Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) characterized by inflammation and ulceration of the innermost lining of the large intestine. Unlike other forms of IBD, such as Crohn’s disease, ulcerative colitis is confined to the colon and rectum.Â
What are the Symptoms of Ulcerative Colitis
The symptoms of ulcerative colitis can vary widely, depending on the severity of the inflammation and the extent of the colon involved.Â
Common symptoms include:
- Diarrhea, which can often be bloody and accompanied by an urgent need to have a bowel movement.
- Abdominal pain and cramping are typically located in the lower left of the abdomen.
- Rectal pain and bleeding. Blood in the stool is a sign because the colon and rectum often become inflamed.
- Fatigue may be due to the body’s response to chronic inflammation and anemia from blood loss.
- Weight loss which results from decreased appetite and malabsorption of nutrients.
- Fevers, especially during severe flare-ups.
How is UC Diagnosed?
Diagnosing ulcerative colitis involves a combination of medical history, physical examinations, and diagnostic tests. Here are the primary methods used:
- A thorough physical examination with a review of the symptoms and whether there’s any family history of IBD.
- Blood tests to check for anemia and inflammation markers in red blood cells, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
- Stool samples to rule out the possibility of infections or parasites causing symptoms.
- A colonoscopy visually examines the whole large intestine (colon). It is considered the gold standard for colorectal cancer screening and is recommended for average-risk individuals every ten years starting at the age of 45-50. Colonoscopy allows visualization of the colon’s interior and the collection of tissue samples for examination in the laboratory. An alternative to colonoscopy is a Flexible Sigmoidoscopy, which is similar to a colonoscopy but only examines the lowest part of the colon. It helps evaluate symptoms localized to the lower bowel, such as rectal bleeding and can help diagnose conditions like ulcerative proctitis, diverticulosis, and distal colon cancers.Â
- Imaging tests such as X-rays, CT scans, and MRIs can assess the extent of inflammation and rule out complications.
What are the Treatment Options for Ulcerative Colitis
The treatment of ulcerative colitis aims to reduce inflammation, manage symptoms, and induce and maintain remission. Treatment plans are tailored to the individual and depend on many factors, such as the severity and extent of the disease, any other health issues, and the patient’s age.
Lifestyle and dietary changes are often recommended when the symptoms are mild and are not worsening. Since ulcerative colitis is a chronic condition, maintaining a balanced diet, managing stress, and regular exercise can help manage symptoms. Specific dietary adjustments may be recommended during flare-ups. These include reducing fiber intake because fiber is a component of plant foods that the body cannot fully digest. While fiber is generally beneficial for healthy digestive systems, it can increase stool bulk and frequency, which might exacerbate symptoms for some individuals with digestive disorders like ulcerative colitis and Crohn’s. It’s usually advised to limit fiber intake to about 10-15 grams per day, compared to a typical adult’s recommended 25-38 grams daily. It involves limiting the intake of certain foods, including whole grains, nuts, seeds, raw fruits and vegetables, and legumes.
Surgery is an option in cases where medication fails to control symptoms or complications arise. The usual method involves removing the colon (colectomy). It often involves creating an ileostomy or a J-pouch to restore bowel function.
Medications that doctors can prescribe fall into several distinct categories:
| Class | Function | Drug |
| Aminosalicylates (5-ASAs) | They are used to reduce inflammation in the lining of the intestines. The exact mechanism is not entirely understood but is believed to involve the inhibition of certain inflammatory mediators. | Mezavant Sulfazine Pentasa Asacol |
| Corticosteroids | They are for short-term use during flare-ups to reduce inflammation quickly. They work to suppress the immune system and reduce inflammation by inhibiting multiple inflammatory pathways. They are highly effective in rapidly controlling severe flare-ups of ulcerative colitis and Crohn’s disease but typically are used only for short periods due to their potential side effects. | Entocort EC Depo Medrol |
| Immunomodulators | They help to suppress the immune system to prevent inflammation by altering the immune response to reduce chronic inflammation. They inhibit the proliferation of immune cells and interfere with cytokine signaling. | Imuran Methotrex Purinethol Neoral Prograf |
| TNF blockers (Biologics) | Block the activity of Tumor Necrosis Factor (TNF), a pro-inflammatory cytokine that plays a crucial role in systemic inflammation and immune system regulation. These drugs help alleviate symptoms, prevent long-term damage, and manage chronic inflammatory diseases by inhibiting TNF. | Remicade Humira |
| Interleukin blockers (Biologics) | Block the actions of integrins, which are proteins on cell surfaces that enable cell adhesion and migration. In inflammatory conditions, integrins help leukocytes migrate to sites of inflammation. Integrin inhibitors help reduce localized inflammation and tissue damage by inhibiting this migration. | Stelara Skyrizi |
| JAK inhibitors (Biologics) | Block the activity of one or more enzymes in the Janus kinase pathway. These are a signaling mechanism in the immune system. They can effectively reduce the production of multiple cytokines involved in the inflammatory process, offering a more targeted approach to controlling IBD symptoms. JAK inhibitors are an alternative to TNF and integrin inhibitors. They target the Janus kinase pathway. | Rinvoq Xeljanz |
FAQ
How can doctors distinguish UC from other conditions with similar symptoms?
Since many conditions can present identical or very similar symptoms, doctors need to identify the underlying cause as a first step in treatment. Understanding how ulcerative colitis differs from similar conditions is crucial for accurate diagnosis and treatment.
Inflammatory Bowel Disease (IBD) is a broad classification of bowel disease, with UC and Crohn’s disease being the two main types. While UC is limited to the large intestine (colon and rectum), Crohn’s can affect any part of the gastrointestinal tract, including the small intestine, often causing deeper inflammation and a broader range of symptoms.
What are the potential outcomes of Ulcerative Colitis?
Toxic megacolon is a severe complication of UC characterized by rapid swelling and paralysis of the lower bowel, potentially leading to perforation and requiring immediate medical intervention.
Ulcerative proctitis is a mild form of UC limited to the rectum, causing symptoms like rectal bleeding and pain but often less severe than those of more extensive UC.
Are there genetic factors in the development of Ulcerative Colitis?
Research has shown a higher prevalence of ulcerative colitis among individuals of Ashkenazi Jewish descent. Genetic studies indicate that specific genetic mutations are more common in this population, contributing to their increased risk of developing UC. The exact genetic mechanisms are not fully understood, but these findings indicate a genetic predisposition in the disease’s development.
What are the differences between the various biologics treating IBD?
Tumor Necrosis Factor (TNF) is a pro-inflammatory cytokine, a signaling protein involved in systemic inflammation. It plays a crucial role in the immune system by promoting inflammation to help fight infections and diseases. However, excessive or chronic production of TNF can lead to severe inflammation and tissue damage, contributing to autoimmune diseases like rheumatoid arthritis, psoriasis, and inflammatory bowel diseases (IBD) such as ulcerative colitis and Crohn’s disease.
TNF inhibitors are designed to reduce inflammation by blocking the activity of TNF. These drugs help reduce inflammation, alleviate symptoms, and prevent long-term damage associated with chronic inflammatory diseases. TNF inhibitors bind to TNF molecules, preventing them from interacting with their receptors on the surface of cells. This blockage prevents the inflammatory cascade that TNF typically triggers, reducing inflammation and immune system overactivity.
Integrins are proteins found on the surface of cells that play a crucial role in cell adhesion and migration. They help cells stick to each other and the extracellular matrix, vital for immune responses. In the context of inflammation, integrins facilitate the movement of white blood cells (leukocytes) to sites of inflammation.
Integrin inhibitors target and block integrins, thereby preventing white blood cells from migrating to sites of inflammation. By blocking this migration, they help reduce inflammation and immune system overactivity. Integrin inhibitors bind to specific integrins on the surface of leukocytes, preventing these cells from adhering to the blood vessel walls and migrating into inflamed tissues. This action reduces the infiltration of immune cells into the inflamed areas, decreasing inflammation and tissue damage.
Interleukins are a group of cytokines (signaling proteins) that play numerous roles in the immune system, including regulating immune responses, inflammation, and the development of white blood cells.
Interleukin blockers are designed to block the activity of specific interleukins, thereby reducing inflammation and modulating the immune response. Interleukin inhibitors can bind to particular interleukins or their receptors, preventing them from interacting with cells and initiating inflammatory responses. This blockage reduces the inflammatory cascade, alleviating symptoms and controlling disease progression.
Interleukin inhibitors, which can be prescribed for IBD, help manage symptoms and prevent damage in autoimmune and inflammatory conditions by targeting interleukin-12 and interleukin-23, two proteins associated with inflammation in the GI tract.
