Ulcerative Colitis

Ulcerative colitis is a chronic disease that causes inflammation in the rectum, colon (large intestine), and, infrequently, the last part of the small intestine (ileum). The inflammation affects the inner lining of the colon, causing small sores, or ulcers. This is a lifelong condition that will go through periods of active disease (flare-ups) and remission. Ulcerative colitis, along with a another condition known as Crohn's disease, are collectively called inflammatory bowel disease (IBD).

Ulcerative colitis affects the rectum and large intestine.

Receiving a diagnosis of ulcerative colitis is going to mean making some lifestyle changes and learning how to work with physicians, such as a gastroenterologist, to manage the disease. There have been many advances in treating ulcerative colitis in recent years, which has improved outcomes for patients. Taking time to learn more about IBD is also going to be an important part of managing symptoms and preventing flare-ups.

The Most Important Things to Know About Ulcerative Colitis

  • Ulcerative colitis is one form of IBD and affects the large intestine (colon).
  • IBD is often diagnosed in young people between the ages of 15 and 25.
  • There is no known cause or cure for ulcerative colitis.
  • Inflammation from ulcerative colitis begins starts in the rectum and spreads upward through the colon.
  • Some of the medications used to treat ulcerative colitis include aminosalicylates (5-ASA), immunomodulators, steroids, and biologics.
  • Surgery is also used to treat ulcerative colitis, with the most common surgery being ileal pouch-anal anastomosis (IPAA), also called a J-pouch.

Forms of Ulcerative Colitis

Ulcerative colitis actually has several subtypes within it. Doctors may refer to the type of ulcerative colitis in order to best choose an appropriate treatment, as not every treatment will work for every type of disease.

  • Ulcerative proctitis: This refers to disease when inflammation is located only in the rectum.
  • Proctosigmoiditis: With this form of ulcerative colitis, both the rectum and the last section of the colon, the sigmoid colon, are involved.
  • Left-sided colitis: The colon is sometimes referred to as being in two sections: the proximal and the distal. In left-sided colitis, it's the last section, the distal, that's affected, which is located on the left side of the abdomen. 
  • Pancolitis: Ulcerative colitis is called pancolitis when the colitis has affected the entire colon.

Symptoms of Ulcerative Colitis

Ulcerative colitis causes certain signs and symptoms, some of which are in the digestive tract and some that are outside the digestive system.

 The symptoms of ulcerative colitis include:

Possible Causes of Ulcerative Colitis

The cause of ulcerative colitis, and of all forms of IBD, is still unknown, although there are some theories. There is a genetic component to IBD; you are more likely to develop IBD if a family member has it. However, the majority of people with IBD don't have a family history of the disease.

It is thought that IBD is an autoimmune or immune-mediated disease, and one theory about the cause is that it could be a result of the body having an allergic response. Another possibility is that IBD may be caused by some combination of environmental factors that "turn on" the IBD genes. The actual cause of IBD is more than likely a result of a combination of these ideas, or there may still be a cause that research hasn't uncovered.

We know that ulcerative colitis does run in families, but the exact mechanism for this is still being studied.

In fact, most people who have IBD have no family history of the disease. However, first-degree relatives of people who have IBD are more likely to have IBD themselves. Research into the genes that play a role in the development of ulcerative colitis is ongoing.

How Ulcerative Colitis Is Diagnosed

A physician's first clue to suspecting a patient might have ulcerative colitis is often learning that he or she is experiencing the hallmark symptoms of cramping, abdominal pain, and bloody diarrhea. Ulcerative colitis is typically diagnosed by examining a biopsy of tissue taken from the colon during a colonoscopy. Other tests, such as X-raysbarium enemaupper gastrointestinal seriessigmoidoscopy, and upper endoscopy, have less value in diagnosis but may also be used. Because ulcerative colitis only affects the colon, tests done to look for problems in other areas of the digestive tract will likely not show anything (unless there are complications or other conditions present).

Blood tests can also offer helpful information about the status of IBD, especially the red blood cell and white blood cell counts.

 Blood tests can also monitor levels of electrolytes such as sodium and potassium, which may be depleted because of chronic diarrhea. Other, more specialized tests may also be used, especially at larger digestive disease centers or IBD centers.

How Ulcerative Colitis Is Treated

There are several different classes of medications used to treat ulcerative colitis. Surgery is also used to treat ulcerative colitis, but most people never need surgery.

Medication: A variety of medications are used to treat ulcerative colitis. Medications fall into two categories: maintenance drugs, which are taken all the time to prevent flare-ups, and fast-acting drugs, which are taken occasionally to stop a flare-up.

Types of drugs commonly used to treat ulcerative colitis include:

Surgery: Surgery to treat ulcerative colitis involves removing the large intestine. Removing sections is not done because the colitis will only recur in the part of the colon that is left.

The most common surgery done to treat ulcerative colitis is a proctocolectomy with creation of pelvic pouch. The technical name for this surgery is ileal pouch-anal anastomosis (IPAA), but it is better known as J-pouch surgery. During this surgery, the large intestine is removed and the last part of the small intestine (the ileum) is used to create an internal pouch. The internal pouch is then connected to the rectum, which allows for more normal elimination.

Proctocolectomy with creation of ileostomy is another surgery that is used to treat ulcerative colitis. In this surgery, the large intestine is removed and a stoma is created. An ileostomy pouch is worn on the abdomen to collect waste.

Colorectal Cancer Risk in Ulcerative Colitis

People with ulcerative colitis are at increased risk for colorectal cancer, particularly those who have had extensive disease with inflammation for 8 to 10 years. Those who are at a greater risk for colorectal cancer will need to work with their gastroenterologist to develop an individualized plan to regularly monitor for colorectal cancer, such as with colonoscopy. However, most people with ulcerative colitis never develop cancer.

Related Conditions

  • Extra-intestinal: Ulcerative colitis is associated with certain complications, some of which are outside the colon and called extra-intestinal complications. This includes delayed growth in children, eye diseases, arthritis, skin conditions, mouth ulcers, and an increase of symptoms during menstruation. Most of these extra-intestinal symptoms follow the course of the ulcerative colitis: they may get worse when the ulcerative colitis is flaring, and improve when the ulcerative colitis is under control.
  • Intestinal: Some of the intestinal, or local, complications of ulcerative colitis can include bowel perforation, fissures, and toxic megacolon. Some of these complications can be treated with medications or other non-invasive methods. Others, such as a bowel perforation or toxic megacolon, are true medical emergencies and need prompt treatment to prevent more serious disease. These complications are uncommon, however.

Pregnancy

Women who have ulcerative colitis can have a healthy pregnancy and baby. Pregnancy, however, should be planned whenever possible. The most important factor when considering a pregnancy is getting the ulcerative colitis into remission. Women who begin a pregnancy while in remission have a greater chance of staying in remission until delivery. In most cases, medications will not need to be discontinued, with the exception of those drugs that have been shown to be harmful to a fetus (such as methotrexate), in which case patients taking those drugs should be utilizing appropriate birth control methods.

Ulcerative Colitis Prognosis

For the first 10 years after diagnosis, the prognosis for people with ulcerative colitis is good. Most people see their symptoms improve with treatment, and do not need surgery. After 10 years with ulcerative colitis, the risk of colorectal cancer does increase, but only develops in about 5 percent of people with the disease.

A Word From Verywell

Receiving a diagnosis of ulcerative colitis is stressful and will bring with it many emotions, as well as changes to diet and habits. People with ulcerative colitis will need regular care from a gastroenterologist, which is a big change in lifestyle, especially for young people. However, experts agree that it is an exciting time for research into IBD and in the development of new therapies. Medications currently being used to treat IBD are successful in getting patients into remission and keeping them there, and studies into new treatments are ongoing. With regular care, people with ulcerative colitis have a higher quality of life than ever before.

Sources:

Crohn's and Colitis Foundation of America. "Colitis Medication Options." CCFA.org 2016.

Crohn's and Colitis Foundation of America. "Colitis Treatment Options." CCFA.org 2016.

de Lima-Karagiannis A, Zelinkova-Detkova Z, van der Woude CJ. "The Effects of Active IBD During Pregnancy in the Era of Novel IBD Therapies." Am J Gastroenterol. 2016 Jun 28. [Epub ahead of print]

Lutgens MW, van Oijen MG, van der Heijden GJ, Vleggaar FP, Siersema PD, Oldenburg B. "Declining risk of colorectal cancer in inflammatory bowel disease: an updated meta-analysis of population-based cohort studies." Inflamm Bowel Dis. 2013 Mar-Apr;19:789-799. 

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