Ulcerative colitis

Overview

Ulcerative colitis is one of the two main forms of inflammatory bowel disease (the other is Crohn's disease). The inflammation affects the lining of the large intestine: it starts in the rectum and can extend continuously toward other parts of the colon.

The disease goes through periods of activity (flares) and periods of quiet (remission). It is not an infection and it is not contagious.

Symptoms

• diarrhea with blood or mucus
• urgency to go to the toilet and a sensation that the bowel does not empty completely
• abdominal pain or cramps
• fatigue and anemia
• in severe forms: fever and weight loss

There may also be manifestations outside the bowel: joint pain, skin lesions, eye inflammation or liver disease.

Causes

The exact cause is not known. The disease arises from the interaction of genetic predisposition, the immune system, the gut microbiome and environmental factors. Stress and some foods can worsen symptoms, but they do not cause the disease.

Diagnosis

• Blood and stool tests — including fecal calprotectin, which measures inflammation, and tests to rule out infections (e.g. C. difficile).
• Colonoscopy with biopsy confirms the diagnosis and shows the extent of the disease. In severe acute colitis, a limited sigmoidoscopy, which is safer, may be preferred.

No single test makes the diagnosis; it is based on the combination of all the data.

Treatment

The goal is to achieve remission and to maintain it for as long as possible.

• Mesalamine (5-ASA) — the foundation of treatment in mild and moderate forms, as tablets, suppositories or enemas.
• Corticosteroids — to quickly settle a flare. They are not used as long-term treatment.
• Immunomodulators, biologic drugs and targeted small-molecule drugs — for more severe forms or when the first treatment is not enough.

Do not stop maintenance treatment just because you feel well: this is the most common reason for relapses.

Surgery may be needed for complications (perforation, toxic megacolon, uncontrolled bleeding), for precancerous changes or when the disease is not controlled with medicines.

Long-term follow-up

• Regular checks of disease activity, anemia, nutrition and the safety of the medicines.
• After several years of disease involving the colon, periodic colonoscopy is needed for early detection of precancerous changes, at an interval according to individual risk.
• Diet is adapted to the periods of the disease, but does not replace treatment.