Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in the innermost lining of the large intestine (colon) and rectum. The inflammation usually starts in the rectum and spreads continuously upward through the colon.
Causes:
The exact cause of ulcerative colitis is unknown, but it is believed to be a combination of factors:
- Immune System Dysfunction: A leading theory suggests that the immune system mistakenly attacks harmless bacteria, food, and other substances in the gut, leading to chronic inflammation.
- Genetics: UC tends to run in families. People with a family history of UC are at higher risk. Specific gene mutations have been identified that increase susceptibility.
- Environmental Factors: While no specific environmental trigger has been definitively identified, factors like diet, stress, and certain infections may play a role in triggering flare-ups in genetically predisposed individuals. However, they are not considered direct causes.
- Gut Microbiome: Imbalances in the bacteria normally found in the gut may contribute to the inflammatory response.
Symptoms:
Symptoms of ulcerative colitis can vary in severity and may come and go, with periods of remission (no symptoms) and flare-ups (worsening symptoms). Common symptoms include:
- Diarrhea: Often with blood or pus. This is the most common symptom.
- Abdominal pain and cramping: Usually felt in the lower abdomen.
- Rectal pain.
- Rectal bleeding: Passing small amounts of blood with stool.
- Urgency to defecate (tenesmus): A strong, sudden urge to have a bowel movement.
- Inability to defecate despite urgency.
- Weight loss.
- Fatigue.
- Fever.
- Anemia: Due to chronic blood loss from the inflamed bowel.
- Extraintestinal manifestations: Inflammation can also affect other parts of the body, including:
- Joint pain and swelling (arthritis)
- Skin lesions (e.g., erythema nodosum, pyoderma gangrenosum)
- Eye inflammation (e.g., uveitis, episcleritis)
- Liver and bile duct inflammation (e.g., primary sclerosing cholangitis)
Diagnosis:
Diagnosing ulcerative colitis involves a combination of medical history, physical examination, and various diagnostic tests:
Medical History and Physical Exam: The doctor will ask about your symptoms, family history, and perform a physical examination.
- Blood Tests:
- Complete Blood Count (CBC): To check for anemia (low red blood cells) and signs of inflammation.
- C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR): Markers of inflammation in the body.
- Liver function tests.
- Stool Tests:
- To rule out infections (bacterial, viral, parasitic) that can cause similar symptoms.
- To check for markers of inflammation in the stool (e.g., fecal calprotectin).
- Endoscopy with Biopsy:
- Colonoscopy: A thin, flexible tube with a camera is inserted into the rectum and advanced through the entire colon to visualize the lining. Biopsies (small tissue samples) are taken to confirm inflammation and rule out other conditions.
- Sigmoidoscopy: Similar to colonoscopy but examines only the rectum and lower part of the colon.
- Imaging Tests:
- CT scan or MRI: May be used to assess the extent of inflammation, rule out complications, or differentiate UC from Crohn’s disease.
Treatment:
There is no cure for ulcerative colitis, but treatment aims to reduce inflammation, relieve symptoms, prevent flare-ups, and achieve long-term remission. Treatment plans are individualized based on the severity and extent of the disease.
- Medications:
- Aminosalicylates (5-ASAs): Often the first-line treatment for mild to moderate UC. They reduce inflammation in the colon (e.g., mesalamine, sulfasalazine). Available orally or as suppositories/enemas.
- Corticosteroids: Used for short-term control of moderate to severe flare-ups due to their powerful anti-inflammatory effects (e.g., prednisone, budesonide). Not for long-term maintenance.
- Immunomodulators: Suppress the immune system to reduce inflammation and maintain remission (e.g., azathioprine, mercaptopurine). They can take several weeks to months to become effective.
- Biologic therapies: Target specific proteins in the immune system to reduce inflammation. Used for moderate to severe UC that hasn’t responded to other treatments (e.g., infliximab, adalimumab, vedolizumab, ustekinumab). Administered by injection or infusion.
- Janus kinase (JAK) inhibitors: Oral medications that block specific immune pathways (e.g., tofacitinib).
- Lifestyle and Dietary Management:
- Dietary adjustments: While diet doesn’t cause UC, certain foods can trigger symptoms during flare-ups. Identifying and avoiding personal trigger foods can help. A balanced, nutritious diet is important.
- Stress management: Stress can exacerbate symptoms. Techniques like meditation, yoga, and exercise can be beneficial.
- Avoid NSAIDs: These can worsen UC symptoms.
- Surgery:
- Surgery (proctocolectomy, removal of the colon and rectum) is a curative option for UC. It is considered when medical therapy fails, for severe complications (e.g., toxic megacolon, severe bleeding), or if there is a high risk of colon cancer.
- Often, a pouch (ileal pouch-anal anastomosis or J-pouch) is created from the small intestine to allow for stool passage, avoiding a permanent ostomy in many cases.
Regular monitoring by a gastroenterologist is essential for managing UC, adjusting treatment, and screening for complications like colon cancer.
