

The drugs used are usually so-called immunosuppressants, which have the effect that the immune system, which in the case of ulcerative colitis is locally impaired in the area of ​​the large intestine, is modulated, influenced or inhibited in its overfunction with the aim to minimize or even prevent the discomfort.

However, a definitive cure cannot yet be achieved with them. What is possible, however, is the achievement of a remission in which the affected patients can live completely symptom-free, but the respective duration until a possible next episode of the disease varies from person to person.

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What is the perspective - will ulcerative colitis be curable?

Ulcerative colitis, as a chronic inflammatory bowel disease that strictly only affects the large and rectum, is already curable in principle. Surgical removal of these same sections of the intestine prevents the disease from recurring. However, the operation is a big one and the consequences that stand behind it cannot be neglected: a non-significant part of the intestinal system is removed, which has an impact on digestion and stool production; the stool is then discharged either through an artificial anus (stoma) or - if this is individually surgically possible - via a continence-preserving, surgically newly created reservoir (ileoanal pouch).

A drug therapy that brings about a permanent cure of ulcerative colitis is not yet known. This is particularly difficult because the cause of this disease has still not been fully understood. The medicinal approach that is currently being successfully used to combat symptoms suggests that there is a malfunction in the immune system.

What is the current life expectancy with ulcerative colitis?

Life expectancy with existing ulcerative colitis depends primarily on the extent to which the colon and rectum are affected, but also on the complications that this chronic inflammatory bowel disease can present.

With an isolated infestation of the rectum and the sigmoid loop of the large intestine, the patients usually have a completely normal life expectancy. The further the inflammation spreads across the colon, the greater the likelihood of complications. If the entire colon and rectum are affected (Pancolitis) one speaks of a 20-year survival rate of approx. 80%.

The course of the disease is also decisive: chronic-intermittent courses with adequate therapy usually have a better prognosis than chronic-continuous courses, since the disease is permanently active. The acute-fulminant course can be life-threatening, in which the disease occurs suddenly in its full picture and in its strongest form.

Complications that can become dangerous in the course of the disease are, for example, bleeding (acute mass bleeding or chronic bleeding), ruptures in the intestinal wall, an inflammatory reaction of the surrounding peritoneum (Peritonitis), the so-called toxic megacolon (acute enlargement of the large intestine) and the development of large intestine carcinoma due to the chronic inflammation of the intestinal wall.

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