Ulcerative colitis is a chronic condition in which the lining of the colon and rectum is inflamed and ulcerated. As a result of this inflammation, patients suffer from diarrhea and bleeding. When only the rectum is involved, it is termed ulcerative proctitis.
The exact cause of ulcerative colitis is not well understood. Ulcerative colitis results in uncontrolled inflammation within the rectum and colon. There are autoimmune, genetic and environmental factors implicated, but no single cause has been established. Ulcerative colitis tends to run in families, but only a small fraction of patients have a first degree relative suffering from the condition. It is believed that the immune system of the colon is activated in the setting of something foreign. Once activated, the immune system of the colon is unable to “turn off” and as a result unregulated inflammation occurs.
The main symptom of ulcerative colitis is diarrhea. This diarrhea is frequently associated with blood and mucus in stools. Furthermore, patients often suffer from urgency and frequent nighttime bowel movements. Patients can also suffer from generalized fatigue, fevers, weight loss and abdominal pain. Outside the gastrointestinal tract, ulcerative colitis can be associated with joint inflammation (arthritis), redness or pain in the eyes and liver disease, among others.
Overall, ulcerative colitis symptoms can range from mild to severe disease. Symptoms can be episodic and occur in flares, during which time disease activity is high and more aggressive therapy may be required.
The diagnosis of ulcerative colitis relies on a combination of a detailed history, physical exam findings, labs, stool testing and colonoscopy.
The goal of treatment in ulcerative colitis is to achieve a state of remission (no disease activity). Treatment is done using a combination of dietary modifications, lifestyle changes and medical therapies. Medical treatments aim to control inflammation and stop further damage. Some of the medicines used in the treatment of ulcerative colitis include:
• Steroids - These include prednisone, methylprednisolone and budesonide. These medications are used in the acute setting to get control of inflammation but are not recommended in the long-term due to side effects.
• 5-Aminosalicylates (5-ASA) - This group of medicines have anti-inflammatory effects on the intestines.
• Immunomodulators - These medications are used in patients with more severe disease not responding to steroids or 5-ASAs. They work by suppressing the body’s immune system to control the inflammation seen in ulcerative colitis.
• Biologics - These medications are used in the patients who have not responded to conventional therapy. They are antibodies that are directed against certain proteins within the body that cause inflammation. Examples include Adalimumab (Humira®), Golimumab (Simponi®), Infliximab (Remicade®), Ustekinumab (Stelara®),Vedolizumab (Entyvio®) and Tofacitinib (Xeljanz®).
For patients who do not respond to medications or have side effects to medications limiting their use, surgery may be an option in the treatment of ulcerative colitis. There are several different surgical options that exist in the management of ulcerative colitis. Your physician can discuss these options with you further and review the benefits and risks of surgery in ulcerative colitis.
The information provided above is meant to be used as an informative guide for patients. For precise and individualized recommendations, please consult with one of our board certified gastroenterologists to discuss your symptoms.
For additional information or to book an appointment at the Gastroenterology Center of New York, please feel free to reach out to our dedicated team by calling us at 718-210-2960. You can also schedule online or reach out to us via the Contact Us form.