By Dr Ananya Mandal, MD
Ulcerative colitis is a chronic condition that affects the large intestines, particularly the colon. It is classified as one of the two inflammatory bowel diseases along with Crohn’s disease.
The condition is characterized by inflammation within the linings of the gut walls.
Causes of ulcerative colitis
Ulcerative colitis is considered to be an autoimmune disease. Normally the body’s immune system works to defend the body against infection and invading microbes. In autoimmune disorders, this goes awry and the immune system attacks body’s own cells.
There are billions of harmless bacteria present in the gut. In inflammatory bowel diseases like Crohn’s disease and Ulcerative colitis, the immune system targets these harmless bacteria inside the colon and in turn attacks the tissues of the colon, causing it to become inflamed.
The inflammation leads to formations of ulcers and painful sores oozing mucus and pus. Both genetic and environmental factors may be responsible for causation of ulcerative colitis.
Symptoms of ulcerative colitis
Symptoms of ulcerative colitis commonly include abdominal pain, bloating, and frequent urge to evacuate bowels, bloody diarrhea and an abnormal weight loss.
The symptoms may range from mild to severe, with the condition fluctuating between extremes of symptoms.
Symptoms can flare up and then disappear for months or even years. Periods of absence of symptoms are termed remission.
Types of ulcerative colitis
The type of ulcerative colitis depends on the part affected:-
If only the left side of the colon is affected it is called limited or distal colitis.
When the inflammation occurs in the rectum and lower part of the colon it is called ulcerative proctitis.
If the entire colon is affected it is called pancolitis.
Ulcerative colitis statistics
Ulcerative colitis is relatively uncommon. In England 1 in every 1000 persons is diagnosed with the condition annually.
The condition is usually detected between the ages of 15 and 30 and nearly equally among men and women.
It affects white people of European descent especially those from Ashkenazi Jewish communities and black people more than others. It is rare among people of Asian descent.
Worldwide incidence rate of ulcerative colitis varies greatly between 0.5–24.5 per 100,000 persons.
It is estimated that as many as 1.4 million persons in the United States suffer from inflammatory bowel diseases including ulcerative colitis and Crohn’s disease.
Diagnosis of ulcerative colitis
Ulcerative colitis is confirmed by examining the insides of the colon using sigmoidoscopy or colonoscopy. This also helps rule out Crohn’s disease and bowel cancers that may have similar symptoms.
Treatment of ulcerative colitis
There is currently no cure for ulcerative colitis. Treatment aims to relieve symptoms during a flare-up and prevent symptoms from returning during remission.
One of the commonest medications used include aminosalicylates and corticosteroids (steroid medications). Serious flare up of symptoms may necessitate hospital admission. Some persons may benefit from colon surgery to remove the affected parts as well.
Without treatment, several complications may occur with ulcerative colitis. For example, inflammation of the bile ducts called primary sclerosis cholangitis may occur leading to jaundice and other features.
Another life threatening complication is toxic megacolon where the gases become trapped inside the colon, causing it to swell. Those with ulcerative colitis are also at a raised risk for developing bowel cancers.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)