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 the form of oral medications, suppositories, and enemas.

Initially developed as arthritis treatments, their efficacy for inflammatory bowel diseases such as ulcerative colitis and Crohn's disease was discovered. Since then, they have become widely established as the foundational drugs for ulcerative colitis and Crohn's disease.

Characteristics and Limitations:
The exact mechanism by which these drugs are effective for ulcerative colitis or Crohn's disease is not clearly understood, and they are widely used in mild initial stages without knowing the exact mechanism of action. In cases of early ulcerative colitis, remission may be induced for about 1-2 years upon initial intake, but generally, relapse occurs after 1-2 years even with continued use. After a relapse, even increasing the dosage often fails to re-induce remission.

                        Major Side Effects: Headache, dizziness, abdominal pain, fever, dermatitis, hair loss, hepatotoxicity, nephrotoxicity, darkening of urine, etc., most of which are generally mild.
                    

"Steroid administration is by no means a cure,
it should be thought of as merely putting out a fire temporarily."

Strong Anti-inflammatory

Steroids
(Steroid)

A potent steroid, prednisolone (product name: Solondo), is frequently used. Because steroids strongly suppress inflammation, symptoms often improve after intake, but they are drugs that cannot be taken for a long time because they are accompanied by serious side effects.

STEP 01

Start of Administration

Generally, it starts by taking 6 to 8 tablets of 5mg Solondo per day to strongly suppress inflammation.

STEP 02

Tapering

The internationally recommended duration for steroid use is 4 weeks. The method is to reduce the dosage by 1 tablet per week and discontinue after 6 to 8 weeks.

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 stopping the medication in the long term.

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, hypertrichosis, skin stretch marks and thinning, skin ulcers, bruising due to vascular weakening, purpura, menstrual irregularities, and secondary adrenal insufficiency.

Immunosuppressive Drug

Immunosuppressants

Product names: Azafrine(Azathioprine), Imutera, Purinethol, Imuran, etc.

As long-term use became impossible 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 to reduce inflammation by suppressing the body's immune system.

Limitation

Limitations of Treatment Effect

In clinical practice, they are often not very effective, and long-term use weakens the immune system, making patients susceptible to simple illnesses like the common cold.

Mild Side Effects

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

Severe Side Effects

Bone Marrow Suppression and Severe Side Effects

Seriously, there are significant risks such as decreased white blood cell and platelet counts due to bone marrow suppression, sepsis, and myelodysplasia.

Management

Regular Checkups and Korean Medicine Recovery

Regular blood tests (WBC) every 1-2 months are essential. If white blood cell counts decrease, taking Korean herbal medicine while stopping the drug can allow the counts to recover to normal levels.

Advanced Therapy

Biologic (Injectable) Agents and Oral Targeted Therapies

These agents are used when oral medication is not sufficiently effective. Previously, they were mostly developed in injectable form, but recently they have also been developed in oral form. As existing biologics are not sufficiently effective, new drugs continue to be developed.

Anti-TNF agents

TNF-α InhibitorsRemicade, Remsima, Humira, Simponi

Action: Agents that inhibit Tumor Necrosis Factor (TNF-α), which causes necrosis of tumor cells in our body.

Administration and Maintenance: Administered 2 weeks, 4 weeks, and 8 weeks after the first dose. Efficacy lasts from 3 months to 5 years at most, and the effect is lost if the body produces antibodies against them.

Characteristics: Pre-screening is essential as latent tuberculosis can develop into active disease. Self-injection methods are also available recently.

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

Anti-IL agents

Interleukin InhibitorsStelara

Action: Inhibits IL-12 and IL-23, which induce immune inflammatory responses. By binding to the p40 subunit, it reduces Th1 and Th17 immune responses.

Characteristics: Unlike TNF-α inhibitors, it provides more selective immune modulation, resulting in relatively less systemic immune suppression.

Administration: Subcutaneous injections are performed at 8 or 12-week intervals after the initial intravenous injection.

Side Effects: Upper respiratory infections, headache, injection site pain, and fatigue are common, and there is also a risk of severe infection or increased cancer incidence.

Gut-selective

Integrin InhibitorsEntyvio

Action: A monoclonal antibody targeting α4β7 integrin that selectively blocks the migration of lymphocytes into the intestinal mucosa, thereby suppressing inflammation.

Characteristics: As a gut-selective immunosuppressant that only suppresses local inflammation in the intestinal mucosa, the risk of infection and systemic side effects is relatively low.

Administration: Can only be administered 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 the signal transduction pathway where inflammatory cytokines (IL-2, IL-6, IL-12, IL-23, IFN-γ, etc.) activate JAK (JAK1, 2, 3, TYK2) inside the receptor.

Advantages and Characteristics: Easy to use because they are oral drugs, and their effect is fast, but they are absorbed systemically and inhibit signal transduction not only in the gut but also within systemic immune cells.

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 risk, and cancer.

Surgical Treatment

Bowel Resection Surgery

The last resort performed when symptoms do not subside and inflammation is too severe, despite using all 5-ASA agents, steroids, immunosuppressants, and biologics.

Surgery is not the end.

Reality after surgery

1. Life with an artificial anus (stoma):
In the case of ulcerative colitis, when performing a total colectomy or removing the rectal area, an artificial anus is made on the abdomen, and one must live with a stool bag for about 2-3 years. Afterwards, a surgery to reconnect it to the anus is performed.
2. Lifelong diarrhea:
If 2/3 or more of the colon is resected or a total resection is performed, the organ that creates stool is gone. Consequently, food residue from the small intestine is discharged immediately, leading to a life of diarrhea 4-6 times a day at minimum, and up to 15-20 times at maximum.

"Resected bowels do not grow back."

Alternative Approach

Before surgery,
the necessity of Korean medicine treatment

If you are in a situation where you are enduring numerous side effects and considering bowel resection surgery, it is highly recommended to check the last possibility of preserving your bowels through Korean medicine treatment.

Surgery is an irreversible choice. HanStep Korean Medicine Clinic prioritizes treating the patient while preserving their own bowels without organ resection, restoring their quality of life.

View HanStep Treatment Philosophy

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