What Does ‘Treatment Failure’ Mean if You Have Ulcerative Colitis?

You’ve followed your ulcerative colitis (UC) treatment plan to a T, and yet you’re still experiencing symptoms that won’t let up — or even seem to be taking a turn for the worse. There’s an unfortunate name for this phenomenon: treatment failure. And you’re not the only one going through it.

“Treatment failure is a bit of a misnomer,” says Aditi Stanton, MD, a board-certified gastroenterologist with Gastro Health in Cincinnati. “It essentially means that a medication is no longer controlling inflammation adequately. But it does not mean that a patient has failed or done anything wrong.”

Here’s how to know whether your treatment is getting a failing grade — and what happens next.

Before talking about failure, let’s talk about what it means for an ulcerative colitis treatment to be successful. Raymond Cross, MD, medical director of the Center for Inflammatory Bowel and Colorectal Diseases at Mercy Medical Center in Baltimore, says that a treatment is working if:

• You feel good and are able to engage in your normal activities, without needing to take steroids.
• Blood and stool tests don’t show markers of heightened inflammation.
• Your colon tissue looks normal and healthy on a colonoscopy, and there’s minimal inflammation on a biopsy.

In this case, you may be experiencing some of the following issues:

• Persistent, New, or Worsening Gastrointestinal Symptoms An uptick in bowel movement frequency or urgency, abdominal pain, diarrhea, fatigue, or rectal bleeding are all red flags. Usually, these are signs of ongoing inflammation in the colon or rectum.
• Persistent, New, or Worsening Systemic Issues For example, anemia, eye pain, joint pain, rashes, and unexplained weight loss can all be linked to uncontrolled ulcerative colitis.
• Persistent, New, or Worsening Inflammation Symptoms can be a sign of inflammation, but your doctor will also check your inflammation levels with blood tests, a colonoscopy, or stool tests. “Some patients can feel okay but still have active inflammation,” says Stanton.
• Severe Complications Ongoing, uncontrolled inflammation can severely damage the lining of the colon, leading to potentially life-threatening complications, such as toxic megacolon (where the colon becomes stretched and leaky) or a bowel perforation (where the colon tears).

Other times, drugs that work initially can start to lose their effectiveness. “I estimate that 10 percent of patients can lose response each year on stable therapy,” says Dr. Cross.

Treatment failure can be frustrating. But there are other options for controlling ulcerative colitis. Your care team can help you decide on the right next step for you.

“[Surgery is] typically considered if multiple advanced therapies have failed or if inflammation remains severe, despite optimal medical management,” says Stanton, “or if complications, such as precancerous changes in the colon, arise.”

• Treatment failure doesn’t mean you’ve done anything wrong. If ulcerative colitis medication isn’t controlling symptoms, the drug is at fault, not you.
• Persistent or worsening symptoms are red flags. Bleeding, fatigue, increased bowel urgency, or unexplained weight loss may signal ongoing inflammation or complications.
• There are still options if treatment stops working. Your care team can help you find a path forward by adjusting the medication dosage, trying a new therapy, or suggesting surgery.