ALIPASHA IMANIVALA

Ulcerative Colitis
Ulcerative colitis (UC) a chronic disease of unknown cause characterized by ulceration of the
colon and rectum, with rectal bleeding, mucosal crypt abscesses, abdominal pain, and diarrhea;
frequently causes anemia, hypoproteinemia, and electrolyte imbalance; sometimes
complicated by peritonitis, toxic megacolon, or carcinoma of the colon. It is recognized as a
multifactorial polygenic disease, as the exact etiology is still unknown. In general, the more of
the colon that's affected, the worse the symptoms will be.

 Causes of Ulcerative colitis

Experts aren't sure what causes it. They think it might be caused by the immune system
overreacting to normal bacteria in the digestive tract. There are certain factors that make it
more likely a person will develop ulcerative colitis. These include:

 Age: While colitis can begin at any age, it usually starts when people are 15 to 30 years
old or 50 to 70 years old.

 Family history: According to the Crohn’s and Colitis Foundation, up to 20 percent of

people with colitis have a close relative with ulcerative colitis or Crohn's disease.

 Ethnic background: There is a higher incidence of ulcerative colitis in white than in

nonwhite people, and a higher incidence among Jewish than in non-Jewish people.

 Where you live: Ulcerative colitis occurs mostly in developed countries, and is found
more often in urban areas than rural ones, and in northern regions rather than southern
regions of the United States.

 Symptoms
According to Cedars-Sinai, about 50 percent of people diagnosed with ulcerative colitis have
mild symptoms. However, symptoms can be severe. Common symptoms of ulcerative colitis
include Belly pain or cramps, Diarrhea, Bleeding from the rectum.

Some people also may have a fever, may not feel hungry, and may lose weight. In severe cases,
people may have diarrhea 10 to 20 times a day. The disease can also cause other problems,
such as joint pain, eye problems, or liver disease.

In most people, the symptoms come and go. Some people go for months or years without
symptoms (remission). Then they will have a flare-up. About 5 to 10 out of 100 people with
ulcerative colitis have symptoms all the time

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 Diagnosing and treatment

Doctors ask about the symptoms, do a physical examination, and do a number of tests. Testing
can help the doctor rule out other problems that can cause similar symptoms, such as Crohn's
disease, irritable bowel syndrome, and diverticulitis.

Tests that may be done include:

 A colonoscopy. In this test, a doctor uses a

thin, lighted tool to look at the inside of your
entire colon. At the same time, the doctor may
take a sample (biopsy) of the lining of the
colon.
 Blood tests, which look for infection or
inflammation.
 Stool sample testing to look for blood,
infection, and white blood cells.
 shows marked thickening of the wall of the
rectum and sigmoid colon with some free fluid in
Figure 1 CT scan of ulcerative colitis
the pelvis (arrow, picture 1). These features are
not specific and may be seen in any form of colitis.

Many people need prescription medicines, such as steroid medicines, or other medicines that
reduce the body's immune response. These medicines can stop or reduce symptoms and
prevent flare-ups.

There’s no cure for ulcerative colitis, but with the right treatment, symptoms can be kept under
control. Aggressive treatment in the early stages of the disease can help you maintain remission
and ensure that your symptoms don’t get worse. Sticking to your treatment plan and
communicating with your doctor about your symptoms and any treatment side effects are key
to living comfortably with the disease. The following are the categories of drugs prescribed to
treat UC:

 Antibiotics
Metronidazole, ciprofloxacin, and other antibiotics may be used when infections occur,
or to treat complications of ulcerative colitis.

 Aminosalicylates (5-ASAs)
Given either orally or rectally, these drugs work to decrease inflammation in the lining
of the intestines and are usually used to treat mild to moderate UC symptoms.

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 Corticosteroids (Steroids)
Given orally, as an injection, rectally, or intravenously, these medications help reduce
inflammation by suppressing the immune system and are usually given to help with
moderate to severe UC symptoms. Steroids are not intended for long-term use; they are
best suited for short-term control of IBD symptoms and disease activity. If not used
appropriately, patients can become steroid dependent or resistant.

If you have severe symptoms and medicines don't help, you may need surgery to remove your
colon. Removing the colon cures ulcerative colitis. It also prevents colon cancer

Figure 2 (A) Gross pathology of amebic colitis showing multiple ulcer formation.
(B) Classic flask-shaped ulcer of amebiasis. Mucosal ulceration with widespread
submucosal invasion shown.

 Diet

For many people with ulcerative colitis, finding the right diet plan is a process of elimination.
You eliminate certain foods that seem to aggravate your symptoms and see how you feel. Since
there are some foods that are known to be common triggers, a diet plan that eliminates these
foods is best. One such diet is a low-fiber diet, also known as the low-residue diet. This diet is
also especially helpful if you are experiencing a flare-up of symptoms.

The diet is based around low-fiber foods that are easy to digest and likely to slow your bowel
movements and limit diarrhea. The diet allows you to eat a lot of the foods that you’d normally
eat, while keeping your fiber consumption down to around 10 to 15 grams per day.

Deli meats; dry fruits, berries, figs, prunes; raw vegetables; spicy sauces, dressings, pickles;
nuts, seeds, and popcorn; foods and beverages that contain caffeine, cocoa, and alcohol; can
make UC symptoms worse.

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The American Dietetic Association recommends to eat small meals every 3 or 4 hours, drink at
least 8 cups of water per day to avoid dehydration and eat food containing added probiotics
and prebiotics to encourage better gut health.

Some people find that certain foods make their symptoms

worse. If this happens to you, it makes sense to not eat
those foods. But be sure to eat a healthy, varied diet to
keep your weight up and to stay strong.

 Affect of UC on your life

Ulcerative colitis can be hard to live with. During a flare-up,
it may seem like you are always running to the bathroom.
This can be embarrassing. And it can take a toll on how you
feel about yourself. Not knowing when the disease will
strike next can be stressful.

People who have ulcerative colitis for 8 years or longer also

have a greater chance of getting colon cancer. The longer
you have had ulcerative colitis, the greater your risk.

Research has shown that ulcerative colitis may make it more likely that a person will develop
arthritis, eye inflammation, liver diseases, and osteoporosis. Scientists don’t know how or why
colitis influences these other health problems, but they think inflammation triggered by the
immune system may play a role. In some cases, the conditions that occur outside of the large
intestine go away when the colitis is treated.
About 5 percent of people who have ulcerative colitis develop colon cancer, which is a higher
rate than for people without the disease. The risk of colon cancer increases in each decade
after ulcerative colitis is diagnosed. Doctors use colonoscopy to screen people with ulcerative
colitis for colon cancer.

Figure 3 Endoscopic appearance of ulcerative colitis. Extensive ulceration of the mucosa is the
most common endoscopic finding (panel A). The surface is irregular, friable, and erythematous,
with loss of the normal vascular markings. Pseudopolyps may form as a reaction to
inflammation (panel B); these can become quite extensive (panel C).

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Resource:

http://www.us.bestpractice.bmj.com/best-practice/monograph/43.html?locale=no&

https://emedicine.medscape.com/article/183084-overview

https://online.epocrates.com/noFrame/showPage?method=diseases&MonographId=43&Act
iveSectionId=33

https://www.healthline.com/health/ulcerative-colitis-take-control/diet-plan-recipes#1

https://www.crohnsandcolitis.com/ulcerative-colitis/treatment

https://www.everydayhealth.com/colitis/10-key-questions-about-ulcerative-colitis/what-is-
ulcerative-colitis.aspx

https://www.healthline.com/health/can-you-die-from-ulcerative-colitis#outlook

Courtesy of Jonathan Kruskal, MD, PhD. Graphic 70898 Version 2.0


Reproduced from: the Centers for Disease Control and Prevention and Drs. Mae Melvin and E
West. Graphic 66341 Version 2.0

https://www.cedars-sinai.org/health-library/diseases-and-conditions/u/ulcerative-
colitis.html

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