Lloydspharmacy.com Health - Ulcerative colitis

Reviewed by Dr Dan Rutherford, GP

What is ulcerative colitis?

Ulcerative colitis is a superficial inflammation of the large intestine, not caused by bacteria, which results in ulceration and bleeding.

The patient typically experiences alternating periods with no or few symptoms, and periods with frequent stomach pains and diarrhoea that is mixed with pus, blood, and mucus.

What causes ulcerative colitis?

The exact cause of ulcerative colitis is unknown. Hereditary, infectious and immunological factors have been proposed as possible causes.

What are the symptoms of ulcerative colitis?

The symptoms of ulcerative colitis can vary considerably.
The disease is characterised by periods with diarrhoea, mixed with pus, blood, and mucus, which alternate with periods of few or no symptoms.
When the colitis is active, the patient often has mild stomach pains, and sometimes a fever.
The symptoms vary according to the extent of the disease. A quarter of patients only have the disease in the rectum, which means that the symptoms are fairly mild. In one third of patients, the disease also affects the lower part of the large intestine. In the remaining patients, ulcerative colitis affects all of the large intestine.

How can ulcerative colitis be prevented?

Flare-ups cannot be prevented, but the severity and extent of the attacks can be reduced. It is important that affected people follow preventive treatments carefully, watch out for symptoms, and consult their doctor if there is blood in their stool.

How is ulcerative colitis diagnosed?

Stool specimens are collected for cultivation and microscopy to exclude infection caused by bacteria and parasites.
The diagnosis is confirmed by means of an endoscopy in the large intestine and the rectum. Small tissue samples from the mucosa are usually obtained during the procedure, which can in many cases confirm the diagnosis.
An endoscopic examination of the entire intestine (colonoscopy), or a barium enema X-ray examination can help determine the extent of the disease.
Blood samples can help determine the severity of the inflammation, and show whether the patient suffers from anaemia (low haemoglobin count).

Activity

Severe, acute flare-ups may confine the patient to bed. When the symptoms subside, the patient should be able to resume their normal activities.

Diet

There are no dietary restrictions because changes in diet have no effect on ulcerative colitis.

What are the complications of ulcerative colitis?

In rare cases, life-threatening bleeding, perforation of the intestine, and inflammation of the abdominal cavity may occur.
Malnutrition.
Inflammation of joints, eyes, and skin.
The risk of colon cancer and rectal cancer begins to rise after 10 years of ulcerative colitis.

How is ulcerative colitis treated?

When the disease is active, it is often treated with tablets. When the disease is in remission, the treatment often continues in order to suppress the inflammation.
Medical treatment is usually sufficient.
If the disease cannot be controlled by medical treatment, it can be cured by surgical removal of the large intestine.
Severe cases may require hospitalisation.

Which medicines can be used?

Corticosteroids to reduce inflammation. Enemas and suppositories are used for mild to moderate symptoms in the rectum. Tablets are used for moderate to severe symptoms and more extensive disease. Hospital admission and injections of corticosteorids are required for very severe symptoms and extensive disease.
Aminosalicylates, as tablets, enemas or suppositories. These are anti-inflammatory medicines for the treatment of mild to moderate symptoms. They can also be used continuously to prevent attacks.
Immunosuppressants, such as azathioprine (eg Imuran) are used for very severe symptoms that cannot be controlled by corticosteroids (unlicensed indication).

Future prospects

The disease can often be controlled by medical treatment. Surgical treatment may become necessary. In these cases, the disease is cured by a removal of some or all of the large intestine.

Based on a text by Dr Jens Kjelsen and Dr Ove Schaffalitzky de Muckadell, professor of internal medicine

Last updated 01.04.2005