Ulcerative Colitis
Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that affects the inner lining of the large intestine (large bowel) leading to erosion and ulcers. It is a lifelong illness with no specific cause or cure.

The life expectancy of patients with ulcerative colitis (UC) is usually the same as anybody without the disease. UC is a lifelong disease with periods of flareups and remission (periods without symptoms, which may last for weeks or years). The longer the periods of remission, the general condition of the patient would be better, and lower will be the risk of complications. About 10% of patients improve after one attack, and the rest have multiple flares throughout life. Appropriate treatment, diet, and lifestyle modifications are necessary to prevent complications some of which could be life-threatening. The doctor would advise a treatment plan even during the periods of remission. Regular screening with colonoscopy is required, the frequency of which would be planned by the doctor. It may be done once every one to three years.

What is ulcerative colitis?

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that affects the inner lining of the large intestine (large bowel) leading to erosion and ulcers. It is a lifelong illness with no specific cause or cure. Patients have repeated cycles of flare-ups and remission with potential extraintestinal manifestations. There is a profound emotional and social impact on the affected patients.

What are the causes of ulcerative colitis?

The exact cause of ulcerative colitis (UC) is unknown. However, research has revealed some possible causes for the disease: 

  • Genetics:
  • Immune reactions:
    • The body’s immune system attacks the inner lining of the large intestine (an autoimmune disorder).
  • Environmental factors:
  • Medications:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of UC.
  • Milk:
    • Consumption may flare up the disease.

What are the signs and symptoms of ulcerative colitis?

The signs and symptoms of ulcerative colitis (UC) are as follows:

  1. Rectal bleeding
  2. Frequent stools
  3. Mucous discharge from the rectum
  4. Tenesmus (constantly feeling the need to empty the bowels)
  5. Lower abdominal pain and cramps
  6. Dehydration 
  7. Severe diarrhea 
  8. Fever
  9. Abdominal distention/bloating
  10. Increased heart rate
  11. Weight loss
  12. Pus discharge through the anus
  13. Extracolonic manifestations (inflammation of the eyes, joints, skin, and lungs)

What are the types of ulcerative colitis?

There are five different types of ulcerative colitis.

  • Ulcerative proctitis: Inflammation limited to the area close to the anus (rectum). Symptoms are usually mild, and rectal bleeding may be the only sign.
  • Proctosigmoiditis: Inflammation involves the lower end of the colon
  • Left-sided colitis: Inflammation extends from the rectum up through the sigmoid and descending colon
  • Pancolitis: Involves the entire colon
  • Acute severe ulcerative colitis (UC): This rare form of colitis affects the entire colon and causes severe pain, profuse diarrhea, bleeding, fever, and inability to eat.

The severity of UC can be graded as follows:

  • Mild: Bleeding through the rectum and fewer than four bowel motions per day
  • Moderate: Bleeding through the rectum with more than four bowel motions per day
  • Severe: Bleeding through the rectum more than four bowel motions per day and a widespread (systemic) illness with protein loss

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How is ulcerative colitis diagnosed?

The physician would do a complete physical assessment, advice a series of specialized blood and radiological investigations (X-ray, computed tomography [CT] scan, etc.). Colonoscopy, endoscopy, biopsy, stool examination, and other tests may be done.

What is the treatment of ulcerative colitis?

Ulcerative colitis (UC) is a lifelong disease with constant periods of flare-ups and remission (relief in symptoms). Presently, there is no permanent medical cure for it, but there are various medications that can provide symptomatic relief, reduce inflammation, and manage flare-ups.

Treatment involves medical and surgical management depending on the disease severity. Patients would also require dietary and lifestyle changes.

  • Medical treatment includes the following:
    • Medication to suppress and/or modulate the immune system
    • Painkillers
    • Antibiotics
    • Anti-diarrhea medication
  • Surgical treatment includes the following:
    • Colectomy (surgical removal of part of the colon or whole colon) may be required in severe cases.
  • Dietary changes:
    • Diet low in fat, meat, sulfur and milk
  • Management of psychological stress and emotional support

What are the complications of ulcerative colitis?

The possible complications of ulcerative colitis are as follows:

  • Bleeding: The ulcers and erosions in the inner lining of the large intestine can perforate through the layers of the intestine causing bleeding. 
  • Nutrition loss and dehydration: Chronic diarrhea and inflammation lead to dehydration, nutrition loss, and a decrease in the absorption of nutrients.
  • Inflammation of other organs: Inflammation of the eyes, joints, skin, liver, and lungs
  • Toxic megacolon: A rare complication that causes swelling and ballooning of the colon manifesting as:
  • Colon cancer and ulcerative colitis (UC): The chances of colon cancer increase if the patient has had UC for over eight years. Appropriate treatment and the availability of new treatment options for UC have lowered the risk of colon cancer.

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Medically Reviewed on 8/6/2020
References
Reference:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1432417/

https://emedicine.medscape.com/article/183084-clinical
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