Western Medical Treatment Background
Medical Treatments

Western Medical Treatments
for Ulcerative Colitis

Types of drug treatments, mechanisms of action, and surgical considerations

Basic Medication

5-ASA Agents
(5-aminosalicylic acid)

  • #Pentasa
  • #Asacol
  • #Mezavant
  • #Salofalk

These include sulfasalazine, mesalazine, and mesalamine-based drugs, available as oral medications, suppositories, and enemas.

Originally developed as treatments for arthritis, their effectiveness against inflammatory bowel diseases like ulcerative colitis and Crohn's disease was discovered. Since then, they have become the widely used, standard medication for these conditions.

Characteristics and Limitations:
The precise mechanism of how these drugs work for ulcerative colitis or Crohn's disease is not clearly understood, yet they are commonly used in mild, early stages without a clear mechanism of action. In early-stage ulcerative colitis, initial use may induce remission for 1-2 years; however, even with continued use, relapse typically occurs after 1-2 years. Once a relapse occurs, increasing the dosage often fails to induce remission again.

Main side effects: Headache, dizziness, abdominal pain, fever, dermatitis, hair loss, hepatotoxicity, nephrotoxicity, and darkened urine; most side effects are mild.
Drug Treatment Image

"Steroid administration is never a cure;
it should be viewed merely as a temporary measure to extinguish an immediate fire."

Strong Anti-inflammatory

Steroids

Potent steroids like prednisolone (brand name: Solondo) are frequently used. Because steroids powerfully suppress inflammation, symptoms often improve after administration, but they cannot be taken for long periods due to severe accompanying side effects.

STEP 01

Starting Treatment

Treatment usually begins with 6-8 tablets of 5mg Solondo per day to powerfully suppress inflammation.

STEP 02

Tapering

The internationally recommended duration for steroid use is 4 weeks. A method of reducing the dosage by one tablet per week and discontinuing after 6-8 weeks is typically followed.

WARNING

The Cycle of Relapse

Even when inflammation is suppressed, symptoms often worsen again when reduced to 1-2 tablets, or relapse typically occurs 1-2 months after long-term discontinuation of the medication.

SIDE EFFECTS

Serious Side Effects

Numerous serious side effects can occur, including Cushing's syndrome, moon face, cardiomegaly, hypertension, diabetes, osteoporosis, depression, memory loss, hair loss, hypertrichosis, skin stretch marks and thinning, skin ulcers, bruising due to vascular weakness, purpura, menstrual irregularities, and secondary adrenal insufficiency.

Immunosuppressive Drug

Immunosuppressants

Brand names: Imutera, Purinethol, Imuran, etc.

Due to the serious side effects of steroids preventing long-term use, these agents were introduced with the goal of maintaining remission without steroids. Rather than directly suppressing inflammation, they work by suppressing the body's overall immunity to reduce inflammation.

Limitations of Immunosuppressants
Limitation

Limitations of Treatment Effect

In actual clinical practice, they are often not very effective, and long-term use lowers immunity, leaving the body vulnerable to simple illnesses like the common cold.

Mild Side Effects

Mild Side Effects

Initial side effects such as severe fatigue, loss of appetite, nausea, vomiting, and hepatotoxicity may accompany treatment.

Bone Marrow Suppression and Management
Severe Side Effects

Bone Marrow Suppression and Serious Side Effects

Serious risks exist, including reduced white blood cell and platelet counts, sepsis, and myelodysplasia due to bone marrow suppression.

Management

Regular Checkups and Korean Medical Recovery

Regular blood tests (WBC) every 1-2 months are essential. If white blood cell counts drop, Korean herbal medicine can be taken, and discontinuing the drug can allow counts to return to normal.

Advanced Therapy

Biologics (Injections) and Oral Targeted Therapies

These are used when oral medication is not sufficient. While many were originally developed as injections, oral forms have recently been developed. Because existing biologics may not be sufficiently effective, new drugs are continuously being developed.

Anti-TNF agents

TNF-α Inhibitors

Action: These agents inhibit tumor necrosis factor (TNF-α), which destroys cancer cells in our body.

Administration and Maintenance: Administered after the first dose at 2, 4, and 8-week intervals. Effectiveness lasts from 3 months to 5 years at most; once antibodies are generated, the drug loses its effect.

Characteristics: Pre-screening is mandatory as latent tuberculosis can be reactivated. Self-injection methods are now available.

Side Effects: Viral and respiratory infections, indigestion, vomiting, and nausea. Increased cancer incidence (especially lymphoma) with long-term use.

Anti-IL agents

Interleukin Inhibitors

Action: Inhibit IL-12 and IL-23, which induce immune inflammatory responses. By binding to the p40 subunit, they reduce the immune response of Th1 and Th17.

Characteristics: Unlike TNF-α inhibitors, they provide more selective immune modulation, resulting in relatively less systemic immunosuppression.

Administration: Subcutaneous injection at 8 or 12-week intervals after initial intravenous administration.

Side Effects: Upper respiratory infections, headache, injection site pain, and fatigue are common; risks of serious infection and increased cancer incidence also exist.

Gut-selective

Integrin Inhibitors

Action: A monoclonal antibody targeting α4β7 integrin, selectively blocking lymphocyte migration to the intestinal mucosa to suppress inflammation.

Characteristics: As a gut-selective immunosuppressant, it only suppresses local inflammation in the intestinal mucosa, resulting in relatively lower risks of systemic infection and side effects.

Administration: Administered only by intravenous injection.

Side Effects: Headache, nausea, joint pain, fatigue, and upper respiratory infections are common.

Oral / Janus Kinase Inhibitors

JAK Inhibitors (Oral)

Action: Directly block the signaling pathway where inflammatory cytokines (IL-2, IL-6, IL-12, IL-23, IFN-γ, etc.) activate JAK (JAK1, 2, 3, TYK2) within the receptor.

Advantages and Characteristics: Being oral, they are convenient to use and have rapid onset, but they are absorbed systemically and suppress signal transduction in immune cells throughout the body, not just in the intestines.

Side Effects: Upper respiratory infections, headache, acne, and gastrointestinal symptoms are common; serious side effects include increased risk of shingles, deep vein thrombosis, pulmonary embolism, cardiovascular risks, and cancer.

Surgical Treatment

Bowel Resection Surgery

This is a last resort performed when symptoms are uncontrolled and inflammation is too severe, despite the use of 5-ASA agents, steroids, immunosuppressants, and biologics.

Surgery is not the end.

The Reality After Surgery
  • 1. Life with an Artificial Anus (Stoma):
    In cases of ulcerative colitis requiring total colectomy or removal of the rectal area, an artificial anus may be created in the abdomen, requiring the patient to live with a stool bag for 2-3 years. Subsequently, a follow-up surgery is performed to reconnect the bowel to the anus.
  • 2. Life-long Diarrhea:
    When more than 2/3 of the colon or the entire colon is removed, the organ responsible for forming stool is lost. As a result, food residue from the small intestine is discharged directly, meaning the patient must live with 4-6 bowel movements daily at best, and 15-20 at worst.

"A removed intestine does not grow back."

Alternative Approach

Before Surgery,
The Necessity of Korean Medical Treatment

If you are in a situation where you have endured numerous side effects from drug treatments and are now considering bowel resection, it is strongly recommended that you explore the final possibility of preserving your intestine through Korean medical treatment.

Surgery is an irreversible choice. HanStep Korean Medicine Clinic makes preserving the patient's own intestine and recovering their quality of life our top priority in treatment.

F.A.Q

Frequently Asked Questions

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