I have ulcerative colitis. Since antibiotics are prescribed for ulcers in the stomach and can cure these, would antibiotics be a logical choice for ulcers of the intestines? Prednisone and Azulfidine haven't cured anyone, right? Could this so-called autoimmune disease really be caused by a bacterium that we just haven't found yet?

Chad

You raise some interesting points regarding the cause and treatment of ulcerative colitis. Let me start by summarizing some of our knowledge of ulcerative colitis. This condition is an inflammatory destruction of the mucosa (inner lining) of the large intestine. We know the immune system is involved based on the types of cells that are seen on biopsy and surgical specimens, and by the molecular mediators of inflammation found in the bloodstreams of people with active ulcerative colitis.

The cause of ulcerative colitis is unknown, although many theories have been raised. Some speculate it is an inherited autoimmune disease since it runs in families and certain ethnic groups. Others theorize that an external agent, such as a bacterium, may sensitize the colon and lead to uncontrolled inflammation in certain predisposed individuals.

Your analogy to stomach ulcers is a thoughtful one. It's true that while ulcers require acid to form, the main risk factor is a type of bacterium called Helicobacter pylori. Eradication of H. pylori dramatically lowers ulcer relapse rates, even if patients do not receive long-term therapy with acid-suppressive medications. Unfortunately, we have not identified such a bacterium in ulcerative colitis.

There are many medications used to treat ulcerative colitis. Most are blockers of inflammation, such as steroids (prednisone) and mesalamine compounds (Azulfidine and others). While these are effective, we do not yet know the exact mechanism by which they work. It's likely that they act in several ways.

You are correct in stating that such medications do not cure ulcerative colitis or treat the underlying cause. Instead, they act on the effect of ulcerative colitis, which is the inflammation. They are very powerful in this respect, achieving high rates of response and remission.

Interestingly, other effective medications in treating ulcerative colitis are antibiotics such as metronidazole (Flagyl) and ciprofloxacin (Cipro). They are used in some patients who have severe flare-ups requiring hospital admission, and they have been used increasingly in patients who do not respond completely to combinations of the standard anti-inflammatory drugs.

Those who argue in favor of a bacterial factor in the genesis of ulcerative colitis use the action of antibiotics to support their claims. However, in general, antibiotics have not been found to be as uniformly effective in treating ulcerative colitis as anti-inflammatory drugs. Still, maybe one day we will find a specific organism at the root of this disease.