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Treatment of Ulcerative Colitis

This is a summary of the treatment of ulcerative colitis. The following is a list of treatments independently collected from the Intractable Disease Information Center of the Foundation for Intractable Diseases and Wikipedia, etc.


5-aminosalicylic acid (5-ASA) drugs 5-ASA drugs include the traditional salazosulfapyridine (salazopyrine) and an improved new drug, mesalazine (Pentasa or Asacol), which was developed to reduce its side effects. Administered orally or rectally, they reduce persistent inflammation. By reducing inflammation, symptoms such as diarrhea, bleeding, and abdominal pain are significantly reduced. 5-ASA drugs are effective in mild to moderate ulcerative colitis and in preventing flare-ups.

Corticosteroids Prednisolone (prednisone) is a typical drug. They are administered orally, rectally, or transvenously. These drugs are used in patients with moderate to severe disease and are potent at reducing inflammation, but have not been shown to prevent flare-ups.

Blood Cell Component Removal Therapy Although not a drug therapy, this treatment removes abnormally activated white blood cells from the blood and includes LCAP (leukocyte removal therapy: Selsorba) and GCAP (granulocyte removal therapy: Adakaram). They are used to treat the active phase of the disease in patients who do not respond to corticosteroids.

Immunomodulators These drugs include azathioprine (Imuran), 6-mercaptopurine (Leukerin), and more recently cyclosporine (Sandimmune) and tacrolimus (Prograf). These agents are used to treat patients who are ineffective on steroids or who cannot discontinue steroids.

Anti-TNF-alpha receptor antagonist infliximab (Remicade) is an injectable drug that has been used in patients with Crohn’s disease and rheumatoid arthritis, but can also be effective in ulcerative colitis. When effective, administration is continued every 8 weeks in many patients, with the expectation of relapse-prevention effects.

Surgical Treatment Most cases of ulcerative colitis can be controlled with drug therapy, but surgery may be indicated in the following cases.

(1) Cases of heavy bleeding

(2) Toxic megacolonosis (swelling of the large intestine and toxins circulating throughout the body)

(3) Perforation (rupture of the colon)

(4) Cancerous growth or suspected cancerous growth

(5) Severe cases that do not respond to medical therapy

(6) Cases in which drugs such as steroids cannot be used due to side effects.

The basic surgical procedure is a total resection of the colon. In the past, surgery to install a colostomy was performed, but nowadays, surgery to preserve the anus is the most common method. In this surgery, after removing the large intestine, a stool bag is made from the small intestine and connected to the anus. This surgical method has dramatically improved the quality of life of patients.

ATM Therapy (under clinical trial since 2003) A sterilization therapy targeting Fusobacterium varium (antibacterial drug triple therapy, ATM therapy) has been under clinical trial since 2003 by Dr. Toshifumi Ohkusa, Juntendo University School of Medicine, and others. (A treatment method in which three antibiotics are taken. It has some efficacy in erythema nodosum, but its efficacy in ulcerative colitis has not been demonstrated.)

None of these treatments has yet been established as effective, but based on the information provided in the comments of this blog, it seems that “Indigo naturalis” is overwhelmingly effective.


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