Emerging Strategies in the Management of Ulcerative Colitis: A Review

Abstract

Ulcerative Colitis (UC) represents a critical and life-threatening. The rising incidence of UC, particularly in newly industrialized nations, coupled with limited access to advanced therapeutic options, underscores the pressing need for innovative strategies to manage Acute Severe Ulcerative Colitis (ASUC) effectively. ASUC necessitates hospitalization and intravenous corticosteroid therapy, which remains the cornerstone of treatment since its introduction in the 1950s. However, up to one-third of patients exhibit steroid refractoriness, requiring medical rescue therapies such as infliximab or cyclosporine or, in severe cases, surgical interventions like emergency colectomy. Recent advancements in biologic therapies and oral small molecules have revolutionized the treatment landscape for moderate to severe UC, but their application in ASUC remains limited. Current management strategies emphasize early identification of corticosteroid non-responders using clinical, biochemical, and endoscopic indices to facilitate timely escalation to rescue therapies. Despite these advances, a universally validated predictive index for corticosteroid or medical rescue therapy outcomes is lacking, necessitating further research to optimize treatment algorithms. Emerging evidence highlights the significant role of nutritional and dietary factors in modulating disease progression in UC. High-fat, high-sugar diets exacerbate mucosal dysbiosis and inflammatory signaling pathways, while fiber-rich diets that promote short-chain fatty acid (SCFA) production support mucosal barrier integrity and immune regulation. Deficiencies in micronutrients, including zinc, iron, and vitamin D, further compromise intestinal barrier function and exacerbate inflammation. The potential of dietary interventions to enhance remission induction and sustain remission in UC warrants comprehensive investigation. This review focuses on nanoformulation, and advancements in therapeutic options, and dietary factors in UC management. It underscores the importance of multidisciplinary approaches, integrating pharmacological innovations with nutritional strategies, to improve patient outcomes and reduce the burden of ASUC globally. Future research must prioritize the development of validated predictive tools and evidence-based dietary guidelines tailored to the unique needs of ASUC patients.