Ulcerative colitis
Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD). It is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptoms of active disease are abdominal pain and diarrhea mixed with blood (hematochezia). Weight loss, fever, and anemia may also occur. Often, symptoms come on slowly and can range from mild to severe. Symptoms typically occur intermittently with periods of no symptoms between flares. Complications may include abnormal dilation of the colon (megacolon), inflammation of the eye, joints, or liver, and colon cancer.
| Ulcerative colitis | |
|---|---|
| Endoscopic image of a colon affected by ulcerative colitis. The internal surface of the colon is blotchy and broken in places. Mild-moderate disease. | |
| Specialty | Gastroenterology |
| Symptoms | Abdominal pain, diarrhea mixed with blood, weight loss, fever, anemia, dehydration, loss of appetite, fatigue, sores on the skin, urgency to defecate, inability to defecate despite urgency, rectal pain |
| Complications | Megacolon, inflammation of the eye, joints, or liver, colon cancer |
| Usual onset | 15–30 years or >60 years |
| Duration | Long term |
| Causes | Unknown |
| Diagnostic method | Colonoscopy with tissue biopsies |
| Differential diagnosis | Dysentery, Crohn's disease, ischemic colitis |
| Treatment | Dietary changes, medication, surgery |
| Medication | Sulfasalazine, mesalazine, steroids, immunosuppressants such as azathioprine, biological therapy |
| Frequency | 2–299 per 100,000 |
| Deaths | 47,400 together with Crohn's (2015) |
The cause of UC is unknown. Theories involve immune system dysfunction, genetics, changes in the normal gut bacteria, and environmental factors. Rates tend to be higher in the developed world with some proposing this to be the result of less exposure to intestinal infections, or to a Western diet and lifestyle. The removal of the appendix at an early age may be protective. Diagnosis is typically by colonoscopy with tissue biopsies.
Dietary changes, such as maintaining a high-calorie diet or lactose-free diet, may improve symptoms. Several medications are used to treat symptoms and bring about and maintain remission, including aminosalicylates such as mesalazine or sulfasalazine, steroids, immunosuppressants such as azathioprine, and biologic therapy. Removal of the colon by surgery may be necessary if the disease is severe, does not respond to treatment, or if complications such as colon cancer develop. Removal of the colon and rectum generally cures the condition.