Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers in the innermost lining of the large intestine (colon and rectum). While there is no cure, medications and therapies can effectively manage symptoms and induce long periods of remission. [1, 2, 3]
Symptoms
Symptoms typically develop over time and range from mild to severe, often alternating between active flare-ups and periods of no symptoms. The most common indicators include: [1, 2]
- Abdominal pain and severe cramping
- Diarrhea (often bloody, or mixed with mucus and pus)
- Unexplained weight loss and fatigue
- An urgent, unrelenting need to have a bowel movement
- Fever and loss of appetite [1, 2]
Causes and Risk Factors
The exact cause of ulcerative colitis is unknown, but medical professionals believe it stems from an overactive immune system, genetics, environmental factors, or an abnormal response of the gut microbiome to bacteria. Risk factors include: [1, 2]
- Age: It can develop at any age, but it most frequently starts before the age of 30.
- Genetics: Having a close relative with the disease increases your risk.
- Ethnicity: While it can affect anyone, white individuals and those of Ashkenazi Jewish descent face a higher risk. [1, 2, 3]
Diagnosis
To properly diagnose UC, gastroenterologists will use a combination of the following:
- Blood and stool tests: To check for anemia, high inflammatory markers, and elevated levels of calprotectin (an indicator of intestinal inflammation). [1]
- Endoscopic procedures: A colonoscopy or flexible sigmoidoscopy is the most definitive way to visualize the lining of the colon, find ulcers, and take tissue biopsies. [1]
- Imaging: X-rays or CT scans may be used in severe cases to rule out complications like a perforated colon. [1, 2]
Treatment and Management
Treatment aims to reduce inflammation, allow the digestive tract to heal, and address nutrient deficiencies. [1, 2]
- Medications: The first line of defense typically includes anti-inflammatory drugs (e.g., aminosalicylates), corticosteroids, immunosuppressants, or biologic therapies. [1, 2, 3, 4]
- Diet and Lifestyle: While diet doesn’t cause UC, trigger foods can worsen flare-ups. Dietary changes, hydration, and nutritional supplements are frequently part of a management plan. [1, 2, 3, 4]
- Surgery: If medications are ineffective, or if severe complications arise (like massive bleeding or a ruptured colon), surgery to remove the entire colon and rectum may be required. This can sometimes be followed by a procedure (such as an ileal pouch-anal anastomosis) that allows waste to pass normally.[1, 2, 3, 4]