What is ulcerative colitis?

Ulcerative colitis is a chronic (long-term) disease marked by inflammation and ulceration (erosion and pitting) in the wall of the large intestine, also called the colon. Although the disease may begin at any age, it usually affects people between the ages 15 and 30.

Causes and symptoms

The exact cause of ulcerative colitis is unclear. It sometimes runs in families, suggesting that people inherit a genetic tendency toward the disease. This tendency is toward an abnormal response of the immune system, which may be triggered by an infection or even a food allergy. The result is intestinal
inflammation. It usually begins in the rectum or lower colon and over time may spread throughout the colon.

The disease alternates between symptom-free periods (remissions) and flare-ups. Typical symptoms during flare-ups include an urgent need to have a bowel movement, bloody diarrhea, abdominal cramps, nausea and vomiting, and fever. People with extensive disease may have 10 to 20 bowel movements a day. Poor appetite and weight loss are common. Flare-ups may last for days or weeks.

Symptoms of ulcerative colitis may extend beyond the intestine. Other areas of inflammation may include the joints, eyes, and skin.

Diagnosis and treatment

Ulcerative colitis is confirmed by a sigmoidoscopy (for the lower colon) or a colonoscopy (for the entire colon). These procedures involve the insertion of a lighted tube into the anus, then up into the large intestine. With the scope, a doctor can see erosions and ulcerations on the inner lining of the colon. The goals of treatment are to control inflammation, reduce symptoms, and replace fluids and nutrients.

The type of medication prescribed depends on the extent and severity of the disease. Drugs such as sulfasalazine and mesalamine are delivered by enema, a suppository, or orally, depending on the location of the inflammation. They may be adequate for mild disease. Corticosteroids are often used for moderate-to-severe disease. For severe inflammation, a person may also need drugs called immunomodulators, such as azathioprine.

When severe flare-ups can no longer be controlled with medication or if a serious complication occurs, surgery may be necessary to remove the colon and rectum.