Ulcerative colitis is a type of inflammatory bowel disease (IBD) in which the large intestine (colon) is chronically inflamed with sores. Ulcerative colitis usually involves the lower part of the colon and the rectum, but it can affect the entire colon.
Crohn’s disease is another type of IBD that is different from ulcerative colitis because it can affect any part of the gastrointestinal tract from the mouth to the anus.
Ulcerative colitis is diagnosed with:
- A physical exam, which may include:
- Examining the abdomen, pressing to check for pain or tenderness
- Checking for eye inflammation, mouth sores, skin rashes, joint swelling or irritation, bleeding, or signs of inflammation in the anus and the surrounding area
- Patient history
- Symptoms, when they first occurred, how frequent and severe, and if they interfere with daily activities
- Symptoms related to an immune system abnormality, such as fever, loss of appetite, weight loss, eye irritation or blurred vision, and arthritis.
- Questions about travel and if symptoms occurred during a trip to another country
- Diet, and if there have been any dietary changes recently
- Any other medical conditions or medications used
- Past abdominal or gastrointestinal surgery
- Tests and procedures
- Stool testing
- To rule out infection and parasites
- Calprotectin
- Stool testing
- Blood tests
- Complete blood count (CBC)
- Iron studies
- C-reactive protein
- Sedimentation rate
- Kidney function
- Liver function tests
- Endoscopic procedures
- Colonoscopy or sigmoidoscopy (tissue biopsy may be performed)
- Video capsule endoscopy
- Upper endoscopy
- Imaging tests
- Barium enema X-ray
- Computerized tomography (CT) scans
- Magnetic resonance imaging (MRI) scans
- CT/MRI enterography
- MR enterography
What Are Symptoms of Ulcerative Colitis?
Symptoms of ulcerative colitis are mild in about half of all patients, and may include:
- Persistent diarrhea (may be bloody)
- Painful urge to move the bowels caused by the inflammation
- Abdominal cramps and pain
- Urgent bowel movements
- Rectal pain
- Rectal bleeding
- Weight loss
- Dehydration
- Fatigue
- Fever
- Night sweats
Inflammation and symptoms may worsen (flares), followed by periods when symptoms subside (remission), that can last months to years.
What is the Treatment for Ulcerative Colitis?
Treatment for ulcerative colitis depends on the severity of the condition and how often a patient’s symptoms worsen (flare). The goal of treatment is to reduce symptoms, and induce and maintain remission (which is a period without symptoms).
Ulcerative colitis is usually treated with medication to induce or maintain remissions and improve quality of life. Surgery is a last-resort for patients who have severe inflammation and life-threatening complications.
Medications used to treat ulcerative colitis include:
- Anti-inflammatory drugs
- Aminosalicylates (also called 5-ASAs) are used help to reduce inflammation and allow damaged tissue to heal
- Systemic corticosteroids (prednisone, prednisolone, cortisone)
- More powerful than 5-ASAs, and may be used with or instead of 5-ASAs to treat flare-ups when 5-ASAs alone are not effective
- Not used long-term because they can cause potentially serious side effects
- Topical corticosteroids
- Immunomodulators
- For mild or moderate flare-ups, or to maintain remission if symptoms do not respond to other medicines
- Azathioprine/6-MP (Imuran, Azasan)
- Methotrexate (Trexall, Otrexup)
- Tacrolimus (Prograf)
- Cyclosporine (Sandimmune, Neoral)
- For mild or moderate flare-ups, or to maintain remission if symptoms do not respond to other medicines
- Biologic therapies
- For adults with moderate to severe ulcerative colitis for whom other treatments are not suitable or working
- Alimumab (Humira)
- Golimumab (Enbrel)
- Infliximab (Remicade)
- Vedolizumab (Entyvio)
- For adults with moderate to severe ulcerative colitis for whom other treatments are not suitable or working
- Janus kinase inhibitors (JAK Inhibitors)
- For moderate to severe ulcerative colitis if standard treatments or biologics have not worked or are not suitable
- Tofacitinib (Xeljanz)
- For moderate to severe ulcerative colitis if standard treatments or biologics have not worked or are not suitable
Surgery for ulcerative colitis is a last-resort used for severe cases. Surgery usually involves removing the entire colon and the rectum, which is the only permanent cure for ulcerative colitis.
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https://pubmed.ncbi.nlm.nih.gov/8613037/
https://www.crohnscolitisfoundation.org/
https://www.nhs.uk/conditions/ulcerative-colitis/treatment/
https://nyulangone.org/conditions/inflammatory-bowel-disease-in-adults/diagnosis