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Ulcerative Colitis

Ulcerative colitis, or UC, is a common form of inflammatory bowel disease. Occurring in the anus, rectum and large intestine, the condition causes the inflammation of the innermost lining, known as the mucosa. UC always begins in the last few inches of the intestines and spreads proximally through the colon, sometimes causing the entire colon to become inflamed.  

Ulcerative colitis can happen to anyone, even if there is no family history. It is most common in developed countries, however, and among certain groups, including those who are of Jewish descent and Caucasians; about 700,000 Americans have been diagnosed with the disease. If you do have a relative with either Crohn’s disease or ulcerative colitis, you have an increased risk of developing either disease. The most common time of life for the diagnosis to occur is between the ages of 15 and 35; that said, there has been an increase in the number of pediatric patients, with about 10 percent of patients being diagnosed before the age of 18.

Symptoms of Ulcerative Colitis

The disease manifests itself in the mucosa. Changes at that level lead to the inflammation and ulceration that in turn cause a disturbance in the absorption of salt and water. The malabsorption of the water leads to diarrhea; damage to the mucosa can also lead to excessive amounts of mucous in the fecal matter. The ulcerations cause bleeding, which can lead to anemia. Abdominal pain, fever, fatigue, loss of appetite and weight loss often accompany the disease as well.

Ulcerative colitis also can manifest itself in other areas of the body such as the liver, the eyes, the skin, the joints and the kidneys and can account for symptoms such as strange bumps on the skin, a reddened or itchy eye, liver or biliary diseases, swollen and painful joints.     Usually, these conditions are present only when the disease is active, less so when the disease is in remission.

There is no known cause of UC. It has been thought in the past that stress or certain foods could cause the condition. While stress can make any condition worse, it does not cause UC. Certain foods – including fatty or fried foods, high-fiber items, carbonated beverages – can make symptoms worse but have not been found to cause the condition.

Instead, scientists believe that the condition is caused by a combination of genes, environmental factors and immune systems that react inappropriately by attacking the intestines.

Diagnosis of Ulcerative Colitis

Because most individuals with UC report frequent and urgent diarrhea, excessive mucous or blood in the stool, the diagnostic testing for the condition usually involves radiologic tests like CT scans and endoscopic procedures like sigmoidoscopy or colonoscopy, the latter tests usually being confirmed with the pathological results of a biopsy.

In a small percentage of patients, it is difficult to tell if the inflammation is related to Crohn’s disease or ulcerative colitis. As the diseases are treated with similar drugs, this usually is not an issue. If a patient develops inflammation that burrows through the bowel wall, develops and abscess or fistula or begins having small bowel symptoms, the diagnosis usually becomes Crohn’s disease.   

Treatment of Ulcerative Colitis

In the past two decades, the science of medically treating UC has advanced rapidly. Where steroids and sulfa drugs used to be the mainstay of treatment, gastroenterologists now rely on sophisticated biologic medications, drugs that suppress the overactive immune system and new generations of salicylates to reduce or eliminate symptoms. You can learn more about these medications here.

The good news about these medications is that they have helped more people with UC go into remission and stay in remission. However, anywhere from 25 to 40 percent of UC patients will require surgery, usually when medical therapies fail to control the disease, when scar tissue causes blockages in the intestines or when cancer develops.