CONDITIONS
Ulcerative Colitis (UC)
What is ulcerative colitis (UC)?
Ulcerative colitis (UC) is a chronic condition that causes the inflammation and ulceration of the inner lining of the rectum and colon (large intestine). Inflammation is the body’s natural response to injury or irritation, resulting in symptoms such as redness, swelling, and pain. In UC, the lining develops small ulcers that can cause bleeding or discharge of pus. Although the inflammation typically begins in the rectum and lower colon, it can affect the entire colon.
What causes ulcerative colitis?
According to researchers, the development of ulcerative colitis is complex and influenced by multiple risk factors. Experts generally agree that it is associated with an overactive immune response. Although the immune system is meant to protect against harmful substances, it can occasionally malfunction and attack the body’s own tissues, leading to inflammation.
Who gets ulcerative colitis?
Ulcerative colitis can occur at any stage of life, but it is most likely to develop between the ages of 15 and 30. There is also a notable increase in risk after the age of 60. People who have a close family member (parent, sibling, or child) diagnosed with ulcerative colitis have a higher chance of developing the condition. While genetics play a significant role, environmental factors such as diet, smoking, lifestyle choices, exposure to pollutants, and other factors can also impact the disease’s onset, progression, and recurrence.
What are the types of ulcerative colitis and their associated symptoms?
The symptoms of ulcerative colitis can vary depending on the extent of inflammation and the location of the disease within the large intestine. Here are some of the most common types of ulcerative colitis:
- Ulcerative proctitis: This type of colitis involves inflammation limited to the rectum. The rest of the colon is unaffected. The symptoms may include rectal bleeding, urgency, and rectal pain. Some people with proctitis often feel that they have the urge to pass a stool but cannot pass anything because the bowel is empty. This is called tenesmus.
- Left-sided colitis: In this form, inflammation starts at the rectum and extends up to the splenic flexure, a bend located in the colon in the upper left abdomen. Proctosigmoiditis is a subtype of left-sided colitis. Symptoms may include loss of appetite, weight loss, bloody diarrhoea, and pain on the left side of the abdomen.
- Extensive colitis: This type affects the entire colon, with continuous inflammation starting at the rectum and extending beyond the splenic flexure. Symptoms may include loss of appetite, bloody diarrhoea, abdominal pain, and weight loss.
What are the common symptoms of ulcerative colitis?
- Diarrhoea
- Blood, pus, or mucus in the stools
- Blood loss may lead to a low red blood cell count, called anaemia
- Crampy abdominal pain on the left side
- Urgent bowel movements
- Loss of appetite
- Weight loss
Moreover, in addition to experiencing symptoms in the gastrointestinal (GI) tract, individuals with ulcerative colitis may also have various symptoms in different parts of the body, known as extraintestinal manifestations. These manifestations can manifest in the eyes, mouth, joints, skin, and liver.
- In the eyes – redness, pain, and changes in vision.
- Mouth sores.
- Swelling and pain in the joints
- skin may show tender bumps, painful ulcerations, and other sores or rashes.
- Liver – development of primary sclerosing cholangitis (a condition affects the bile duct) and cirrhosis of the liver.
Some people may experience extraintestinal manifestations as the first indicators of ulcerative colitis, which could appear long before any bowel symptoms develop. On the other hand, these manifestations might also occur right before a disease flare-up.
Around half of the ulcerative colitis patients have mild symptoms, while the rest suffer from severe abdominal cramping, bloody diarrhoea, nausea, and fever. The symptoms of this condition come and go, with periods of remission where individuals may have no symptoms at all. These remission phases can last for months or even years, although symptoms usually return over time.
How is ulcerative colitis diagnosed?
Various tests are utilized to diagnose ulcerative colitis. The initial step typically involves a physical examination and review of medical history.
- Blood tests may be conducted to identify anaemia, which could suggest bleeding in the colon or rectum, or to detect a high white blood cell count, indicating inflammation in the body.
- Stool test can provide insight by revealing the presence of white blood cells, which are indicative of ulcerative colitis or inflammatory disease. This sample also enables the doctor to identify any bleeding or infections in the colon or rectum caused by bacteria, viruses, or parasites.
- A colonoscopy or sigmoidoscopy is the most precise method for diagnosing ulcerative colitis and excluding other potential gastrointestinal conditions like Crohn’s disease, diverticular disease, or cancer. In both procedures, a doctor inserts an endoscope (a lengthy, flexible, illuminated tube connected to a computer and TV monitor) into the anus to examine the interior of the colon and rectum. The doctor can identify any inflammation, bleeding, or ulcers on the colon wall. Additionally, a biopsy may be performed during the examination, which entails extracting a tissue sample from the colon lining for microscopic analysis.
- Specialized X-rays, such as a barium enema, is utilized to diagnose signs of inflammation in the colon.
- A CT scan and MRI can detect inflammation in the colon, particularly in cases of moderate and severe UC.
What is the treatment for ulcerative colitis?
The main goals of treatment are to achieve and maintain remission. If remission is not possible, the focus shifts to reducing the severity of symptoms to improve the person’s quality of life. Treatment for ulcerative colitis aims to decrease inflammation in the colon, promoting healing and relieving symptoms like diarrhoea, rectal bleeding, and abdominal pain. Since ulcerative colitis varies from person to person, treatment must be tailored to each individual’s specific needs. The treatment includes a combination of diet changes, medications, and surgery, depending on the severity of the symptoms.
Diet
- Decrease oily or fried foods consumption in diet to prevent diarrhoea and gas.
- Consume smaller meals more frequently throughout the day.
- If lactose intolerant, reduce the intake of dairy products.
- If excessive gas is an issue, avoid carbonated drinks.
- When experiencing severe diarrhoea, limit caffeine intake as it can have a laxative effect.
- Choose bland, soft foods over spicy foods for easier digestion.
- Limit high-fiber foods like nuts, seeds, and raw vegetables to alleviate symptoms.
Medication
- Antibiotics fight with infections and promote healing in the large intestine.
- Aminosalicylates helps to fight inflammation and manage symptoms. Treatment may involve oral pills or rectal enemas/suppositories.
- Corticosteroids are prescribed if aminosalicylates are ineffective or symptoms are severe, providing short-term anti-inflammatory relief.
- Immunomodulators help prevent the immune system from attacking the colon, although their effects may take several months to become noticeable.
- Biologics, derived from living cell proteins, are reserved for individuals with severe ulcerative colitis.
- Janus kinase inhibitors (JAK inhibitors) are oral medications that can quickly induce and sustain remission in ulcerative colitis.
- Sphingosine 1-phosphate (S1P) receptor modulators are oral drugs for patients with moderately to severely active UC.
Loperamide can be used to manage diarrhoea, but consultation with a doctor is recommended before starting treatment.
Surgery
In case dietary changes and medications are ineffective, or UC is severe, surgery may be necessary to remove both the colon and rectum (proctocolectomy). There are two kinds of surgeries.
- Proctocolectomy and Ileostomy: In this procedure, a small opening called a stoma is created in the abdomen. The end of the small intestine, known as the ileum, is then attached to the stoma. Waste will pass through the small intestine and exit the body through the stoma. The stoma is usually located in the lower right part of the abdomen near the beltline. A pouch is worn over the opening to collect waste, which the patient can empty as needed.
- Proctocolectomy and Ileoanal anastomosis: This procedure allows patients to have normal bowel movements as it preserves part of the anus. During this operation, the surgeon removes the colon and the inside of the rectum, while leaving the outer muscles of the rectum intact. The surgeon then attaches the ileum to the inside of the rectum and the anus, creating a pouch. Waste is stored in the pouch and passes through the anus in the usual manner.
In summary, ulcerative colitis is a chronic inflammatory bowel disease characterized by inflammation and ulcers in the lining of the colon and rectum. This condition typically presents with symptoms such as abdominal pain, diarrhoea (often bloody), rectal bleeding, the urgency to have bowel movements, and weight loss. The exact cause of ulcerative colitis remains unclear, but it is believed to involve a combination of genetic predisposition, environmental factors, and immune system dysfunction. Diagnosis often involves a combination of medical history review, physical examination, laboratory tests, and imaging studies. Treatment aims to control inflammation, relieve symptoms, and achieve remission through medications like anti-inflammatory drugs, immunosuppressants, and biologics. In severe cases or those unresponsive to medication, surgery to remove the colon (colectomy) may be necessary.
References
- Overview Ulcerative Colitis. Available from: https://www.nhs.uk/conditions/ulcerative-colitis/ . Accessed on May 10th, 2024
- Cleveland Clinic. Ulcerative Colitis. Available from: https://my.clevelandclinic.org/health/diseases/10351-ulcerative-colitis. Accessed on May 10th, 2024
- Corhn’s and Colitis Foundation. Living with ulcerative colitis. Available from: https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/living-with-ulcerative.pdf. Accessed on May 10th, 2024
- Ulcerative Colitis (UC). Available from: https://www.webmd.com/ibd-crohns-disease/ulcerative-colitis/what-is-ulcerative-colitis. Accessed on May 10th, 2024
- NHS Foundation. Ulcerative colitis. Available from: https://www.cddft.nhs.uk/media/455504/ulcerative%20colitis%20patient%20information%20leaflet%20pdf%20panel%20approved.pdf. Accessed on May 10th, 2024
