I would get surgery if alternative treatments such as diet, probiotics, and fecal transplantation stopped working and my colon was severely damaged. A damaged colon is not of much use and is easier to develop colon cancer.
I'm not one for taking medicines that don't fix the problem and can do more harm to the body than having the colon taken out. I took meds for three months when I first found out I had colitis. It gave me enough time to research alternative treatments and get the inflammation under control. I have no plans to take additional medications--even the more mild ones. I can eat foods with turmeric and ginger instead.
It's not that I don't believe in taking medication. I do take medications for other things. It's that I don't believe in taking medications that can harm the body more than the problem and don't fix the reason for having the problem to begin with. Moreover, I do have the option of getting the colon taken out. If I didn't have that option, I would be more inclined to take the medications.
Figuring out how to reduce a flare or get into remission is a trial and error experience. Don't expect your GI to have all the answers. He was trained in making diagnoses, prescribing medications, and surgically removing the colon. He was not trained in alternative treatments. That's why they are called alternative treatments.
What works for me: Fecal transplantation, Probiotics, Anti-inflammatory foods, No HFCS, No crystalline fructose, No foods high in fructose, No artificial sweeteners, No pro-inflammatory foods when flaring, Vitamins, Lexapro (for stress).