Western Medical Treatment for Ulcerative Colitis | HanStep Korean Medicine Clinic

Medical Treatments

Western Medical Treatment
for Ulcerative Colitis

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

Basic Medication

5-ASA Agents
(5-aminosalicylic acid)

These are drugs in the sulfasalazine, mesalazine, and mesalamine classes, available in oral, suppository, and enema forms.

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

Features and Limitations:
The exact mechanism by which these drugs are effective for ulcerative colitis or Crohn's disease is not clearly understood, yet they are frequently used in mild, early stages without a full understanding of the mechanism. In cases of early ulcerative colitis, initial administration may induce remission for about 1-2 years, but relapse typically occurs after 1-2 years despite continued use. Often, even increasing the dosage after relapse fails to induce remission again.

                        Major Side Effects: Headache, dizziness, abdominal pain, fever, dermatitis, hair loss, hepatotoxicity, nephrotoxicity, and dark urine may occur, though most are mild.
                    

"Steroid administration is never a cure,
but should be thought of as a way to temporarily extinguish a fire."

Strong Anti-inflammatory

Steroids
(Steroid)

Potent steroids such as Prednisolone (brand name: Solondo) are frequently used. Because steroids strongly suppress inflammation, symptoms often improve after administration, but they cannot be taken for long periods due to serious accompanying side effects.

STEP 01

Start of Administration

Usually started by taking 6-8 tablets of 5mg Solondo daily to strongly suppress inflammation.

STEP 02

Tapering

The international recommended duration for steroid use is 4 weeks. A method of reducing by one tablet per week and discontinuing after 6-8 weeks is adopted.

WARNING

Vicious Cycle of Relapse

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

SIDE EFFECTS

Serious Side Effects

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

Immunosuppressive Drug

Immunosuppressants

Product names: Azaprine, Immutera, Purinethol, Imuran, etc.

As long-term use was not possible due to the serious side effects of steroids, these agents were introduced with the goal of maintaining remission without steroids.

Rather than directly suppressing inflammation, they work by suppressing our body's immunity to reduce inflammation. However, in actual clinical practice, effectiveness often falls short of expectations, and long-term use can weaken immunity, making patients susceptible to diseases like the common cold.

Major Side Effects and Risks

Mild Side Effects: Initial side effects such as severe fatigue, loss of appetite, nausea, vomiting, and hepatotoxicity may accompany treatment.
Serious Side Effects: Significant risks exist, including reduction in white blood cell and platelet counts due to bone marrow suppression, occurrence of sepsis, and myelodysplasia.

Regular Check-ups and Korean Medical Recovery: Regular blood tests (WBC) are essential every 1-2 months. If issues like decreased white blood cell counts occur due to immunosuppressants, taking Korean herbal medicine while discontinuing the drugs can allow levels to return to normal.

Advanced Therapy

Biologic (Injectable) Agents and Oral Targeted Therapies

These are agents used when oral medication is not sufficiently effective. While many were originally developed in injectable form, they are recently being developed as oral medications as well. Because the effectiveness of existing biologics is often insufficient, new drugs are constantly being developed.

Anti-TNF agents

TNF-α InhibitorsRemicade, Remsima, Humira, Simponi

Action: Agents that inhibit tumor necrosis factor (TNF-α), which causes cancer cell necrosis in our bodies.

Administration and Maintenance: Administered at intervals of 2, 4, and 8 weeks after the first dose. Effectiveness lasts from 3 months up to 5 years at most, and effectiveness is lost if antibodies are generated.

Features: Pre-screening is essential as it can trigger latent tuberculosis. Self-injection methods have also been introduced recently.

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

Anti-IL agents

Interleukin InhibitorsStelara

Action: Inhibits IL-12 and IL-23, which induce immune inflammatory responses. It binds to the p40 subunit to reduce Th1 and Th17 immune responses.

Features: Unlike TNF-α inhibitors, it provides more selective immune regulation, resulting in relatively less systemic immunosuppression.

Administration: Subcutaneous injection is administered every 8 or 12 weeks after the initial intravenous injection.

Side Effects: Upper respiratory infections, headache, injection site pain, and fatigue are common, with risks of severe infection or increased cancer incidence.

Gut-selective

Integrin InhibitorsKinteles (Entivio)

Action: A monoclonal antibody targeting α4β7 integrin, which selectively blocks the movement of lymphocytes to the intestinal mucosa to suppress inflammation.

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

Administration: Available only via intravenous injection.

Side Effects: Headache, nausea, arthralgia, fatigue, and upper respiratory infections are common side effects.

Oral / Janus Kinase Inhibitors

JAK Inhibitors (Oral)Xeljanz, Rinvoq

Action: Directly blocks signal transduction pathways 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 Features: Oral administration makes it convenient and provides rapid onset of efficacy, but it is absorbed systemically, suppressing signal transduction in immune cells throughout the entire body, not just the intestine.

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 development.

Surgical Treatment

Bowel Resection Surgery

The last resort performed when symptoms are not controlled and inflammation is too severe even after using 5-ASA agents, steroids, immunosuppressants, and biologics.

Surgery is not the end.

Reality After Surgery

1. Living with an artificial anus (ostomy):
In the case of ulcerative colitis, when the colon is totally resected or the rectal area is removed, an artificial anus is created on the abdomen, and one must live with a stool bag for about 2-3 years. Later, a surgery to reconnect to the anus is performed.
2. Life-long Diarrhea:
When more than 2/3 of the colon is resected or a total resection is performed, the organ that creates stool is gone. Eventually, food residue from the small intestine is discharged immediately, meaning one must live with diarrhea, at least 4-6 times, and up to 15-20 times daily.

"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 been undergoing drug treatment while enduring numerous side effects and are now considering bowel resection surgery, you should definitely confirm the final possibility of preserving your intestine through Korean medical treatment.

Surgery is a choice that can never be reversed. HanStep Korean Medicine Clinic sets the preservation of the patient's own intestine without resection and the recovery of daily quality of life as the top priority of treatment.

View HanStep Treatment Philosophy

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