What is ulcerative colitis?

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers in the large intestine. Crohn’s disease is another form of IBD that can affect the entire gastrointestinal tract or gut, extending from the esophagus to the anus.

Who gets ulcerative colitis?

UC affects people all over the world, including one to two million Americans. UC is more common than Crohn’s disease. Although it can occur at any age, most people who have UC develop symptoms before they turn 30. UC affects both genders, although it is slightly more common in men. UC is more common in people who are Caucasian or of Ashkenazi Jewish ancestry — less so in people who are of Asian, African or South American descent. UC is more common in non-smokers and those who have stopped smoking. Patients who have UC may also have other family members who have IBD.

What causes ulcerative colitis?

The exact cause of UC is unknown, although it may be related to genetic and environmental factors that can lead to an abnormal response from the body’s immune system, the body’s natural defense system for fighting infections. When a person has UC, it is believed that this abnormal immune response results in inflammation and ulcers within the digestive tract.

Infections and other illnesses, nonsteroidal pain medications (e.g., ibuprofen), antibiotics and stress are some of the factors that can exacerbate UC.

What are the symptoms of ulcerative colitis?

Common symptoms of UC include diarrhea, bloody bowel movements, mucus in the stool, abdominal pain, rectal pain, fecal urgency (i.e., a sudden, strong feeling of needing to have a bowel movement), fever and weight loss. Other possible symptoms include mouth ulcers, lower back pain, joint pain and swelling, painful red eyes and skin sores.

Some patients with UC can develop a related liver condition that is called primary sclerosing cholangitis (PSC). While some patients with PSC may only have abnormal liver tests without any other symptoms, others may develop itching and jaundice (i.e., yellowing of the skin and/or whites of the eyes). Please let your gastroenterologist know if you have any of these symptoms or abnormal tests.

Patients with active UC, or a UC “flare,” typically have ongoing symptoms of UC, as described above, or have evidence of active inflammation that can be seen on blood tests, stool tests or colonoscopy. Patients with UC in remission do not have ongoing symptoms of UC or testing that suggest active inflammation.

How do gastroenterologists diagnose ulcerative colitis?

Gastroenterologists use a mixture of tools to evaluate a patient for UC. In addition to reviewing the results of blood and stool tests, doctors use an endoscope to remove tiny pieces of tissue from the lower portions of the colon (i.e., a flexible sigmoidoscopy) or the entire colon (i.e., a colonoscopy) — a painless procedure that’s known as a biopsy.

How do gastroenterologists treat people who have ulcerative colitis?

There is no cure for UC, but there are several effective medical treatments that gastroenterologists can use to reduce or heal a patient’s colon inflammation and prevent complications. Patients who have UC often need long-term medical treatment to remain in remission (i.e., control the symptoms and inflammation).

The medications that gastroenterologists use to treat patients who have UC depend on several factors including the extent and severity of illness, whether they have any allergies, what medications the patient is taking or has taken already for UC, potential side effects and the patient’s preference.

Steroids are a type of medication that can be used for short periods of time to treat patients who have active UC symptoms. They are not considered appropriate for long-term treatment because chronic steroid use can have multiple harmful side effects.

Amino-salicylates are a group of medicines that gastroenterologists use to treat patients who have mild inflammation.

Some patients are given immunomodulators, which regulate or calm the immune system in order to reduce inflammation.

Patients who have UC may also be treated with biologic drugs, which reduce inflammation through various biologic mechanisms. These medicines are administered with a shot or infusion (i.e., through an intravenous line). Many gastroenterologists have a dedicated area in their practice where patients can get an infusion, a process that takes a few hours.

Finally, gastroenterologists are now using a new class of small-molecule medications that are available in an oral form to treat UC.

In addition to taking any prescribed medications, it is essential for patients who have UC to eat a healthy, balanced diet and stay up to date on their vaccinations for the flu, pneumonia, hepatitis A, hepatitis B, tetanus and shingles. Staying up to date on cancer screening with regular colonoscopies and pap smears is also very important. Sun-protective clothing and sunscreen should be used when outdoors. Depending on the type of medication you are taking, your gastroenterologist may recommend annual appointments with a dermatologist to screen for skin cancer. Prolonged treatment with steroids and other risk factors may also prompt your gastroenterologist to recommend screening for osteoporosis.

If you are pregnant or plan to become pregnant, please contact your gastroenterologist to discuss if any changes need to be made to your medication regimen.

Can ulcerative colitis be treated with surgery?

Sometimes patients choose not to be treated with medications and instead choose to have surgery.
In some cases, the medications patients take do not work well enough or complications develop and surgery may be required. In addition, patients with UC may develop precancerous changes or cancer in the colon. For these patients, surgery is an option.

Some precancerous changes can be treated during a colonoscopy, but others may require surgical removal of the colon. Patients with colon cancer often require surgical removal of the colon. For patients with UC who do not respond to medical treatments, surgical removal of the entire colon may be performed. It is typical for patients to return to normal activities and enjoy a normal quality of life following surgery.

Patients with PSC may require endoscopic retrograde cholangiopancreatography (ERCP) or liver transplantation for advanced liver disease or bile duct cancer. These options will be carefully considered by your doctor after extensive workup and evaluation. Liver transplantation is a surgery that is recommended when all the other treatments do not work and the liver cannot do its job properly anymore.

Does ulcerative colitis lead to other complications?

UC can result in lower gastrointestinal bleeding, iron deficiency anemia, colon dilation or colon perforation (i.e., a hole or tear). Patients with UC can also develop blood clots in their legs, arms, lungs and rarely, in the veins of their abdomen. Patients who have had UC for many years have a greater risk of developing precancerous changes or cancer in the colon. It is important for patients to follow the recommendations of their gastroenterologists for regularly scheduled colonoscopies. In some cases, gastroenterologists perform a special endoscopic procedure that is known as chromoendoscopy in which blue dye is used to detect suspicious changes in the colon. Patients with both UC and PSC have a particularly high risk of developing colon cancer. It is essential for these patients to get a surveillance colonoscopy every one to two years. Patients with PSC are also at risk for developing bile duct cancer. Your doctor will monitor this over time.