Ulcerative colitis is an inflammatory bowel disease (IBD) that causes ongoing inflammation and ulcers (open sores) in the innermost layers of the large intestine (colon) and rectum. The ulcers bleed and produce pus and mucus, and the inflammation causes the colon to empty frequently, causing diarrhea. Ulcerative colitis is similar to Crohn disease, another IBD. Crohn disease can happen anywhere in the digestive tract, often in patches, and can spread deeper into tissues. Ulcerative colitis, on the other hand, is usually confined to the innermost layers of tissue and is uniform throughout the colon. Ulcerative colitis can be painful and have life-threatening complications.
Although ulcerative colitis condition most commonly affects people between the ages of 10 to 20, with a smaller peak at 50 to 80 years of age, infants and children may also develop the disease. Ulcerative colitis occurs 5 times more frequently in those with a Jewish heritage than it does in the general population. There is no cure for ulcerative colitis, but diet and medications can help control the disease.
Signs and Symptoms
The signs and symptoms of ulcerative colitis vary depending on the severity of inflammation, and where it is located. The most common symptoms include abdominal pain and bloody diarrhea, ranging from mild to severe. They may come on either very suddenly or more gradually.
Other common symptoms include:
People with ulcerative colitis are at increased risk for malnutrition. The condition is also associated with other health problems, including arthritis, eye infections, liver disease, skin rashes, blood clots, or gallstones. No one is sure why such problems occur outside the colon. But some researchers think they may be linked to a faulty immune system response.
What Causes It?
No one knows what causes ulcerative colitis. The most likely theory is that it is caused by several factors ranging from genetics, faulty immune system reactions, and environmental influences. For example, some people are genetically at risk for the condition (it runs in their family). Bacteria or a virus may then trigger their immune system, which causes inflammation. Because ulcerative colitis is more common in the developed world, it is possible that a diet high in saturated fat and processed foods contributes to the disease.
Risk factors for ulcerative colitis include:
What to Expect at Your Doctor's Office
Your doctor will do a physical exam and a series of tests to diagnose ulcerative colitis. Blood tests may show anemia (due to a significant loss of blood) and a high white blood cell count (a sign of inflammation somewhere in the body). Stool samples may show whether there is bleeding or infection in the colon or rectum.
The following procedures may also help distinguish between ulcerative colitis, Crohn disease, and other inflammatory conditions.
Colonoscopy and sigmoidoscopy: In a colonoscopy, a doctor uses a long, flexible, lighted tube with a camera to take pictures of the colon. These pictures can reveal inflammation, bleeding, or ulcers along the entire colon wall. Your doctor may also take a biopsy of colon cells to see whether you have ulcerative colitis or Crohn disease. The person is sedated during the procedure. A sigmoidoscopy is similar, but is used to examine the rectum and lower part of your colon. It can be done without sedation, but may miss inflammation higher in the colon or the small intestine.
Barium enema: This test examines the large intestine with an x-ray. You receive barium (a dye) as an enema, which coats the lining of your large intestine and rectum. It is generally not as reliable as colonoscopy and is not used when symptoms are severe because of the risk of complications.
Small intestine x-ray: In this test, you drink a barium "shake" and the doctor takes an x-ray of your small intestine. This test allows doctors to see the small intestine (which cannot be seen with colonoscopy). It can help distinguish between ulcerative colitis and Crohn disease.
There is no known way to prevent ulcerative colitis, but you can usually manage the condition with a combination of medication, diet, and lifestyle changes. A low-fat diet rich in fruits, fluids, magnesium, and vitamin C; exercise; and stress-reduction techniques (including hypnosis) may also help prevent recurrences.
The primary goals in treating ulcerative colitis are to control acute flares of the disease and to maintain remission. The type of treatment often depends on the severity of the disease is. For example, people with mild-to-moderate ulcerative colitis are usually treated with medications that reduce inflammation and suppress the immune system. More severe cases may require surgery.
Many people with inflammatory bowel diseases (IBD) use complementary and alternative remedies along with prescription medication. Preliminary studies indicate that lifestyle changes may be useful additions to treatment, including:
Many people with ulcerative colitis report that stress makes their symptoms worse. Relaxation and stress-reduction techniques can be helpful, particularly when used with other forms of treatment. Some techniques to consider:
Exercise may help people with ulcerative colitis, both in terms of maintaining health and reducing stress. Although exercise is considered safe for those with ulcerative colitis, anyone with a chronic illness should talk to their doctor before starting a new exercise regimen. It is especially important for people with ulcerative colitis to drink water before and during exercise to prevent dehydration.
Although medications cannot cure ulcerative colitis, they can reduce symptoms and help you control your condition. Sometimes, they can bring on remission of the disease for a period of time. Doctors often prescribe the following medications commonly to treat ulcerative colitis:
Aminosalicylates: Anti-inflammatory drugs used to treat mild-to-moderate symptoms. Up to 80% of people respond within 4 weeks to orally-administered aminosalicylates. They include:
Corticosteroids (such as budesonide, prednisone, and prednisolone): These drugs can reduce inflammation throughout your body but have many side effects, including acne, and an increased risk of infection, osteoporosis, high blood pressure, excessive hair growth, diabetes, and disorders of the eye including glaucoma and cataracts. Budesonide (Entocort) may have fewer side effects. Corticosteroids also suppress your body's production of the hormone cortisol and cannot be stopped abruptly. They are not for long-term use, but may be used to control flares.
Immune system suppressors: These medications reduce inflammation by suppressing the immune system. They are sometimes used in combination with steroids to reduce the dose of the steroid medication. These drugs can take several months to work, and all may have significant side effects. Drugs include azathioprine (Imuran), mercaptopurine (Purinethol), and cyclosporine.
Biologics: Infliximab (Remicade) is used to treat moderate-to-severe symptoms. It keeps a protein produced by immune system from causing inflammation in the body. Researchers are testing other drugs in this class, such as adalimumab (Humira).
Nicotine patches: Researchers are not sure why, but nicotine patches seem to help some people find short-term relief during flares, particularly if the person used to be a smoker. The risks of smoking greatly outweigh any potential benefits, so no one who has ulcerative colitis should start smoking.
Antidiarrheal medications (such as diphenoxylate, loperamide, or psyllium): Medications that treat diarrhea must be used only under medical supervision and with extreme caution. They can slow down the normal movements of the gastrointestinal tract and, in severe cases, may cause a complication known as toxic megacolon.
20 to 30% of people with ulcerative colitis must eventually have their colon or colon and rectum removed (colectomy or proctocolectomy) because of massive bleeding, severe illness, rupture of the colon, or the risk of cancer. The surgery often eliminates the disease. To allow for the elimination of waste, the surgeon creates an internal pouch from the small intestine, which empties into the anus. It may result in having 5 to 7 watery bowel movements a day, and up to one-third of people who undergo this procedure develop pouchitis, an inflammation of the pouch that is treated with a short course of antibiotics.
Complementary and Alternative Therapies
Although diet cannot cure ulcerative colitis, some studies suggest that people who eat foods high in saturated fat and sugar, and who eat less amounts of fruits and vegetables, may be at greater risk of developing the disease. Certain foods may also reduce symptoms.
People with significant malnourishment, severe symptoms, or those awaiting surgery may require parenteral (intravenous) nutrition.
Nutrition and Supplements
Many people with ulcerative colitis have vitamin and mineral deficiencies (because of loss of appetite, reduced absorption by the colon, and chronic diarrhea). Some medications may also lower important nutrients in the body. For example, sulfasalazine reduces the body's ability to absorb folate (folic acid), and corticosteroids can reduce calcium levels. Making sure you get enough nutrients is a crucial part of treating ulcerative colitis. Your doctor may recommend taking a multivitamin daily.
Because of the presence of inflammation and the nature of the disease, ulcerative colitis should not be treated with herbs alone. However, herbs may be a useful complement to traditional medical treatment. Herbs can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.
Other evidence for using herbs to treat ulcerative colitis is mostly lacking. Among the herbs that have been used traditionally to treat inflammation within the digestive tract are:
Acupuncture is often used in Traditional Chinese Medicine to treat inflammatory bowel disease. Several studies indicate that it can provide relief from symptoms in ulcerative colitis. It may be especially useful when combined with traditional medical treatment because it can help relieve stress, as well as pain. Acupuncturists treat people with inflammatory bowel disease based on an individualized assessment of the excesses and deficiencies of qi located in various meridians.
Symptoms of ulcerative colitis often become worse during pregnancy. About 50% of women in remission have a recurrence of the disease, usually during the first trimester or during the postpartum period. For this reason, women with ulcerative colitis who are or wish to become pregnant should keep taking medications under the guidance of their doctor. Corticosteroids or sulfasalazine are considered safe during pregnancy. Unlike Crohn disease, pregnant women with ulcerative colitis are not at increased risk for stillbirths or premature deliveries.
Pregnant women should avoid high doses of vitamins. An obstetrician can provide instructions about multivitamin use during pregnancy.
Prognosis and Complications
If left untreated, people with ulcerative colitis can develop a wide range of chronic, sometimes dangerous complications. Fortunately, however, most of these complications can be treated successfully.
Although there is no cure for ulcerative colitis other than surgical removal of the colon, many people with the disease lead active lives by controlling their symptoms with medication. In fact, drug treatment is effective for about 70 to 80% of all people with the condition. About 45% of all people with ulcerative colitis are free of symptoms at any given time, but most have at least one relapse in any 10-year period. People who have ulcerative colitis are at increased risk of developing colon cancer, however this increased risk has decreased steadily over the last 6 decades.
Abela MB. Hypnotherapy for Crohn's disease: a promising complementary/alternative therapy. Int Med. 1999;2(2/3):127-131.
Ammon HP. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006 Oct;72(12):1100-16. Review.
Anton PA. Stress and mind-body impact on the course of inflammatory bowel diseases. Semin Gast Dis. 1999;10(1):14-19.
Ball E. Exercise Guidelines for patients with inflammatory bowel disease. Gastroenterology Nursing. 1998;21(3):108-111.
Belluzzi A, Boschi S, Brignola C, Munarini A, Cariani C, Miglio F. Polyunsaturated fatty acids and inflammatory bowel disease. Am J Clin Nutr. 2000;71(suppl):339S-342S.
Biasco G, Zannoni U, Paganelli GM, et al. Folic acid supplementation and cell kinetics of rectal mucosa in patients with ulcerative colitis. Cancer Epidemiol Biomarkers Prevent. 1997;6:469-471.
Blumenthal M, Goldberg A, Brinckman J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000.
Bope & Kellerman: Conn's Current Therapy 2013. 1st ed. Philadelphia, PA: Elsevier Saunders; 2012.
Castano-Milla C, Chaparro M, Gisbert JP. Systematic review with meta-analysis: the declining risk of colorectal cancer in ulcerative colitis. Aliment Pharmacol Ther. 2014;39(7):645-59.
Cohen AD, Dreiher J, Birkenfeld S. Psoriasis associated with ulcerative colitis and Crohn's disease. J Eur Acad Dermatol Venereol. 2009;23(5):561-565.
Cravo ML, Albuquerque CM, Salazar de Sousa L, et al. Microsatellite instability in non-neoplastic mucosa of patients with ulcerative colitis: effects of folate supplementation. Am J Gastroenterol. 1998;93:2060-2064.
Devlin S, Panaccione R. Evolving Inflammatory Bowel Disease Treatment Paradigms: Top-Down Versus Step-Up. Medical Clinics of North America. 2010;94(1).
Dichi I, Frenhane P, Dichi JB, et al. Comparison of omega-3 fatty acids and sulfasalazine in ulcerative colitis. Nutrition. 2000;16:87-90.
Ewaschuk JB, Tejpar QZ, Soo I, Madsen K, Fedorak RN. The role of antibiotic and probiotic therapies in current and future management of inflammatory bowel disease. Curr Gastroenterol Rep. 2006 Dec;8(6):486-498. Review.
Fernandez-Banares F, Hinojosa J, Sanchez-Lombrana L, et al. Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Am J Gastroenterol. 1999;94:427-433.
Ferri: Ferri's Clinical Advisor 2016. 1st ed. Ulcerative colitis. St. Louis, MO: Elsevier Mosby; 2016.
Geerling BJ, Stockbrugger RW, Brummer RJ. Nutrition and inflammatory bowel disease: an update. Scand J Gastroenterol. 1999;34(suppl 230):95-105.
Gionchetti P, Rizzello F, Venturi A, Campieri M. Probiotics in infective diarrhea and inflammatory bowel diseases. J Gastroenterol Hepatol. 2000;15:489-493.
Goel A, Kunnumakkara AB, Aggarwal BB. Curcumin as "Curecumin": from kitchen to clinic. Biochem Pharmacol. 2008 Feb 15;75(4):787-809.
Gupta I, Parihar A, Malhotra P, et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res. 1997;2:37-43.
Haas L, McClain C, Varilek G. Complementary and alternative medicine and gastrointestinal diseases. Curr Opin Gastroenterol. 2000;16:188-196.
Harris MS, Lichtenstein GR. Review article: delivery and efficacy of topical 5-aminosalicylic acid (mesalazine) therapy in the treatment of ulcerative colitis. Aliment Pharmacol Ther. 2011;33(9):996-1009.
Heilpern D, Szilagyi A. Manipulation of intestinal microbial flora for therapeutic benefit in inflammatory bowel diseases: review of clinical trials of probiotics, pre-biotics and synbiotics. Rev Recent Clin Trials. 2008 Sep;3(3):167-184. Review.
Joachim G. The relationship between habits of food consumption and reported reactions to food in people with inflammatory bowel disease -- testing the limits. Nutr Health. 1999;13(2):69-83.
Joos S, Wildau N, Kohnen R, et al. Acupuncture and moxibustion in the treatment of ulcerative colitis: a randomized controlled study. Scand J Gastroenterol. 2006;41:1056-1063.
Kleigman: Nelson Textbook of Pediatrics. 18th ed. St Louis, MO: Elsevier Saunders; 2007.
Kozuch PL, Hanauer SB. Treatment of inflammatory bowel disease: a review of medical therapy. World J Gastroenterol. 2008 Jan 21;14(3):354-377. Review.
Kruis W, Jonaitis L, Pokrotnieks J, et al. Randomised clinical trial: a comparative dose-finding study of three arms of dual release mesalazine for maintaining remission in ulcerative colitis. Aliment Pharmacol Ther. 2011;33(3):313-322.
Latella G, Sferra R, Vetuschi A, Zanninelli G, D'Angelo A, Catitti V, Caprilli R, Gaudio E. Prevention of colonic fibrosis by Boswellia and Scutellaria extracts in rats with colitis induced by 2,4,5-trinitrobenzene sulphonic acid. Eur J Clin Invest. 2008 Jun;38(6):410-420.
Levenstein S, Prantera C, Varvo V, et al. Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled in remission. Am J Gastroenterol. 2000;95(5):1213-1220.
Lindberg A, Fossum B, Karlen P, Oxelmark L. Experiences of complementary and alternative medicine in patients with inflammatory bowel disease - a qualitative study. BMC Complement Altern Med. 2014;14:407.
Ling SC, Griffiths AM. Nutrition in inflammatory bowel disease. Curr Opin Clin Metab Care. 2000;3(5):339-344.
Marteau PR, de Vrese M, Cellier CJ, Schrezenmeir J. Protection from gastrointestinal diseases with the use of probiotics. Am J Clin Nutr. 2001;73(suppl):430S-436S.
Meister D, Ghosh S. Effect of fish oil enriched enteral diet on inflammatory bowel disease tissues in organ culture: differential effects on ulcerative colitis and Crohn's disease. World J Gastroenterol. 2005 Dec 21;11(47):7466-7472.
Ng SC, Kamm MA. Therapeutic strategies for the management of ulcerative colitis. Inflamm Bowel Dis. 2008 Nov 4. [Epub ahead of print].
Nowacki TM, Bruckner M, Eveslage M, et al. The risk of colorectal cancer in patients with ulcerative colitis. Dig Dis Sci. 2015;60(2):492-501.
Oliva S, Di nardo G, Ferrari F, et al. Randomised clinical trial: the effectiveness of lactobacillus reuteri ATCC 55730 rectal enema in children with active distal ulcerative colitis. Ailment Pharmacol Ther. 2012;35(3):327-334.
Onken JE, Greer PK, Calingaert B, Hale LP. Bromelain treatment decreases secretion of pro-inflammatory cytokines and chemokines by colon biopsies in vitro. Clin Immunol. 2008 Mar;126(3):345-352.
Reif S, Klein I, Lubin F, Farbstein M, Hallak A, Gilat T. Pre-illness dietary factors in inflammatory bowel disease. Gut. 1997;40:754-760.
Rembacken BJ, Snelling AM, Hawkey PM, Chalmers DM, Axon ATR. Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomized trial. Lancet. 1999;354:635-639.
Salaga M, Zatorski H, Sobczak M, Chen C, Fichna J. Chinese herbal medicines in the treatment of IBD and colorectal cancer: a review. Curr Treat Options Oncol. 2014;15(3):405-20.
Salvatore S, Heuschkel R, Tomlin S, et al. A pilot study of N-acetyl glucosamine, a nutritional substrate for glycosaminoglycan synthesis, in pediatric chronic inflammatory bowel disease. Aliment Pharmacol Ther. 2000;14:1567-1579.
Shimizu T, Kitamura T, Suzuki M, Fujii T, Shoji H, Tanaka K, Igarashi J. Effects of alpha-linolenic acid on colonic secretion in rats with experimental colitis. J Gastroenterol. 2007 Feb;42(2):129-34.
Steed H, Macfarlane GT, Macfarlane S. Prebiotics, synbiotics and inflammatory bowel disease. Mol Nutr Food Res. 2008 Aug;52(8):898-905. Review.
Sturniolo GC, Mestriner C, Lecis PE, et al. Altered plasma and mucosal concentrations of trace elements and antioxidants in active ulcerative colitis. Scand J Gastroenterol. 1998;33(6):644-649.
Walsh A, Mabee J, Trivedi K. Inflammatory Bowel Disease. Primary Care: Clinics in Office Practice. Philadelphia, PA: W.B. Saunders Company. 2011;38(3).
Wu HG, Liu HR, Tan LY, Gong YJ, Shi Y, Zhao TP, Yi Y, Yang Y. Electroacupuncture and moxibustion promote neutrophil apoptosis and improve ulcerative colitis in rats. Dig Dis Sci. 2007 Feb;52(2):379-384.
Review Date: 8/6/2015
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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