Digestive health centre

Digestive diseases: Ulcerative colitis

Ulcerative colitis is long-lasting disease that inflames the lining of the large intestine (colon) and rectum. Ulcerative colitis usually affects people between 15 and 30 years old. People with ulcerative colitis have tiny ulcers and small abscesses in their colon and rectum that flare up periodically and cause bloody stools and diarrhoea.

Ulcerative colitis is characterised by alternating periods of flare-ups and remission, when the symptoms of the disease disappear. The periods of remission can last from weeks to years.

Inflammation usually begins in the rectum and then spreads to other segments of the colon. How much of the colon is affected varies from person to person. If it is limited to the rectum, the disease may be called ulcerative proctitis. Ulcerative colitis, unlike Crohn's disease, does not affect the oesophagus, stomach or small intestine.

When grouped together, ulcerative colitis and Crohn's disease are referred to as "inflammatory bowel disease" because they cause inflammation of the bowel.

What are the symptoms of ulcerative colitis?

Symptoms may include:

• Blood or pus in diarrhoea
• Dehydration
• Abdominal pain
• Fever
• Painful, urgent bowel movements

Ulcerative colitis may also be associated with weight loss, skin disorders, joint pain or soreness, eye problems, anaemia (a deficiency in red blood cells), blood clots and an increased risk for colon cancer.

What causes ulcerative colitis?

The cause of ulcerative colitis remains unknown, but it is likely caused by an abnormal response of the immune system. Food or bacteria in the intestines, or even the lining of the bowel may cause the uncontrolled inflammation associated with ulcerative colitis.

Who gets ulcerative colitis?

Ulcerative colitis can be inherited. Up to 20% of people with inflammatory bowel disease have a first-degree relative (mother, father, brother, sister) with the disease.

The disease is most common in the US and northern Europe and in people of Jewish (Ashkenazi) descent. Around 120,000 people in the UK have ulcerative colitis.

How is ulcerative colitis diagnosed?

A variety of diagnostic procedures and laboratory tests are used to distinguish ulcerative colitis from other conditions. First your doctor will review your medical history and perform a complete physical examination. One or more of the following tests may be ordered:

• Endoscopy such as colonoscopy or proctosigmoidoscopy
• Blood tests
• Stool samples
• X-rays

How is ulcerative colitis treated?

Treatment can include drug therapy, dietary modifications and/or surgery. Though treatments not involving surgery cannot cure ulcerative colitis, they can help most people lead normal lives.

It is important for you to seek treatment as soon as you start having symptoms. If you have severe diarrhoea and bleeding, hospital admission may be necessary to prevent or treat dehydration, reduce your symptoms and ensure that you receive proper nutrition.

Medication

Several medications - including aminosalicylate drugs, corticosteroids, immunosuppressive agents and antibiotics - are used to reduce inflammation of the bowel tissue, allowing it to heal and relieve symptoms.

• Aminosalicylates. Mesalazine and sulfasalazine are principal medications in the treatment for ulcerative colitis.
• Corticosteroids. These anti-inflammatory medications can be used when aminosalicylates are ineffective. Corticosteroids are also used to treat people who have more severe disease. The use of corticosteroids is limited by side effects and the potential of long-term complications. In general corticosteroids are used for short periods of time to cause remission. Remission is maintained with an aminosalicylate medication.
• Immunosuppressants. If corticosteroids or aminosalicylates are not effective, immunosupressants such as azathioprine may be prescribed.
• Biologicals. The newest type of treatment are called TNF-alpha inhibitors, for example infliximab, which are used in severe ulcerative colitis when steroids are not appropriate.