Digestive Disorder: Ulcerative Colitis

Ulcerative colitis is a chronic inflammatory disease of the large intestine caused by an abnormal autoimmune reaction. It affects about 700,000 Americans and usually surfaces between ages 15 and 40. The inflammation starts in the rectum and gradually progresses to the sigmoid, descending, transverse, and ascending colon and, eventually, the cecum. The inflammation does not extend beyond the colon to affect the small intestine.

Causes of Ulcerative Colitis

The cause of ulcerative colitis is unknown, but some people appear to have a genetic predisposition. Like Crohn's disease, ulcerative colitis is hypothesized to be activated by an environmental factor, such as an infection or food allergy, which triggers an abnormal response by the immune system. The disease is more common in Caucasians than in non-Caucasians and in Jewish than in non-Jewish people.

Symptoms of Ulcerative Colitis

Active ulcerative colitis usually causes abdominal pain and bloody, mucusy diarrhea. Severe attacks may also produce nausea, vomiting, and fever. Like Crohn's disease, ulcerative colitis cycles between flare-ups and remissions.

Diagnosis of Ulcerative Colitis

The best diagnostic tests for ulcerative colitis are sigmoidoscopy and colonoscopy. The disease is diagnosed when the inner lining of the colon appears swollen and red and contains erosions and ulcerations.

Biopsies of the affected areas may be done to distinguish ulcerative colitis from other conditions affecting the colon, for example, cancer, infections, ischemia (reduced blood flow), or Crohn's disease. Blood tests, stool samples, and additional scans such as barium enemas or CT scans may be used.

Treatment of Ulcerative Colitis

The medications used to treat ulcerative colitis are similar to those for Crohn's disease. If you have mild disease limited to the rectum and sigmoid colon, corticosteroid-or mesalamine-containing enemas may help to control flare-ups. If this therapy fails, you may need to take oral drugs such as Asacol, Azulfidine, balsalazide (Colazal), olsalazine (Dipentum), or Pentasa.

If you have extensive ulcerative colitis—meaning that it affects most of the colon—you may need intravenous or oral corticosteroids and oral mesalamine to treat a flare-up, followed by maintenance therapy with mesalamine to prevent future flare-ups.

Severe cases may also require immunosuppressive drugs such as Purinethol or Imuran or a tumor necrosis factor (TNF) inhibitor like Humira or Remicade to keep the disease under control. If there is a stress-related component to the disease, stress reduction techniques like hypnosis may be helpful.

Surgical removal of the entire colon (called a colectomy) may be necessary if you have severe flare-ups that do not respond to corticosteroids and mesalamine, complications such as a perforation, colon cancer, or symptoms that significantly impair your quality of life.

Between 25 and 40 percent of people with ulcerative colitis will eventually have their colons removed. Surgery can either be done in the traditional manner (open) or through laparoscopy. After a colectomy, an opening called an ileostomy is made in the skin to allow fecal material to pass directly from the small intestine into an external plastic bag.

Most people with an ileostomy lead normal, active lives and engage in the same job and recreational activities they did before the surgery. As an alternative, a surgeon may perform an ileoanal anastomosis, which preserves a part of the anus and allows you to have normal bowel movements (although they may be more frequent and watery).

Ulcerative colitis predisposes individuals to colon cancer and requires surveillance colonoscopy to look for dysplasia (abnormal cells that can become cancer). When dysplasia is identified, colectomy is required.

Publication Review By: H. Franklin Herlong, M.D.

Published: 28 Mar 2011

Last Modified: 13 Nov 2014