- Ulcerative colitis is a chronic, or long lasting, disease that causes inflammation—irritation or swelling—and sores called ulcers on the inner lining of the large intestine.
- The exact cause of ulcerative colitis is unknown. Researchers believe that factors such as an overactive intestinal immune system, genes, and environment may play a role in causing ulcerative colitis.
- Ulcerative colitis can occur in people of any age. However, it is more likely to develop in people
- between the ages of 15 and 30
- older than 60
- who have a family member with inflammatory bowel disease (IBD)
- of Jewish descent
- The most common signs and symptoms of ulcerative colitis are diarrhea with blood or pus and abdominal discomfort.
- A health care provider diagnoses ulcerative colitis with the following:
- medical and family history
- physical exam
- lab tests
- endoscopies of the large intestine
- Which treatment a person needs depends on the severity of the disease and symptoms.
- Good nutrition is important in the management of ulcerative colitis. A health care provider may recommend that a person make dietary changes.
- People with ulcerative colitis should talk with their health care provider about how often they should get screened for colon cancer.
What is ulcerative colitis?
Ulcerative colitis is a chronic, or long lasting, disease that causes inflammation—irritation or swelling—and sores called ulcers on the inner lining of the large intestine.
Ulcerative colitis is a chronic inflammatory disease of the gastrointestinal (GI) tract, called inflammatory bowel disease (IBD). Crohn's disease and microscopic colitis are the other common IBDs.
Ulcerative colitis most often begins gradually and can become worse over time. Symptoms can be mild to severe. Most people have periods of remission—times when symptoms disappear—that can last for weeks or years. The goal of care is to keep people in remission long term.
Most people with ulcerative colitis receive care from a gastroenterologist, a doctor who specializes in digestive diseases.
What causes ulcerative colitis?
The exact cause of ulcerative colitis is unknown. Researchers believe the following factors may play a role in causing ulcerative colitis:
- overactive intestinal immune system
Overactive intestinal immune system. Scientists believe one cause of ulcerative colitis may be an abnormal immune reaction in the intestine. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. Researchers believe bacteria or viruses can mistakenly trigger the immune system to attack the inner lining of the large intestine. This immune system response causes the inflammation, leading to symptoms.
Genes. Ulcerative colitis sometimes runs in families. Research studies have shown that certain abnormal genes may appear in people with ulcerative colitis. However, researchers have not been able to show a clear link between the abnormal genes and ulcerative colitis.
Environment. Some studies suggest that certain things in the environment may increase the chance of a person getting ulcerative colitis, although the overall chance is low. Nonsteroidal anti-inflammatory drugs,1 antibiotics,1 and oral contraceptives2 may slightly increase the chance of developing ulcerative colitis. A high-fat diet may also slightly increase the chance of getting ulcerative colitis.3
Some people believe eating certain foods, stress, or emotional distress can cause ulcerative colitis. Emotional distress does not seem to cause ulcerative colitis. A few studies suggest that stress may increase a person's chance of having a flare-up of ulcerative colitis. Also, some people may find that certain foods can trigger or worsen symptoms.
Who is more likely to develop ulcerative colitis?
Ulcerative colitis can occur in people of any age. However, it is more likely to develop in people
- between the ages of 15 and 304
- older than 601
- who have a family member with IBD
- of Jewish descent
What are the signs and symptoms of ulcerative colitis?
The most common signs and symptoms of ulcerative colitis are diarrhea with blood or pus and abdominal discomfort. Other signs and symptoms include
- an urgent need to have a bowel movement
- feeling tired
- nausea or loss of appetite
- weight loss
- anemia—a condition in which the body has fewer red blood cells than normal
Less common symptoms include
- joint pain or soreness
- eye irritation
- certain rashes
The symptoms a person experiences can vary depending on the severity of the inflammation and where it occurs in the intestine. When symptoms first appear,
- most people with ulcerative colitis have mild to moderate symptoms
- about 10 percent of people can have severe symptoms, such as frequent, bloody bowel movements; fevers; and severe abdominal cramping1
What are the complications of ulcerative colitis?
Complications of ulcerative colitis can include
- rectal bleeding—when ulcers in the intestinal lining open and bleed. Rectal bleeding can cause anemia, which health care providers can treat with diet changes and iron supplements. People who have a large amount of bleeding in the intestine over a short period of time may require surgery to stop the bleeding. Severe bleeding is a rare complication of ulcerative colitis.
- dehydration and malabsorbtion, which occur when the large intestine is unable to absorb fluids and nutrients because of diarrhea and inflammation. Some people may need IV fluids to replace lost nutrients and fluids.
- changes in bones. Some corticosteroid medications taken to treat ulcerative colitis symptoms can cause
- osteoporosis—the loss of bone
- osteopenia—low bone density
Health care providers will monitor people for bone loss and can recommend calcium and vitamin D supplements and medications to help prevent or slow bone loss.
- inflammation in other areas of the body. The immune system can trigger inflammation in the
Health care providers can treat inflammation by adjusting medications or prescribing new medications.
- megacolon—a serious complication that occurs when inflammation spreads to the deep tissue layers of the large intestine. The large intestine swells and stops working. Megacolon can be a life-threatening complication and most often requires surgery. Megacolon is a rare complication of ulcerative colitis.
Ulcerative Colitis and Colon Cancer
People with ulcerative colitis may be more likely to develop colon cancer when
- ulcerative colitis affects the entire colon
- a person has ulcerative colitis for at least 8 years
- inflammation is ongoing
- people also have primary sclerosing cholangitis, a condition that affects the liver
- a person is male
People who receive ongoing treatment and remain in remission may reduce their chances of developing colon cancer.
People with ulcerative colitis should talk with their health care provider about how often they should get screened for colon cancer. Screening can include colonoscopy with biopsies or a special dye spray called chromoendoscopy.
Health care providers may recommend colonoscopy every 1 to 3 years for people with ulcerative colitis who have
- the disease in one-third or more or of their colon
- had ulcerative colitis for 8 years
Such screening does not reduce a person's chances of developing colon cancer. Instead, screening can help diagnose cancer early and improve chances for recovery.
Surgery to remove the entire colon eliminates the risk of colon cancer.
Reference: The National Institute of Diabetes and Digestive and Kidney Diseases
Last updated February 10, 2017
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