DEAR MAYO CLINIC: I recently quit smoking and ended up with a moderate ulcerative colitis flare. Could a short return to nicotine help with my symptoms? Are there any other recently discovered treatments for flare-ups?

ANSWER: Studies have shown that smoking can reduce symptoms of ulcerative colitis, and people who quit smoking are at risk of an ulcerative colitis flare. But a return to smoking is not recommended. A variety of other safe, effective treatment options are available.

Ulcerative colitis is a chronic inflammatory bowel disease that causes inflammation in part of the digestive tract. It typically affects the innermost lining of the large intestine, or colon, and rectum. Symptoms come and go. They often include abdominal pain, rectal bleeding, diarrhea, cramps and weight loss. The severity of ulcerative colitis varies significantly from one person to another.

It has been observed that when some people stop smoking and then have a flare-up of ulcerative colitis, if they return to smoking, the symptoms go away. It's not clear why this happens. It may be linked to an association between smoking and the changes it causes in rectal blood flow, mucus within the colon, or the way certain white blood cells work.

Due to the other overwhelming health risks associated with smoking, however, do not start smoking again to get rid of your ulcerative colitis symptoms. Instead, make an appointment to see a gastroenterologist -- a doctor who specializes in treating diseases of the digestive tract. He or she can help you find a safe and effective treatment for the disease.

In some cases of mild ulcerative colitis, people wear a nicotine patch or use other nicotine-replacement therapies to help control ulcerative colitis symptoms. That is not a standard treatment, though, as other medications are typically more effective.

For many mild to moderate ulcerative colitis cases, the first step in treatment is a drug from a class of medications called 5-aminosalicylates. These anti-inflammatory drugs work through direct contact with the colon lining. They come in pill form, or they may be given as a medicated suppository or enema.

For people who don't respond to 5-aminosalicylates or other anti-inflammatory medications, prednisone or another steroid may help reduce symptoms. But they can only be used for short-term treatment because the side effects of long-term steroid use can be significant. For severe or hard-to-treat cases of ulcerative colitis, stronger medications may be necessary, including drugs that suppress the body's immune system.

One group of immunosuppressants, called anti-TNF biologic agents, has been shown to be particularly useful in people for whom other medications have not been effective. They work by neutralizing an immune system protein known as tumor necrosis factor, or TNF. The drugs find TNF in the bloodstream and remove it before it can cause inflammation in the colon or rectum. Another new drug currently in review, called vedolizumab, also looks promising in the treatment of severe ulcerative colitis.

When medications do not work and ulcerative colitis is severe, surgery may be an option. Typically it is considered only when all other treatment options have failed, however, because it usually involves removing the entire colon and rectum.

Although there's no solid evidence that diet has an effect on ulcerative colitis, some people do seem to get relief from symptoms by reducing the amount of certain foods they eat, such as red meat, sugar and dairy products. Results vary considerably from one person to another. But, if you wish, you can experiment with your diet to see if changes are helpful.

See a gastroenterologist to discuss your condition and your treatment options. Also, ask about colon cancer screening. The risk of developing colon cancer in people who have ulcerative colitis is about twice the normal risk, so being checked on a regular basis is important. And remember, to protect your overall health, do not start smoking again. -- Edward Loftus, Jr., M.D., Gastroenterology, Mayo Clinic, Rochester, Minn.

(Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. E-mail a question to medicaledge@mayo.edu. For more information, visit http://www.mayoclinic.org.)

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