Skip to main contentLast updated: 08-Nov-2026
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Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Gastro & Cancer Surgeon
Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad · 18 years of experience
In short
Medicine for ulcerative colitis goes in steps. A 5-ASA tablet, often with a suppository or enema, is the usual first step for mild or moderate disease.
Steroids bring a flare under control, but they are not for long-term use. Stronger medicines, such as biologics, are added when flares keep coming back.
Some tests must be done before the stronger medicines, and surgery becomes an option when medicine no longer holds the colitis.
This post explains the medicines. For the full picture of ulcerative colitis, from symptoms to surgery, see our ulcerative colitis treatment page.
A 5-ASA medicine, also called mesalamine or mesalazine, is the usual first choice. It calms the lining of the bowel and also helps keep the colitis quiet later.
It comes as a tablet, a suppository and an enema or foam. The right form depends on how far the colitis reaches. A suppository suits inflammation limited to the rectum. An enema or foam reaches further up the left side. A tablet works along the whole colon.
In many people, a tablet plus a suppository or enema works better than either one alone. Yet the local form is often skipped, because people find it awkward. When a medicine seems to have failed, we first ask two things. Did it reach the diseased part? Was it taken every day?
| Step | Medicines | What they are used for |
|---|---|---|
| 5-ASA | Mesalamine tablets, suppository, enema; sulfasalazine | Mild to moderate disease, and keeping it quiet |
| Steroids | Prednisolone tablets; budesonide; steroid enemas | Bringing a flare under control, for a short time |
| Immune-calming tablets | Azathioprine, mercaptopurine | Keeping the colitis quiet so steroids can stop |
| Biologics | Infliximab, adalimumab, golimumab, vedolizumab, ustekinumab and others | Moderate to severe disease that has not settled |
| Newer tablets | Tofacitinib, upadacitinib, ozanimod, etrasimod | Moderate to severe disease, when a tablet is preferred |
Steroids are for bringing a flare down, over a few weeks. They are not meant to keep the colitis quiet in the long run.
Prednisolone tablets are used for a moderate flare that has not settled on 5-ASA. A budesonide tablet acts mainly in the bowel. It has fewer effects on the rest of the body, but it is also milder. Steroid enemas can help when the disease is low in the bowel.
The dose is lowered slowly over weeks and not stopped at once. Taking steroids for months brings weak bones, high sugar, weight gain, infections and eye problems. So two situations are warning signs:
Either one tells us that the colitis needs a stronger plan. It is not a reason to keep repeating steroids.
Azathioprine or mercaptopurine is added when the colitis keeps relapsing or when steroids cannot be stopped. These tablets are slow, and they take two to three months to work.
They are for keeping the colitis quiet, not for settling a flare. So they are usually started while steroids are still being tapered, and the steroid is stopped later.
Before starting, doctors check a blood test of the genes NUDT15 and TPMT. These genes decide how the body handles the medicine. Some people develop a sharp fall in blood counts on a normal dose. NUDT15 changes are more frequent in Indian patients. Blood tests are then repeated on a regular schedule. We also explain the small but real risk of infection and of some blood and skin growths. You then decide with full knowledge.
They come in when 5-ASA and an immune-calming tablet are not enough. They are also used when steroids cannot be stopped, or when the disease is moderate to severe from the start.
Biologics are made proteins, given by drip or injection. Some block a body chemical called TNF, such as infliximab and adalimumab. Vedolizumab acts mainly in the bowel. Ustekinumab and newer medicines block other messengers of inflammation. Newer tablets, called JAK blockers and S1P modulators, are taken by mouth.
No single medicine is right for everyone. The choice depends on several things: how fast you need relief, the medicines you have used, your age and other illnesses. Your preference for a tablet or an injection counts too, and so does the cost. Biosimilar versions of infliximab and adalimumab have made the cost lower in India.
Doctors also adjust how a medicine is used before they give up on it. A higher dose or a shorter gap between doses sometimes brings back control. If a medicine truly stops working, the next one is chosen from a different group. For the basics of the disease, see our post on ulcerative colitis in adults.
A TB check, a hepatitis B and C blood test, and a check of past chickenpox and shingles protection come first. These tests protect you from the medicine.
Biologics and JAK tablets lower the body’s defence. In India, old TB can wake up under them, and so can hepatitis B. So the checks are not optional.
Doctors also rule out infections that look like colitis, such as amoebiasis and bowel TB, before any strong medicine. Stool tests and a scope help with this. Starting an immune-lowering medicine on the wrong diagnosis can do harm.
An operation to remove the colon is discussed when several medicines have failed. It is also discussed when steroids cannot be stopped, or when the colitis is very severe. It is not a sign of failure.
Surgery is not the end of the line for everyone, but it is a real option. Long years on steroids carry their own harm. An operation can free a person from medicines and from the flares. The usual operation removes the colon and rectum. A new internal pouch is built from the small bowel, so that stool can still pass the normal way.
Dr Harsh Shah is a surgeon and works with your own gastroenterologist. We do not take over the medicines. We see you when medicine is no longer holding the colitis, or when you want to know what surgery would mean. We then plan the timing together. The hub page on ulcerative colitis treatment in Ahmedabad explains the operation.
Please bring these to the visit:
A 5-ASA medicine, also called mesalamine, is the usual first choice. It comes as a tablet, a suppository or an enema, chosen by how far the colitis reaches.
No. Steroids bring a flare down but are not meant for long-term use. Months of steroids cause weak bones, high sugar and infections, so a second medicine is added.
A tablet reaches the whole colon, but the lower bowel gets a stronger dose from a local form. The two together often work better than either alone.
A biologic blocks one of the body's inflammation signals. It is given by drip or injection when 5-ASA and immune-calming tablets have not been enough.
A TB check, hepatitis B and C blood tests, and a vaccine review come first. Some newer tablets also need a heart or eye check.
Biosimilar versions of infliximab and adalimumab cost less than the original brands. Your doctor can tell you which one suits your case and your budget.
Please do not stop on your own. Many people relapse when 5-ASA or other maintenance medicine is stopped. Any change should be planned with your doctor.
See a surgeon when several medicines have failed or steroids cannot be stopped. You can also come to learn what an operation would mean.
For questions before you travel, call +91-63555-64601. The pages below cover the next steps.
Dr Harsh Shah — Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Dr. Jivraj Mehta Hospital, Dr Jivraj Mehta Marg, Vasna, Ahmedabad 380007.
Consultations, review of reports and scans, operations and follow-up. OPD Monday to Saturday, 9 am to 5 pm.
Appointments: +91-63555-64601 · +91-63590-11009 · Hospital 079-2663 6363
Directions to the hospital · WhatsApp +91-63555-64601
Living with ulcerative colitis and unsure if your medicines are right? Or is it time to step up? The choice depends on how far the colitis spreads, how strong the flares are and what you have already tried. Dr Harsh Shah goes through your reports and medicine history with you. He also explains where surgery fits if tablets stop working. Call, or message us on WhatsApp. Call For Appointment Book on WhatsApp Tapping Book on WhatsApp will likely open the WhatsApp app on your phone.
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