How Long Does Remission for Ulcerative Colitis Last?

If you’ve been trying to control ulcerative colitis (UC), you’re probably looking forward to the day your doctor says you’re in remission.

“When you start UC treatment, the first goal is just … to start feeling better,” says Adam S. Cheifetz, MD, director of the center for inflammatory bowel disease at Beth Israel Deaconess Medical Center and a professor of medicine at Harvard Medical School in Boston.

Within a few weeks to months, though, the hope is that symptoms will have resolved and you’ll be in remission, to some extent. For some people, the relief lasts years, while others have a flare within weeks. Here’s what you can expect.

There are a few different types and signs of remission for ulcerative colitis, including:

• Clinical Remission Symptoms, such as rectal bleeding and stool frequency, have resolved. It’s often the top goal for people with ulcerative colitis and their doctors, says Dr. Cheifetz. “We want the patient to feel well. I tell them, ‘I want you to feel like you did prior to getting ulcerative colitis.’”
• Endoscopic Remission The gut appears normal during an endoscopy, a test in which a doctor uses a thin tube with a camera to see the inside of the gastrointestinal (GI) tract. “The lining of the colon, called the mucosa, should look healed, with no signs of overt inflammation or ulceration,” says Cheifetz. When someone with ulcerative colitis reaches both clinical and endoscopic remission, doctors call it “deep remission,” he adds.
• Histologic Remission There are no signs of inflammation when doctors analyze tissue from the GI tract under a microscope. This test is often used in research settings, says Cheifetz.
• Biochemical Remission You have normal levels of blood and stool markers of inflammation, such as C-reactive protein and fecal calprotectin. While these tests are less reliable than imaging tests, with more false negatives and false positives, they are less invasive and offer clues about how well treatment is working, says Cheifetz.
  

While there’s no cure for ulcerative colitis, “The hope is that once someone is in remission, they stay in remission,” says Cheifetz.

One of the most significant factors that influences whether someone stays in remission is how well they stick with treatment, says Cheifetz.

“If someone doesn’t take their medication as prescribed, they have an increased risk of flares,” he says.

Sometimes, though, relapse is unpredictable.

“There are people who do great for years, and then they flare,” says Cheifetz. “For whatever reason, their immune system, their biology, changed, and they’re no longer responding to the medication they’re on.”

In those cases, he recommends switching to a new medication that works differently. If symptoms flare, tell your doctor right away. You should also stay in regular contact with your gastroenterologist, even if the condition isn’t causing problems. This way, your doctor can help you stay on track with treatment and identify any early signs of trouble. Cheifetz sees his patients one to four times per year, even when they’re in remission.

“If, all of a sudden, we start to see some endoscopic disease, maybe we can optimize their medication before they develop any symptoms,” he says.

• There are different types of ulcerative colitis remission, but in general, remission means that symptoms have resolved and medical tests show that the gut is healing.
• Remission can last months to years. Sticking with your treatment plan is the best way to stay in remission.
• If the disease flares, your doctor might switch medications or consider other treatment options, such as surgery.