Ulcerative colitis (UC) is a chronic inflammatory condition affecting the colon (large intestine), and treatment aims to reduce inflammation, manage symptoms, and maintain remission. Here are the main treatment approaches for UC, particularly focusing on large intestinal ulcers:

1. Medication Therapy

• Aminosalicylates (5-ASA): Medications like mesalamine or sulfasalazine reduce inflammation in mild to moderate UC. They can be taken orally or rectally, depending on the extent of the disease.
• Corticosteroids: Used for moderate to severe flare-ups, these help to quickly reduce inflammation but are not recommended long-term due to side effects.
• Immunomodulators: Drugs like azathioprine or mercaptopurine suppress the immune system to reduce inflammation, often used when 5-ASAs are ineffective.
• Biologic Agents: TNF-alpha inhibitors (like infliximab and adalimumab) and other biologics, like vedolizumab or ustekinumab, are used in moderate to severe cases unresponsive to other treatments.
• Janus Kinase (JAK) Inhibitors: Tofacitinib is an oral option for moderate to severe UC, especially when other treatments fail.

2. Diet and Lifestyle Modifications

• Anti-inflammatory Diet: Avoiding trigger foods (spicy, greasy, or high-fiber foods) and consuming anti-inflammatory foods may ease symptoms.
• Supplements: Ensuring adequate vitamin D, calcium, and folate intake, particularly if corticosteroids are used.
• Hydration and Small, Frequent Meals: Helps manage digestive discomfort.

3. Surgery

• Colectomy: In severe cases or when other treatments fail, a colectomy (removal of part or all of the colon) may be performed, potentially leading to a permanent ileostomy or creation of a J-pouch for waste storage.

4. Newer Therapies and Clinical Trials

• Research is ongoing into newer biologic agents, fecal microbiota transplants (FMT), and other innovative treatments for better symptom control and remission maintenance.

5. Probiotics and Complementary Therapies

• Probiotics: May help restore gut flora, especially when taken with standard medications.
• Mind-Body Approaches: Stress management techniques like mindfulness, yoga, or acupuncture may help alleviate symptoms.

Each UC case is unique, so treatment plans are typically tailored to the individual's condition and response to therapies. Working closely with a gastroenterologist is essential for managing UC effectively.