Dear XXXXXXX

Thank you for posting on HCM

You should know that the goals of treatment are to:

- Control the acute attacks
- Prevent repeated attacks
- Help the colon heal

Certain types of foods may worsen diarrhea and gas symptoms, especially during times of active disease. Diet suggestions include:
- Eat small amounts of food throughout the day.
- Drink plenty of water (drink small amounts throughout the day).
- Avoid high-fiber foods (bran, beans, nuts, seeds, and popcorn).
- Avoid fatty, greasy or fried foods and sauces (butter, margarine, and heavy cream).
- Limit milk products if you are lactose intolerant. Dairy products are a good source of protein and calcium.
Stress is another factor to manage. You may feel worried, embarrassed, or even sad or depressed about having a bowel diseases. Other stressful events in your life, such as moving, or losing a job or a loved one can cause digestive problems.
Ask your doctor or nurse for tips on your to manage your stress.

Medicines that may be used to decrease the number of attacks include:

- 5-aminosalicylates such as mesalamine (asacol) or sulfazine, which can help control moderate symptoms. You are right to worry about the side effects of this medication, but you should know that all drugs have side effects which most of the times depend on each individual. Asacol is the drug of choice for your condition both for its healing and preventive properties. It is given with precautions in situations of kidney diseases (failure). Hence doctor has to test your kidney functions or any other kidney diseases. Alternatively, you could take sulfazine.

Other drug classes that could be prescribed

- Immunomodulators such as azathioprine and 6-mercaptopurine
- Corticosteroids (prednisone and methylprednisolone) taken by mouth during a flare-up or as a rectal suppository, foam, or enema. Take note of their own side effects.
- Infliximab (Remicade) or other biological treatments, if you do not respond to other medications
Now the last alternative is surgery.
Surgery to remove the colon will cure ulcerative colitis and removes the threat of colon cancer. Surgery is usually recommended if you have:

- Colitis that does not respond to complete medical therapy
- Changes in the lining of the colon that are thought to be precancerous
- Serious complications such as rupture (perforation) of the colon, severe bleeding (hemorrhage), or toxic megacolon
Most of the time, the entire colon, including the rectum, is removed (total proctocolectomy with ileostomy). Afterwards, you may need a surgical opening in the abdominal wall (ileostomy), or a procedure that connects the small intestine to the anus to gain more normal bowel function.

Since you are having an associated condition such as gastritis, I will suggest that a test to rule out H. pylori infection should be done. If positive, antibiotics to eradicate need to be given. Drugs such as protein pump inhibitors (omeprazole) could also be given for gastritis.

Now you can see that treatment of ulcerative colitis is multidisciplinary.
Note that even after you will be off medications, other measures as mentioned above still have to be implemented.

Hope this helps and if you have further questions, please do email back.
Dr Nsah

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