Ulcerative colitis

Ulcerative colitis is one of two forms of inflammatory bowel disease, which typically affects the large bowel only.

Crohn's disease, however, is known to affect any part of the digestive tract from the mouth to the anus.

What are the symptoms?

The main symptoms of ulcerative colitis include abdominal pain with bloody diarrhoea often containing mucus.

Additional symptoms include weight loss, malaise and general fatigue.

The disease is also known to result in eye complications, skin changes and joint problems.

Who is likely to get it?

People in the western world are more likely to be affected by the condition.

It commonly occurs between the ages of 20 to 40 and affects both sexes equally.

What is the cause?

A variety of environmental and genetic factors have been linked to the condition.

Research has shown that there may be certain infective agents that predispose individuals to the development of ulcerative colitis.

Such factors may lead to a change in the lining of the bowel allowing for bacteria to culminate and activate one's immune system.

As a result there is an increased production of inflammatory cells which all contribute to inflammation and subsequent tissue damage.

It has also been noted that ulcerative colitis is less common in smokers but at present the mechanism behind this is not clearly understood.

Genetic factors also exist and studies suggest a familial tendency in ulcerative colitis with approximately 15-20 % of people with the disease also having a close relative affected by the condition.

How is it diagnosed?

The gold standard diagnosis of ulcerative colitis is via endoscopy.

This is where a camera is inserted into the back passage and used to assess for evidence of inflammation and obtain tissue samples.

Individuals suspected of the condition also undergo blood tests to detect the presence of anaemia and evidence of inflammation by monitoring of the CRP (C reactive protein) and ESR (erythrocyte sedimentation rate).

How is it treated?

Management of ulcerative colitis is two-fold, with either medical or surgical intervention.

Medical management involves the use of drugs called aminosalicylates which help maintain remission in mild forms of ulcerative colitis.

In acute attacks of the disease steroids are often used as well as in those who do not respond to aminosalicylates.

As a final resort immunosuppressant drugs are used such as azathioprine, ciclosporin or infliximab in cases where there is no response to aminosalicylates or steroids.

Surgical management is generally an option in cases where individuals do not respond well to medical treatment or as a result of complications of the disease.

The type of surgery chosen is entirely dependent on the location of disease.

In some cases the colon is removed with the small bowel being joined to the muscles of the anus to form an ileo-anal pouch.

Alternatively the colon is removed with the small bowel being brought to the exterior surface of the abdominal wall to form a stoma which collects digestive waste.

What are the complications?

The major complication of ulcerative colitis is the development of colorectal cancer with a risk of approximately 10-12 % after 25 years of the disease.

Additional complications include toxic dilatation of the large bowel as a result of inflammation and excess gas build up which can cause rupture of the bowel commonly known as a perforation.

Ulcerative colitis can also lead to narrowing or stricture formation within the bowel which is most appropriately managed surgically.

What is the prognosis?

Ulcerative colitis typically presents as a relapsing and remitting disease condition and in the vast majority of cases medical management is the mainstay form of treatment.

The prognosis of the disease is poorly defined.

It is however generally accepted that those who develop disease of the rectum alone have the most favourable prognosis.

Written by Dr Neel Sharma