Medically reviewed by Chris Schwerdt. Last updated on May 24, 2025
General Illness Information
Common Name:
Ulcerative Colitis
Medical Term: Ulcerative Colitis
Description: It is an inflammatory disease of the colon characterized by episodes of abdominal pain and bloody diarrhea. Secondary to ulceration in the mucosal lining of the large bowel. Usually this is a disease of flare ups and remissions. Occurs most commonly between ages of 15 and 40 and more common in women.
Causes: Unknown.
Genetic, infectious, immunologic and psychologic factors have all been suggested. None have been proven.
Prevention: There are no specific preventive measures.
Signs & Symptoms
- Episodes of bloody diarrhea with mucus, alternating with symptom free intervals.
- Left-sided abdominal pain, usually relieved after bowel movement.
- In severe cases, diarrhea and bleeding is extensive, and there may be abdominal pain and tenderness, fever, weight loss, dehydration and general malaise.
- Incidence of attacks varies considerably from person to person.
- Most commonly, attacks occur at intervals of a few months.
- In some patients, attacks occur almost continuously, while in others, they are infrequent.
- If there is predominantly rectal involvement, constipation, rectal bleeding, pain on defecation may be the presenting symptoms.
Risk Factors
Familial predisposition to inflammatory bowel disease.
Diagnosis & Treatment
The diagnosis is made by history, examination, and definitively by sigmoidoscopy (examination of the lower part of the bowel with a special viewing instrument), when a biopsy may be taken. Also barium X-Rays may be performed. In many cases, the entire colon is viewed using a fiber-optic colonoscope.
General Measures:
- The aims of treatment are to control the inflammatory process and to replace nutritional losses. The treatment plan varies with the severity of the illness.
- In most cases, general medical treatment effectively controls the disease.
- Mild ulcerative colitis may be treated on an ambulatory basis.
- Severe cases require hospitalization and intravenous therapy.
- Blood transfusions may be required.
- In the severely ill patient, intravenous alimentation (feeding) may be required.
- Agents to control diarrhea should be used with extreme caution for fear of inducing toxic megacolon, a medical emergency.
- Trust and mutual understanding combined with the compassion and expertise of the physician are essential in the treatment of this disease.
- About 20 to 25 % of patients require surgery at some point in their illness.
- Surgery is indicated if medical therapy fails.
- Though there are various refinements, the usual surgery is a colectomy (removal of the large bowel), with an ileostomy ( an opening on the surface of the abdomen where feces is passed).
Medications:
- Medical treatment usually consists of corticosteroid drugs ( to reduce inflammation), and sulfasalazine (to maintain long-term freedom from symptoms). Newer derivatives of sulfasalazine are being used effectively.
- Topical preparations of 5-aminosalicylate (mesalamine) given as an enema are effective in the treatment of distal sigmoido-proctitis.
- Other more potent drugs may be used if the above measures are not effective. These include azathioprine and cyclosporine.
Activity:
Normal activity if the disease is controlled. Bed rest and curtailment of activity may be advised for severe illness.
Diet:
A normal diet for mild cases. For all other forms of the illness, low roughage or elemental diets may be advised.
Possible Complications:
- Hemorrhage.
- Toxic colitis, toxic megacolon
- Risk of colon cancer.
- Liver: changes occur in about 3 % of patients, and range from mild elevation of liver enzymes to chronic hepatitis, primary sclerosing cholangitis to cirrhosis of the liver. A late complication may be cancer of the biliary tract.
Other complications may include:
- Arthritis
- Ankylosing spondylitis
- Uveitis
- Erythema nodosum
- Pyoderma gangrenosum
- Episcleritis
Prognosis
Depends upon severity of the disease and the complications. Nearly one-third of patients with ulcerative colitis ultimately require colectomy, which is usually curative. Patients with localised ulcerative proctitis have the best prognosis.
Other
Nothing specified.
About Chris Schwerdt