Ulcerative Colitis: Doctor-Patient Collaboration is Key for Management

Ulcerative colitis, a chronic inflammatory bowel disease, is increasingly affecting South Koreans, with over 62,000 patients recorded in 2024. The condition, which can progress from mild symptoms like diarrhea and abdominal pain to severe complications such as bloody stools, intestinal strictures, and perforation, requires specialized management. Its prevalence has surged since the 2000s, with an estimated incidence of 155 per 100,000 people.

Recent advancements in treatments, including biologics and small molecule drugs, offer improved symptom control and aim for mucosal healing, even in moderate to severe cases. Initial treatments often involve 5-aminosalicylic acid (5-ASA) for proctitis or mild to moderate disease. For symptom exacerbation or recurrence, steroids are used but are not suitable for long-term treatment due to side effects. Immunomodulators like azathioprine or mercaptopurine can be added for steroid-dependent or refractory cases, though their slow onset of action can be a limitation.

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When patients' values and lifestyles are prioritized in shared decision-making, treatment adherence and satisfaction increase, directly leading to better treatment outcomes.

For patients who do not respond adequately to these therapies, newer options like biologics and small molecule drugs are available. These include anti-TNF agents (infliximab, adalimumab, golimumab), the gut-selective anti-integrin vedolizumab, and anti-IL-12/23 agents (ustekinumab) or anti-IL-23p19 agents (guselkumab). Janus kinase (JAK) inhibitors (tofacitinib, upadacitinib, filgotinib) and S1P receptor modulators (ozanimod) offer the convenience of oral administration.

Choosing the right medication involves carefully considering each drug's efficacy, safety profile, administration route, and frequency, alongside the patient's disease extent, severity, comorbidities, treatment history, and extra-intestinal manifestations. Crucially, treatment decisions should be made collaboratively between doctor and patient. Professor Song Ju-hye emphasizes that incorporating patient values, such as for those with demanding jobs, planning pregnancy, or at higher risk of infection, leads to better adherence and satisfaction, ultimately improving long-term outcomes for this chronic condition.

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As ulcerative colitis is a chronic disease managed rather than cured, active patient participation in the treatment process is important for a positive long-term prognosis.