Integrative Approaches to Ulcerative Colitis Possible Solutions to Treatment Options (2024)

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by relapsing inflammation of the colon and rectum, with substantial effects on gastrointestinal function and quality of life. This narrative review examines conventional treatments and potential complementary approaches within an individualized framework for UC management. Conventional therapies discussed include aminosalicylates, corticosteroids, immunomodulators, biologic agents, targeted oral medications, and surgery for medically refractory disease. Particular attention is given to persistent microscopic inflammation despite clinical or endoscopic remission and its relevance to relapse risk. Complementary strategies explored include dietary modifications, correction of nutritional deficiencies, probiotics, prebiotics, curcumin, and other compounds investigated for antioxidant, anti-inflammatory, or intestinal barrier-supporting properties. Emerging research on nutritional influences on epigenetic regulation and nicotinamide adenine dinucleotide (NAD) metabolism is also considered. Proposed mechanisms include modulation of immune signaling, oxidative stress, gut microbial composition, and epithelial repair. However, evidence varies considerably across interventions, and many proposed benefits derive from preclinical studies rather than established clinical outcomes. The review emphasizes treatment adherence, nutritional assessment, and coordinated care that accounts for disease activity, individual tolerability, and patient preferences. Further controlled clinical research is needed to establish the safety, effectiveness, dosing, and treatment interactions of complementary interventions used alongside conventional UC therapies.