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Ulcerative Colitis (UC)

Last updated March 1, 2017

Ulcerative Colitis (UC) is a type of inflammatory bowel disease affecting only the large bowel (colon and rectum).


What are the other Names for this Condition? (Also known as/Synonyms)

  • Autoimmune Inflammatory Bowel Disease (Ulcerative Colitis)
  • Chronic Non-Specific Ulcerative Colitis
  • Chronic Ulcerative Colitis

What is Ulcerative Colitis? (Definition/Background Information)

  • Ulcerative Colitis (UC) is a type of inflammatory bowel disease affecting only the large bowel (colon and rectum)
  • The entire colon appears red and inflamed with ulcers
  • It is a chronic disease with intermittent exacerbations and symptom-free periods

Who gets Ulcerative Colitis? (Age and Sex Distribution)

  • Ulcerative Colitis can occur at any age, but two peak age groups observed, 15-30 years and 55-65 years
  • No sexual predilection observed, both males and females are equally affected
  • Caucasians and Ashkenazi Jews are more prone to get the disease than African-Americans and Hispanics

What are the Risk Factors for Ulcerative Colitis? (Predisposing Factors)

The risk factors for Ulcerative Colitis include:

  • Genetic factors play a part, as the risk increases for individuals with a positive family history
  • Individuals who are Caucasians and Ashkenazi Jews are higher prone to be affected by UC, than African-Americans and Hispanics

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Ulcerative Colitis? (Etiology)

No definitive cause has been identified for Ulcerative Colitis, but several hypotheses have been proposed, which include:

  • Environmental factors triggering the onset of the disease, in genetically susceptible individuals
  • Auto- immune cause, where the body fights against its own native cells and causes abnormal reactions
  • There are several studies currently being held to study UC association with certain acne medications and antibiotics

What are the Signs and Symptoms of Ulcerative Colitis?

There are two broad classifications of Ulcerative Colitis symptoms: Intestinal and Extra-intestinal symptoms

Intestinal symptoms include:

  • Diarrhea mixed with blood and pus
  • Cramping rectal pain while passing stool (tenesmus)
  • Cramping abdominal pain
  • Weight loss

Extra-intestinal symptoms include:

  • Fever
  • Anemia from blood loss
  • Mouth ulcers
  • Inflammation of the inner eye called uveitis/iritis
  • Joint inflammation causing pain and swelling. It can affect the small or big joints, and the spine
  • Small painful, multiple pustules, with ulceration of the skin (pyoderma gangrenosum)
  • Scarring of the common bile duct, which drains bile from the gall bladder to the small bowel (Primary Sclerosing Cholangitis)

How is Ulcerative Colitis Diagnosed?

A diagnosis of Ulcerative Colitis is achieved by:

  • Physical exam and medical history
  • Complete blood count; may reveal anemia and markers of infections
  • Metabolic panel; to help assess electrolyte disturbances, kidney and liver  functions
  • Colonoscopy (visualizing the colon using a fiber optic tube with a camera) and biopsy. Since Ulcerative Colitis increases the chance of colon cancer, people diagnosed with this disease are required to undergo a follow-up colonoscopy every 1-2 years
  • Colon biopsy; examined by a pathologist in a laboratory
  • Barium enema: A radio opaque dye mixed with water is given as enema; this is followed by a radiography
  • Stool examination
  • Elevated C – reactive protein (CRP) and Erythrocyte sedimentation rate (ESR); these are markers of inflammation and are elevated in active Ulcerative Colitis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Ulcerative Colitis?

Ulcerative Colitis could bring with it a host of complications and some of them are as listed:

  • Ankylosing spondylitis and spondyloarthropathy (bone problem involving the spine)
  • Inflammation of the joints (arthritis)
  • Perforation in the colon
  • Massive internal bleeding in the colon
  • Colorectal cancer
  • Colon narrowing (strictures)
  • Primary sclerosing cholangitis
  • Mouth ulcers
  • Pyoderma gangrenosum (skin ulcer)
  • Inflammation in the eye

How is Ulcerative Colitis Treated?

The treatment for Ulcerative Colitis is dependent upon the stage and intensity of the disease. It is directed towards treating acute exacerbations and preventing relapse. These include:

Medication:

  • Mesalamine and 5-ASA for moderate disease condition are initially administered; however, a rectal suppository is normally tried before starting oral medications
  • If the disease does not respond to Mesalamine, then it is treated with cytotoxic drugs, like Azathioprine, Cyclosporine
  • Steroids are used in severe cases that do not respond to any medication
  • Avoidance of NSAIDs (pain medications) is advised, as they worsen the effect of the drugs used for treatment

Surgery: Entire colon is removed (total colectomy) in following scenarios

  • When there is no response to complete medical therapy
  • If any pre-cancerous lesions are noted on the tissue biopsy
  • If there is a risk of perforation
  • Massive bleeding

Lifestyle changes:

  • Diet modification: Taking small frequent feeds, drinking plenty of water, avoidance of high fiber and fatty foods
  • Managing stress effectively

How can Ulcerative Colitis be Prevented?

There is no effective way to prevent Ulcerative Colitis disease, as the definitive cause is unknown.

What is the Prognosis of Ulcerative Colitis? (Outcomes/Resolutions)

  • Prognosis of Ulcerative Colitis, depends on the extent and severity of the disease
  • Acute exacerbations can be prevented using medications
  • Complete cure may be achieved in extreme cases through removal of the entire colon

Additional and Relevant Useful Information for Ulcerative Colitis:

Please check back for periodic updates to our ‘physician approved content’.

What are some Useful Resources for Additional Information?

Crohn’s & Colitis Foundation of America (CCFA)
386 Park Avenue South, 17th Floor, New York, NY 10016
Phone: (212) 685-3440
Toll-Free: (800) 932-2423
Fax: (212) 779-4098
Email: info@ccfa.org
Internet: http://www.ccfa.org

United Ostomy Associations of America, Inc. (UOAA)
P.O. Box 512 Northfield, MN 55057–0512
Phone: 1 (800) 826–0826
Email: info@ostomy.org
Website:: http://www.ostomy.org

National Institute of Diabetes and Digestive and Kidney Disorders
Office of Communications and Public Liaison
Building 31, Room 9A04 Center Drive, MSC 2560
Phone: (301) 496-3583
Fax: (410) 689-3998
Email: NDDIC@info.niddk.nih.gov
Website: http://www.niddk.nih.gov

References and Information Sources used for the Article:

http://www.mayoclinic.com/health/ulcerative-colitis/DS00598 (accessed on 10/09/2012)

http://digestive.niddk.nih.gov/ddiseases/pubs/colitis/index.aspx (accessed on 10/09/2012)

http://www.ccfa.org/what-are-crohns-and-colitis/what-is-ulcerative-colitis/ (accessed on 10/09/2012)

Helpful Peer-Reviewed Medical Articles:

Ardizzone, S., Cassinotti, A., & de Franchis, R. (2012). Immunosuppressive and biologic therapy for ulcerative colitis. Expert Opin Emerg Drugs, 17(4), 449-467. doi: 10.1517/14728214.2012.744820

Ford, A. C., Moayyedi, P., & Hanauer, S. B. (2013). Ulcerative colitis. BMJ, 346, f432. doi: 10.1136/bmj.f432

Herfarth, H. (2012). The role of chemoprevention of colorectal cancer with 5-aminosalicylates in ulcerative colitis. Dig Dis, 30 Suppl 2, 55-59. doi: 10.1159/000341894

Machado, R. I., Souto, L. M., & Freire, E. A. (2012). [Psoriasis induced by a TNF-alpha antagonist in a patient with ulcerative colitis]. Acta Gastroenterol Latinoam, 42(4), 325-328.

Zheng, W. Y., Qian, J. M., Yang, H. X., Zhu, F., & Li, J. N. (2012). [Toxic megacolon complicated by ulcerative colitis in six patients: a case report and literature review]. Zhonghua Nei Ke Za Zhi, 51(9), 694-697.

Cohort, U. C. A., Newcomb, C. W., Wu, Q., Chen, L., Xie, F., Roy, J. A., ... & Lewis, J. D. (2015). Mortality Associated With Medical Therapy in Ulcerative Colitis. Ann Intern Med, 163(4), 28.

Mannon, P. (2015, July). Heterogeneity in the IL-13 Receptor Pathway and Activity in Active Ulcerative Colitis. In 17th International Congress of Mucosal Immunology (ICMI 2015). Icmi.

Sahami, S., Konté, K., Buskens, C. J., Tanis, P. J., Lowenberg, M., van den Brink, G. R., ... & D'Haens, G. R. (2015). Su1337 Disease Progression Is a Risk Factor for Colectomy in Ulcerative Colitis: 10-Years of Follow up in a Tertiary Care Facility. Gastroenterology, 148(4), S-479.

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: June 16, 2013
Last updated: March 1, 2017

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