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 drugs include Sulfasalazine, Mesalazine, and Mesalamine, and are available in the form of oral medications, suppositories, and enemas.

Initially developed as an arthritis treatment, their efficacy for inflammatory bowel diseases such as ulcerative colitis and Crohn's disease was discovered. Since then, they have become widely used as the standard treatment for ulcerative colitis and Crohn's disease.

Features and Limitations:
The exact mechanism of how 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 full knowledge of their mechanism. In cases of early ulcerative colitis, initial intake may induce remission for 1-2 years, but recurrence typically occurs after 1-2 years even with continued use. After recurrence, increasing the dosage often fails to induce remission again.

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

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

Strong Anti-inflammatory

Steroids
(Steroid)

The potent steroid Prednisolone (brand name: Solondo) is frequently used. Because steroids powerfully suppress inflammation, symptoms often improve after intake, but they are not drugs that can be taken for a long time due to serious side effects.

STEP 01

Start of Administration

Usually, the treatment begins with 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 the dosage by one tablet per week and discontinuing after 6-8 weeks is adopted.

WARNING

Vicious Cycle of Recurrence

Even if inflammation is suppressed, symptoms often worsen again when reduced to 1-2 tablets, or recur 1-2 months after stopping the medication long-term.

SIDE EFFECTS

Serious Side Effects

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

Immunosuppressive Drug

Immunosuppressants

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

As long-term use became impossible due to serious side effects of steroids, these agents were introduced with the goal of maintaining remission without steroids.

Rather than directly suppressing inflammation, they function to suppress our body's immunity to reduce inflammation. However, in actual clinical practice, effectiveness often falls short of expectations, and long-term use can lower immunity, making the body vulnerable to diseases such as 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 use.
Serious Side Effects: There are significant risks such as decreased white blood cell and platelet counts due to bone marrow suppression, the onset of sepsis, and myelodysplasia.

Regular Checkups and Korean Medicine Recovery: Regular blood tests (WBC) every 1-2 months are essential. If problems such as a decrease in white blood cell count occur due to immunosuppressants, levels can return to normal if the medication is stopped while taking herbal medicine.

Advanced Therapy

Biologic (Injectable) Agents and Oral Targeted Therapies

These are agents used when oral drugs are not sufficiently effective. While many were originally developed in injectable forms, recent developments include oral forms. As the effectiveness of existing biologics is often insufficient, new drugs are continuously being developed.

Anti-TNF agents

TNF-α InhibitorsRemicade, Remsima, Humira, Simponi

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

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

Features: Pre-screening is essential as it can trigger latent tuberculosis. Recently, self-injection methods have become available.

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

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.

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

Administration: Subcutaneous injection is performed every 8 or 12 weeks after an initial intravenous injection.

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

Gut-selective

Integrin InhibitorsEntyvio (Vedolizumab)

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

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

Administration: Available only via intravenous injection.

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

Oral / Janus Kinase Inhibitors

JAK Inhibitors (Oral)Xeljanz, Rinvoq

Action: Directly blocks the signaling pathway through which 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: As an oral medication, it is convenient to use and acts quickly, but it is absorbed systemically, suppressing intracellular signaling not only in the intestine but also throughout the entire body's 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 risks, and cancer.

Surgical Treatment

Bowel Resection Surgery

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

Surgery is not the end.

The Reality of Post-Surgery Life

1. Life 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 must be made on the abdomen, and you must live with a stool bag for about 2-3 years. Afterward, a surgery to reconnect to the anus is performed.
2. Life-long Diarrhea:
If more than two-thirds of the colon is resected or a total resection is performed, the organ that creates stool is lost. Eventually, food residue from the small intestine is discharged immediately, meaning you have to live with diarrhea at least 4-6 times, and up to 15-20 times a day.

"Resected intestines do not grow back."

Alternative Approach

Before Surgery,
The Necessity of Korean Medical Treatment

If you are in a situation where you are considering bowel resection surgery after enduring numerous side effects from drug treatments, it is highly recommended to check the last possibility of preserving your intestines through Korean medical treatment.

Surgery is an irreversible choice. HanStep Korean Medicine Clinic prioritizes restoring quality of daily life by preserving the patient's own intestines without organ resection.

View HanStep Treatment Philosophy