Understanding Ulcerative Colitis

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that is characterised by chronic inflammation of the gastrointestinal (GI) tract.^1-3

• Ulcerative colitis is a chronic disease of the large intestine, also known as the colon^1-3
• Tiny open sores can be seen in this region of the gut using imaging methods²
• Inflammation is limited to the innermost layer of the large intestine, and causes loss of the colon’s lining^2,3

Symptoms of UC can vary in degree, depending on the individual and severity of disease.^1,2 When the disease is active, signs and symptoms may include:

• Abdominal pain
• Diarrhoea
• Rectal bleeding
• Fever
• Weight loss
• Signs of malnutrition

UC and Crohn’s disease (CD) share many of these symptoms,^1,2 so it can be difficult for doctors to distinguish between these two inflammatory bowel diseases.

Complications of UC can include anaemia and pus production in the GI tract.²

Other complications of UC may include perforated bowel and toxic megacolon,³ which is a severe inflammation that leads to rapid enlargement of the colon.

Both UC and CD can increase the risk of colorectal cancer (CRC):³

• The risk is related to the duration of the disease
• Risk is also linked to the extent (i.e. the length of the colon involved) and the severity of the disease

Although much progress has been made in IBD research, a definitive cause has not been found.^2,3

Several factors may contribute to the risk of developing IBD, including:^2,3

Ethnicity: High risk in Caucasians, and notably people of Eastern European (Ashkenazi) Jewish descent

Genetics: Family history – 5–20% of patients have a first-degree relative with IBD

Habitat: Those living in urban areas and industrial nations may be more likely to develop
UC or CD than those in more rural areas

Diagnosis may involve a combination of the following tests and examinations.^1,2

Blood Tests
May be performed to check for anaemia, which may indicate bleeding in the intestines. Blood tests may also uncover a high white blood cell count, which is a sign of inflammation somewhere in the body.^1,2

Faecal Tests
By testing a stool (faecal) sample, clinicians can tell if there is bleeding or infection in the intestines. Stool tests are commonly done to rule out other diseases of the GI tract, such as cancer.^1,2

Imaging Tests
Magnetic resonance imaging (MRI) or computed tomography (CT) may be used to identify visible abnormalities in the gut.^2,4

Flexible sigmoidoscopy and colonoscopy
These tests are performed using a long, flexible tube that has a small video camera on the end. A doctor can carefully examine the rectum, colon and small intestine for inflammation, bleeding, or ulcers, or may perform a biopsy. The tissue taken during a biopsy can be analysed microscopically to confirm a diagnosis.^1,2

The management of IBD may involve medications, surgery, and nutritional support.

The overall aim is to reduce inflammation, correct nutritional deficiencies, and alleviate gastrointestinal symptoms, such as abdominal pain and diarrhoea.^1,2

Medications

The general categories of drugs used in the treatment of UC^1,2,5

• Aminosalicylates or 5-ASA that reduce gut inflammation
• Steroids that reduce gut inflammation
• Immunomodulators that dampen the body’s immune responses that contribute to inflammation in the gut
• Biologic therapies such as anti-TNFα, anti-integrin and anti-interleukin, that reduce gut inflammation
• JAK Inhibitors

Surgery

Surgery may be necessary to relieve symptoms when people do not respond to medications or if complications occur. Partial or total removal of specific sections of the colon or rectum may be necessary.^1-3

Diet and Nutrition

Proper nutrition is also a part of managing both UC and CD, and it is important that patients follow a nutritious diet and avoid foods that may worsen their symptoms.²