I have ulcerative colitis. When should I switch to biologics?

Question

Hello doctor,

I am 34 and was recently diagnosed with ulcerative colitis after a colonoscopy showed inflammation in the sigmoid colon. My CRP level is 18 mg/L, and I have been having frequent loose stools with some blood.

The doctor suggested Mesalazine, but I am worried if biologic injections would be better in my case. So my concerns are -

How do we decide when to escalate treatment to biologics?
Also, does diet really make a significant difference in controlling flare-ups, and are probiotics actually useful?
Should I repeat a colonoscopy regularly, or only if symptoms worsen again in the future?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Mesalazine is the standard, first-line treatment for mild-to-moderate UC (ulcerative colitis), especially when confined to the lower colon (like your sigmoid). It is very effective for many people.

Biologics are typically reserved for more severe disease, extensive colitis, or if Mesalazine fails. Starting with Mesalazine is the appropriate approach.

Regarding diet, while no specific diet causes or cures UC, certain foods can worsen symptoms during a flare.

Keeping a food diary to identify your personal triggers (common ones are high-fiber foods, dairy, spicy foods, or caffeine) can make a significant difference in managing symptoms.

Probiotics, specifically certain strains, may help maintain remission, but they are not a primary treatment for active flares. They are generally safe to try.

About monitoring and colonoscopy, you will not need regular colonoscopies if you are well-controlled.

The main reason for repeat colonoscopy is to monitor for pre-cancerous changes, which typically start after eight to 10 years of having the disease. Before that, scopes are usually only done if symptoms change significantly or to check if treatment is working.

I hope this helps.

Thank you and take care.

Regards.