Ulcerative colitis

Ulcerative colitis (UC) is a medical condition that belongs to the inflammatory bowel disease (IBD) group. It is associated with inflammation, irritation, and ulcers or open sores that develop in the large intestines or colon. UC also results in bloody diarrhea, cramping, and a sense of urgency. These symptoms may sometimes wake a person up in the middle of the night to go to the bathroom. 

With ulcerative colitis, the inflammation normally begins in the rectum, near the anus. This is where fecal matter exits the body. The inflammation may spread across the colon, affecting a section or the whole colon. The condition in which the rectum and lower section of the colon become inflamed is known as ulcerative proctitis. 

 

Signs and Symptoms of Ulcerative Colitis 

The signs and symptoms of ulcerative colitis tend to vary based on the seriousness of the inflammation and location. They can, however, include the following; 

  • Rectal pain 
  • The urge to defecate 
  • Cramping and abdominal pain 
  • Diarrhea. which is usually associated with pus or blood 
  • Rectal bleeding or passing out small traces of blood with stool 
  • Unexplainable weight loss
  • Inability to defecate even with the urgency 
  • Fever 
  • Fatigue 
  • Failure to grow in children 

Most individuals with the condition experience mild to moderate signs and symptoms. Besides, ulcerative colitis courses can vary as others have extended remission periods. At times, differentiating between ulcerative colitis and colitis might be difficult. 

 

Causes of Ulcerative Colitis 

The precise cause of ulcerative colitis is yet to be known. Stress and diet were initially suspected. However, physicians now understand that these aspects can worsen ulcerative colitis but do not cause it. 

A deficiency of the immune system is one potential cause. If the body's immune system attempts to strike off an invading bacteria or virus, an irregular immune response triggers your immune system to invade the digestive tract cells as well. Hence, this could cause ulcerative colitis. 

In addition, ulcerative colitis is more popular among people with family members who have the condition. This suggests that heredity may play a role in the disease. Most individuals with ulcerative colitis, on the other hand, do not have a family history of the disease. 

 

Risk Factors of Ulcerative Colitis 

Ulcerative colitis strikes in both men and women in almost equal numbers. The following are some possible risk factors; 

Age: In most cases, ulcerative colitis is often diagnosed by the age of 30. However, it may strike at any age, while other people do not get the disorder until after they reach the age of 60.

Family history: You might be at a high risk of developing the disease if one of your parents, child, or sibling has ulcerative colitis. 

Ethnicity or race: While whites have the greatest risk of contracting the disease, it may affect people of any race. Your chances are much higher if you are of Ashkenazi Jewish linage.

 

Diagnosing Ulcerative Colitis 

To accurately diagnose ulcerative colitis in adults and children, the doctors will rule out other similar diseases. They will first begin with a physical examination to determine the symptoms you are experiencing. After that, they can order for other additional tests, which can include; 

  • Laboratory tests

Stool analysis: Doctors diagnose ulcerative colitis by assessing the stool for the presence of white blood cells or specific proteins. They can also use the stool sample to rule out other conditions, including bacterial, viral, and parasitic infections. 

Blood checks: The doctor can recommend blood tests to diagnose anemia. This is a condition in which there are no sufficient red blood cells to transport enough oxygen to the tissues. The blood test is also useful in checking for infection signs. 

  • Imaging tests 

CT scan: If the physician suspects a complication associated with ulcerative colitis, he or she can order a CT scan of the pelvis or abdomen. A CT scan can also show the extent of colon inflammation.

X-ray: The doctor can suggest a regular x-ray of the abdominal region if you have extreme symptoms. This is to rule out severe complications, including a perforated colon.

Computerized tomography (CT) enterography and magnetic resonance (MR) enterography: In order to rule out any inflammation within the small intestine, the doctor can suggest one of the non-invasive tests. These tests are more effective than traditional imaging tests for detecting bowel inflammation. MR enterography is a non-radioactive option.

  • Endoscopic tests 

Colonoscopy: This test involves the use of a small, flexible, illuminated tube with a camera at the tip to view the whole colon. The doctor can as well obtain a small sample of the tissue (biopsy) for lab examination during ulcerative colitis on colonoscopy. To make the diagnosis, a tissue sample is needed. 

Flexible sigmoidoscopy: This test involves the use of a thin, flexible, illuminated tube. It allows the doctor to assess the rectum and sigmoid colon (the lower end of the small intestines). The doctor can conduct this test rather than a complete colonoscopy if the colon is badly inflamed. 

 

Ulcerative Colitis Treatment 

There is no specific cure when it comes to ulcerative colitis. However, the available treatments can help reduce inflammation, improve your condition, and allow you to resume your normal activities. Treatment is often dependent on the seriousness of the condition and the needs of the patient. Doctors can also recommend a particular ulcerative colitis diet to manage the symptoms and prevent flare-ups. 

Healthcare providers mostly prescribe ulcerative colitis medications to treat the disorder. They include; 

  • Anti-inflammatory medications 

These medications are also the first line of ulcerative colitis treatment, and they are effective in most patients. The anti-inflammatory medications include:

5-aminosalicylates: Sulfasalazine (Azulfidine), balsalazide (Colazal), and mesalamine (Asacol HD, Delzicol) are examples of this form of the drug. The one you choose, and regardless of whether you take it orally, as an enema, or as a suppository, is determined by the affected part of your colon. 

Corticosteroids: Prednisone and budesonide are examples of corticosteroids. They are used to treat mild to chronic ulcerative colitis that fails to respond to other medications. They are not normally offered for a long time because of the associated negative side effects. 

  • Immune system suppressors

These types of medications minimize inflammation. They do this by suppressing your immune system response that initiates the process. For certain patients, a combination of these medications is more effective than taking only one of them. 

Drugs that suppress the immune system include; 

Cyclosporine (Gengraf, Sandimmune, Neoral): This medicine is usually reserved for patients who have had a poor response to other treatments. Cyclosporine has significant side effects; hence it is not recommended for long-term use. 

Mercaptopurine (Purixan, Purinethol) and azathioprine (Azasan, Imuran): These are the commonly prescribed immunosuppressants for addressing inflammatory bowel disease are. Close monitoring is essential when taking these drugs since it’s associated with side effects on the pancreas and liver. 

Tofacitinib (Xeljanz): This refers to a "small molecule" that acts by inhibiting the inflammatory process. Where other treatments have failed, tofacitinib may help. High risk of shingles infection, as well as blood clots, are the most common side effects.

  • Biologics 

This group of treatments focuses on proteins generated by the immune system. The following are examples of biologics used to address ulcerative colitis: 

Infliximab (Remicade), golimumab (Simponi), adalimumab (Humira): These medications, also known as biologics or tumor necrosis factor inhibitors, function by neutralizing a protein formed by the immune system. They are reserved for patients who have serious ulcerative colitis and can't tolerate or react to other therapies.

Ustekinumab (Stelara): This drug is used to treat ulcerative colitis in patients who do not respond to or endure other therapies. It functions by preventing the production of a protein that induces inflammation. 

Entyvio (Vedolizumab): This drug is recommended to cure ulcerative colitis in patients who haven't had any effect with other medications or cannot endure them. It functions by preventing inflammatory cells from reaching the inflammatory site. 

 

Other ulcerative colitis drugs 

Certain ulcerative colitis symptoms can necessitate the use of additional medications. Before taking any over-the-counter drugs, consult your doctor first. One or more of the following may be suggested; 

  • Pain relievers to ease moderate pain 
  • Anti-diarrheal drugs to treat diarrhea 
  • Iron supplements for people with severe intestinal bleeding that could cause iron deficiency 
  • Antispasmodics to assist with cramps 

 

Surgical procedure 

At times, doctors can address ulcerative colitis with surgery that involves removal of the whole rectum and colon (proctocolectomy). In the majority of cases, this entails ileoanal anastomosis or J-pouch surgery. This technique helps avoid the necessity of collecting stool in a bag. The provider will make a pouch at the end of the small intestine. After that, the pouch is directly attached to the anus, letting you remove waste in a natural manner.

It is not always possible to use a pouch. Rather, surgeons establish an ileal stoma (permanent opening in the abdomen). Through this, the stool passes and collects in the attached bag.

 

Bottom Line

Ulcerative colitis is a long-term disease characterized by the inflammation of the colon and rectum. It's important to work closely with the healthcare team if you have ulcerative colitis.

Even if you don't have any symptoms, take your medications as directed. Skipping drugs can cause flare-ups and make it more difficult to manage the disease. Following your treatment plan and communicating with your healthcare provider frequently are the best ways for handling ulcerative colitis.