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BCM - Baylor College of Medicine

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Inflammatory Bowel Disease Center

Ulcerative Colitis

Ulcerative colitis is a chronic inflammatory disease of the digestive system. Both Crohn's disease and ulcerative colitis are referred to as inflammatory bowel disease (IBD), not to be mistaken for irritable bowel syndrome (IBS), a different disease of the digestive system. Unlike Crohn's disease, ulcerative colitis is primarily limited to the colon (large intestine). There are several ways to diagnose ulcerative colitis, usually requiring at least a colonoscopy. See Diagnostic Testing for Inflammatory Bowel Disease for more details.

For more information see: Inflammatory Bowel Disease.

What causes ulcerative colitis?

Unfortunately the cause of ulcerative colitis is unknown, although both genetic and the environmental causes have been proposed.

Most patients with ulcerative colitis do not have anyone else in the family with ulcerative colitis. However up to 20 percent of patients with ulcerative colitis have at least one relative with either ulcerative colitis or Crohn's disease. The genes involved in ulcerative colitis are not as well understood as in Crohn's disease, and there are no commercially available genetic tests we currently recommend for the diagnosis of ulcerative colitis.

The increase in ulcerative colitis in some populations around the world has led some researchers to believe there may be environmental causes for ulcerative colitis. Infections and diet are among other potential environmental causes for ulcerative colitis; however there is not enough information in this field to make any firm conclusions. There is still much to learn in these areas and research is ongoing to determine the cause of ulcerative colitis. 

What are the symptoms of ulcerative colitis?

Although the cause of ulcerative colitis is unknown, the effects of ulcerative colitis on the body are becoming better understood. In ulcerative colitis, the body's own immune system is overactive and results in inflammation in the colon. This may be a response to the bacteria normally found in the colon, or "gut flora." The persistent inflammation results in the damage and ultimately the symptoms of ulcerative colitis. Most medications for ulcerative colitis work by decreasing or "turning down," the immune system to reduce the inflammation and damage in the colon. More recent medications target very specific molecules to decrease inflammation. There is currently one medication FDA approved to target a molecule called tumor necrosis factor to treat ulcerative colitis. For more information on the medications for ulcerative colitis, see Medications.

The most common symptoms of ulcerative colitis relate to inflammation in the colon, such as diarrhea, bloody stools, and abdominal pain. These symptoms may also be seen in other medical conditions and are not diagnostic of ulcerative colitis. Most patients can have at least partial if not complete relief of these symptoms with medications, which we call "remission." However patients may have symptoms return periodically, or "flare," over time even if they are taking their medications. 

What are the complications of ulcerative colitis?

Colon Cancer. Although most patients with ulcerative colitis will not develop colon cancer, patients with ulcerative colitis are at a 2 to 5 fold increased risk of developing colon cancer compared to persons without ulcerative colitis. Researchers believe the increased risk of colon cancer is related to chronic inflammation in the colon. In order to detect colon cancer at an early stage, most patients with ulcerative colitis will need to undergo colonoscopies on a regular interval that is more frequent than for patients without ulcerative colitis. The risk of colon cancer may be even higher in individuals who have a condition of the liver called primary sclerosing cholangitis (PSC) or with family members who have had colon cancer. All patients with ulcerative colitis should discuss the timing and frequency of colonoscopy with their gastroenterologist.

Surgery. Most patients with ulcerative colitis will not require surgery. However, some patients may not respond to medications or have other severe symptoms that require removal of the colon. Removal of the colon is the closest thing to a "cure" for ulcerative colitis because unlike Crohn's disease, ulcerative colitis does not affect other parts of the digestive system and should not recur after complete removal of the colon. After removal of the colon, patients may require either an ostomy (bag), or reconstructive surgery, referred to as a "J-pouch" or ileal pouch-anal anastomosis (IPAA). The choice of these options is between the patient and the surgeon as each option has its' advantages and disadvantages.

Patients with ulcerative colitis may have symptoms in parts of their body outside of the digestive system.

Joints. There are forms of arthritis and back pain that are related to ulcerative colitis. Some of these conditions improve with medications for the digestive symptoms of ulcerative colitis. The use of over-the-counter pain medications such as ibuprofen, naproxen, and aspirin may increase the symptoms of ulcerative colitis. Patients with ulcerative colitis should speak with their gastroenterologist before using these medications.

Eyes. Some patients with ulcerative colitis develop inflammation in the eyes, called iritis or uveitis. Iritis may results in redness or eye pain and may fluctuate with the severity of the digestive symptoms of ulcerative colitis. Uveitis may results in severe eye pain and loss of vision. Patients with ulcerative colitis should see an eye doctor on a regular basis and report any changes in their vision to their doctor immediately.

Skin. There are two conditions related with ulcerative colitis, erythema nodosum and pyoderma gangrenosum. Erythema nodosum consists of painful red bumps under the skin that may develop when the ulcerative colitis flares; these lesions will often respond to the medication for ulcerative colitis. Pyoderma gangrenosum consists of skin ulcers that may form either with or without a flare of ulcerative colitis digestive symptoms.

Other Complications. Other complications of ulcerative colitis disease include kidney stones, a liver condition called primary sclerosing cholangitis (PSC), and malabsorption of vitamins and nutrients. 

What is life like with ulcerative colitis?

The only cure for ulcerative colitis is complete surgical removal of the colon. However, most patients will not require surgery to have their symptoms under control, and some patients may have complications after the surgery such as pouchitis. Whether they require surgery or not, our goal is to allow our patients to live a full and productive life with ulcerative colitis. Most patients will require medications for an indefinite period of time. Research has shown that patients with ulcerative colitis who do not take their medication, even if they are feeling well, are more likely to have a return of their symptoms compared to patients who continue their medications. It is very important that patients discuss with their doctor if they are considering stopping their medications.

It is important for patients with ulcerative colitis, even if they are feeling well, maintain regular visits with their physician. For example:

  • Patients on medications may need routine blood work to monitor for side effects.
  • Patients with ulcerative colitis should keep up to date on immunizations including influenza (flu), pneumococcal (pneumonia), human papilloma virus (HPV), and hepatitis A and B.
  • Some patients with ulcerative colitis, particularly those who have had been exposed to steroids (prednisone), may need to have bone mineral density tests to screen for early osteoporosis.
  • Patients with ulcerative colitis will need to have colonoscopies to screen for colon cancer.