Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by the development of ulcers in the lining of the digestive tract, which most often affect the colon and rectum. While ulcerative colitis can occur at any age, it most frequently appears between the ages of 15 and 30, or after the age of 60. There are several types of ulcerative colitis that are categorized by the area of the digestive tract affected by the disease, such as ulcerative proctitis (inflammation of area closest to the rectum), proctosigmoiditis (inflammation of the sigmoid colon and rectum), left-sided colitis (inflammation of descending colon, sigmoid colon, and rectum), pancolitis (inflammation of the entire colon), and a rare form of ulcerative colitis known as acute severe ulcerative colitis (severe inflammation of entire colon). Ulcerative colitis can also affect other areas of the body, causing inflammation of the skin, eyes, liver, joints, and back.

There are several alternative names for ulcerative colitis, such as UC, colitis gravis, proctocolitis, inflammatory bowel disease (IBD), pancolitis, ulcerative proctitis, and proctosigmoiditis.

While the cause of ulcerative colitis is unknown, researchers believe it is an autoimmune disease, meaning that, after being triggered by a bacteria or virus, the body’s immune system attacks healthy cells in the digestive tract. Researchers also believe that ulcerative colitis may have a genetic cause, as the disease tends to run in families and more frequently affects Caucasians and people of Eastern European (Ashkenazi) Jewish descent. Taking certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, and oral contraceptives may increase the risk of developing ulcerative colitis as well as eating a high-fat diet.

Symptoms of ulcerative colitis can vary, depending on which part of the intestinal tract is affected (most commonly the colon and rectum) and can range from mild to severe. Symptoms of ulcerative colitis most often develop gradually; however, they can also occur suddenly. The disease may also have periods of remission when no symptoms are occurring, followed by flare-ups, or worsening of the disease. Most patients with ulcerative colitis have mild or moderate symptoms. Ten percent of patients with ulcerative colitis have more severe symptoms. Symptoms may be infrequent or constant. Symptoms of ulcerative colitis may include fatigue, weight loss, loss of appetite, nausea, urgency to defecate, inability to defecate, fever, diarrhea, abdominal pain and cramping, rectal pain and bleeding, anemia, and growth failure in children. Rarer symptoms of ulcerative colitis may include eye redness, rashes, and joint pain.

While there is no cure for ulcerative colitis, several treatments can help to reduce symptoms and increase the possibility of long-term remission. Treatments for ulcerative colitis may include medications, such as anti-inflammatory agents (5-aminosalicylic acid and corticosteroids), immunosuppressive (immunomodulator) drugs, biologics (anti-TNF therapies), anti-diarrheal drugs, diet and nutrition therapy, and surgery, such as ileal pouch anal anastomosis (use of small intestine to replace lower colon and rectum), ileal stoma (permanent opening in abdominal wall), and proctocolectomy (removal of entire colon and rectum). Anti-inflammatory drugs – Anti-inflammatory drugs are often the first-line treatment for ulcerative colitis, can be administered by mouth, enema, or suppository, and include the medication, 5- aminosalicylic acid (5-ASA), which is also known under drug names such as sulfasalazine (Azulfidine), mesalamine (Asacol HD, Delizicol, and others), baldalazide (Colazol), and olsalazine (Dipentum). Other anti-inflammatory drugs include corticosteroids, such as budesonide (Uceris) and prednisone, which are usually administered for moderate-to-severe ulcerative colitis. Immunomodulator drugs – Like anti-inflammatory drugs, immunomodulators also reduce inflammation; however, this is accomplished through the suppression of the immune system response that causes the inflammation and includes the drugs, azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan), cyclosporine (Gengraf, Neoral, Sandimmune), and tofacitinib (Xeljanz). Biologics (anti-TNF therapies) – Biologic agents target specific proteins in the immune system to stop them from causing inflammation and include infliximab (Remicade), adalimumab (Humira), golimumab (Simponi), and vedolizumab (Entyvio). Anti-diarrhea drugs – Anti-diarrheal medications, such as loperamide (Imodium A-D) may be recommended to manage cases of severe diarrhea and should be used with caution under the care of a doctor. Pain medication – Acetaminophen (Tylenol) may be recommended for mild-to-moderate pain associated with ulcerative colitis. Antibiotics – Antibiotics may be prescribed for ulcerative colitis to treat bacterial infections of the digestive tract. Diet and nutrition therapy – Changes in diet may be necessary to help reduce and manage the symptoms of ulcerative colitis, such as eating smaller meals more frequently, drinking more liquids, avoiding fizzy drinks, caffeinated beverages, alcohol, fried foods, high-fiber foods (popcorn, nuts, beans, and lentils), high-fat foods, artificial food additives, dyes, and sweeteners, and lactose. Vitamins and other supplements may also be prescribed to counteract nutritional deficiencies. Surgery – For some patients with severe ulcerative colitis, surgery may be necessary in the case of life-threatening complications, such as bleeding, not improving with medications, severe side effects from medications, long-term dependency on steroids, or the development of precancerous (colon polyps) or cancer of the colon. Removal of the entire colon and rectum can effectively cure ulcerative colitis and involves the following surgical methods: Ileal pouch anal anastomosis – In this surgery, a pouch is constructed from the small intestine and is used to replace the rectum, allowing for normal passage of waste as well as avoiding having a permanent stoma (opening into abdomen). Ileal stoma – When an ileal pouch cannot be done, a stoma (permanent opening in abdomen) will be created along with the placement of a stool collection bag. Proctocolectomy – A proctocolectomy involves the removal of the entire colon and rectum and includes the creation of a stoma (permanent opening in abdomen) along with the placement of a stool collection bag. A proctocolectomy can also be performed in tandem with an ileoanal reservoir, which connects a portion of small intestine (ileum) to the anus, creating an ileal pouch to replace the rectum.

There are several online local, national, and international support groups for ulcerative colitis, including the following: Crohn’s & Colitis Foundation Ulcerative Colitis Support Group - https://www.crohnscolitisfoundation.org/ IBD Support Foundation - http://www.ibdsf.org/ National Ulcerative Colitis Alliance - https://nuca.life/

The outcomes (prognosis) for ulcerative colitis are varied and depend on the individual extent and progression of the disease. While there is no cure for ulcerative colitis, its symptoms can often be managed with treatment that can allow the disease to achieve long-term remission. More commonly, ulcerative colitis is characterized by periods of remission, followed by flare-ups, or worsening of the condition. Patients with ulcerative colitis also have an increased risk of developing colorectal cancer.

Possible complications of ulcerative colitis may include severe dehydration, malabsorption, increased risk of blood clots, inflammation of skin, eyes, and joints, osteoporosis (bone thinning), liver disease, perforated colon, megacolon (swelling colon), rectal bleeding or severe bleeding in other parts of the digestive tract, and the development of colon cancer. Some patients who have had surgery for ulcerative colitis may experience a change in bowel movements after surgery, develop fecal incontinence (uncontrolled defecation), or experience pouchitis (inflammation of the ileoanal reservoir). Some women may experience infertility after surgery for ulcerative colitis.

If you experience any persistent changes in bowel habits or any symptoms such as chronic diarrhea, abdominal pain, fever, or blood in the stool, contact your doctor as soon as possible.

While ulcerative colitis cannot be prevented, due to an increased risk of developing colon cancer, especially when male, patients with ulcerative colitis should undergo frequent screening with surveillance colonoscopy or colon biopsy. Surgery to remove the entire colon both cures ulcerative colitis and prevents colon cancer.