Ulcerative colitis

Ulcerative colitis is an inflammatory bowel disease (IBD) that causes inflammation and ulcers
(sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large
intestine, also called the colon, and rectum.

Symptoms
Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it
occurs. Signs and symptoms may include:
• Diarrhea, often with blood or pus
• Rectal bleeding
• Abdominal pain and cramping
• Rectal pain
• Urgency to defecate
• Inability to defecate despite urgency
• Weight loss
• Fatigue
• Fever
• In children, failure to grow

Types
Health care providers often classify ulcerative colitis according to its location. Symptoms of each
type often overlap. Types of ulcerative colitis include:

• Ulcerative proctitis. Inflammation is confined to the area closest to the anus, also called
the rectum. Rectal bleeding may be the only sign of the disease.

• Proctosigmoiditis. Inflammation involves the rectum and sigmoid colon — the lower end
of the colon. Symptoms include bloody diarrhea, abdominal cramps and pain, and an
inability to move the bowels despite the urge to do so.

• Left-sided colitis. Inflammation extends from the rectum up through the sigmoid and
descending portions of the colon. Symptoms include bloody diarrhea, abdominal cramping
and pain on the left side, and urgency to defecate.

• Pancolitis. This type often affects the entire colon and causes bouts of bloody diarrhea that
may be severe, abdominal cramps and pain, fatigue, and significant weight loss.
Causes
The exact cause of ulcerative colitis remains unknown. Previously, diet and stress were
suspected. However, researchers now know that these factors may aggravate but don't cause
ulcerative colitis.
One possible cause is an immune system malfunction. When your immune system tries to fight
off an invading virus or bacterium, an irregular immune response causes the immune system to
attack the cells in the digestive tract, too.

Risk factors
Ulcerative colitis affects about the same number of women and men. Risk factors may include:

• Age. Ulcerative colitis usually begins before the age of 30, but it can occur at any age.

• Race or ethnicity. Although white people have the highest risk of the disease

• Family history. You're at higher risk if you have a close relative, such as a parent, sibling
or child, with the disease.
Complications
Possible complications of ulcerative colitis include:
➢ Severe bleeding
➢ Severe dehydration
➢ A rapidly swelling colon, also called a toxic megacolon
➢ A hole in the colon, also called a perforated colon
➢ Increased risk of blood clots in veins and arteries
➢ Inflammation of the skin, joints and eyes
➢ An increased risk of colon cancer
➢ Bone loss, also called osteoporosis
Diagnosis
Endoscopic procedures with tissue biopsy are the only way to definitively diagnose ulcerative
colitis. Other types of tests can help rule out complications or other forms of inflammatory bowel
disease.
To help confirm a diagnosis of ulcerative colitis, you may have one or more of the following
tests and procedures:

Lab tests

✓ Blood tests. Your provider may suggest blood tests to check for anemia .
✓ Stool studies. White blood cells or certain proteins in your stool can indicate ulcerative
colitis.
 Endoscopic procedures

✓ Colonoscopy. This exam allows your to view your entire colon using a thin, flexible,
lighted tube with a camera on the end. During the procedure, tissue samples are taken for
laboratory analysis. This is known as a tissue biopsy.
✓ Flexible sigmoidoscopy. You uses a slender, flexible, lighted tube to examine the rectum
and sigmoid colon — the lower end of your colon. If your colon is severely inflamed, this
test may be preferred instead of a full colonoscopy.

Imaging procedures
• X-ray. If you have severe symptoms, your provider may use a standard X-ray of your
abdominal area to rule out serious complications, such as a megacolon or a perforated
colon.
• CT scan. A CT scan of your abdomen or pelvis may be performed if a complication from
ulcerative colitis is suspected. A CT scan may also reveal how much of the colon is
inflamed.
• Computerized tomography (CT) enterography and magnetic resonance (MR)
enterography. These types of noninvasive tests may be recommended to exclude any
inflammation in the small intestine.

Treatment
Ulcerative colitis treatment usually involves either medication therapy or surgery.
Anti-inflammatory medications

Anti-inflammatory medications are often the first step in the treatment of ulcerative colitis and
are appropriate for most people with this condition. These include:

• 5-aminosalicylates. Examples of this type of medication include sulfasalazine

(Azulfidine), mesalamine (Delzicol, Rowasa, others), balsalazide (Colazal) and olsalazine
(Dipentum).

• Corticosteroids. These medications, which include prednisone and budesonide, are

generally reserved for moderate to severe ulcerative colitis that doesn't respond to other
treatments. Corticosteroids suppress the immune system. Due to the side effects, they are
not usually given long term.
Immune system suppressors
Immunosuppressant medications include:

• Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These are

commonly used immunosuppressants for the treatment of inflammatory bowel disease.

• Cyclosporine (Gengraf, Neoral, Sandimmune). This medication is typically reserved for

people who haven't responded well to other medications. Cyclosporine has the potential for
serious side effects and is not for long-term use.

• "Small molecule" medications. More recently, orally delivered agents, also known as
"small molecules," have become available for IBD treatment. These include tofacitinib
(Xeljanz), upadacitinib (Rinvoq) and ozanimod (Zeposia).
Biologics
This class of therapies targets proteins made by the immune system. Types of biologics used to
treat ulcerative colitis include:

• Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). These

medications, called tumor necrosis factor (TNF) inhibitors, work by neutralizing a protein
produced by your immune system. They are for people with severe ulcerative colitis who
don't respond to or can't tolerate other treatments. TNF inhibitors are also called biologics.

• Vedolizumab (Entyvio). This medication is approved for treatment of ulcerative colitis for
people who don't respond to or can't tolerate other treatments. It works by blocking
inflammatory cells from getting to the site of inflammation.

• Ustekinumab (Stelara). This medication is approved for treatment of ulcerative colitis for
people who don't respond to or can't tolerate other treatments. It works by blocking a
different protein that causes inflammation.
Other medications
You may need additional medications to manage specific symptoms of ulcerative colitis. Always
talk with your health care provider before using over-the-counter medications. Your provider
may recommend one or more of the following.
• Anti-diarrheal medications.
• Pain relievers.
• Antispasmodics.
• Iron supplements.
Surgery
Surgery can eliminate ulcerative colitis and involves removing your entire colon and rectum
(proctocolectomy).
In most cases, this involves a procedure called ileoanal anastomosis (J-pouch) surgery. This
procedure eliminates the need to wear a bag to collect stool. Your surgeon constructs a pouch
from the end of your small intestine. The pouch is then attached directly to your anus, allowing
you to expel waste in the usual way. This surgery may require 2 to 3 steps to complete.

In some cases a pouch is not possible. Instead, surgeons create a permanent opening in your
abdomen (ileal stoma) through which stool is passed for collection in an attached bag.