Ulcerative Colitis

What is Ulcerative Colitis?

Ulcerative Colitis and Crohn’s disease are under the category of chronic inflammatory bowel disease (IBD).

Ulcerative Colitis involves the lining of the large bowel (colon) and rectum.

The severity of Ulcerative Colitis can range from mild to severe; the pattern for any individual can range from remission (no symptoms) to flares.

What Causes Ulcerative Colitis?

Ulcerative Colitis is an immune disorder. There are various influences such as genetic susceptibility, infectious agents, and triggers in the diet and environment. However, all the factors that trigger abnormal immune function are not completely known. It is more likely that a combination of factors is involved and that these factors are not necessarily the same for all individuals.

How is Ulcerative Colitis Diagnosed?

The colon inflammation does not “skip” in Ulcerative Colitis as it can in Crohn’s disease. Ulcerative Colitis involves the rectum, but the extension of the disease is continuous (not skip) as it involves the colon higher up. The length of colon involvement differs for each person. The severity of diarrhea and bleeding tends to correlate with the amount of colon inflamed.

Ulcerative Colitis inflammation involves mainly the surface lining of the colon and rectum (and not through all the layers of the bowel wall), so complications that are seen in Crohn’s are less likely (strictures, fistulas, abscesses).

On the other hand, symptoms may not correlate well with what is actually going on in the gastrointestinal (GI) tract. Diarrhea symptoms may or may not be active Ulcerative Colitis (for example, diarrhea may be seen in infections, irritable bowel syndrome, medication side effects, etc.). Sometimes a patient may have minimal to no symptoms but have active Ulcerative Colitis, which may progress to complications if not treated.

Furthermore, approximately 1/4 to 1/3 of patients can have symptoms outside the GI tract, such as joint pains, joint swelling, inflammation of the eye, mouth sores, skin rashes, blood clots, bone loss, liver inflammation, bile duct inflammation, and strictures.

Testing includes colonoscopy (to look at the lining of the colon for inflammation and to take biopsies), radiographic imaging (such as CT scan or MRI), standard blood tests (blood count, nutritional, inflammatory tests), specialty IBD blood tests, and stool studies (inflammation and to rule out infection).

Although not one of these tests diagnoses Ulcerative Colitis, the pattern of findings can support the diagnosis.

What is the Management For Ulcerative Colitis?

NSAIDs (non-steroidal anti-inflammatory drugs such as ibuprofen) could potentially worsen the inflammation and should be avoided.

Good nutrition, healthy lifestyles, and keeping up with immunizations are beneficial.

There are studies to see if there are specific anti-inflammatory types of diets or anti-oxidant supplements that may help the condition, but diets and supplements won’t cure Ulcerative Colitis.

Although there is no cure for Ulcerative Colitis, there are many treatment options.

Treating Ulcerative Colitis early leads to better long-term outcomes and decreases the need for removing the colon. However, due to the different ways Ulcerative Colitis can affect an individual, the gastroenterologist will help determine specific treatments tailored to each patient.

Medications to slow down diarrhea (although won’t help with the inflammation):

• Imodium
• Cholestyramine
• Colestipol
• Dicyclomine
• Hyoscyamine

Medications to help with inflammation:

• Antibiotics (metronidazole, ciprofloxacin)
• Corticosteroids (prednisone, budesonide)
• 5-aminosalicylic acids (sulfasalazine, Pentasa, Asacol, Lialda, Apriso)
• Immunomodulators (mercaptopurine, azathioprine, methotrexate), including the newest agent Zeposia (ozanimod)
• Biologics such as Remicade (infliximab), Humira (adalimumab), Cimzia (certolizumab), Entyvio (vedolizumab), Stelara (ustekinumab)
• Small molecules such as Xeljanz (tofacitinib)

There is ongoing research on other medications (more information can be found on the Gastroenterology Associates website in the Research Department)

The surgical approach may be considered curative in Ulcerative Colitis which is different from Crohn’s disease.

Ulcerative Colitis that does not respond to medications or if precancerous lesions or cancer have been discovered, removing the entire colon and rectum (proctocolectomy) is generally the next step. Either an external ostomy is created (small bowel empties into an opening in the abdominal wall and into a bag), or the small bowel is connected to the anal sphincter by creating an internal pouch (IPAA: ileal pouch-anal anastomosis). The patient’s medical condition and preference, as well as the available local surgical expertise, help determine the choice.

What should I Do If I Am Planning to Get Pregnant and/or Breastfeeding?

The first goal is to make sure the Ulcerative Colitis is in remission or as close to remission as possible since this improves pregnancy outcomes.

Some medications ideally should be stopped several months before pregnancy, and there are some that may be continued through pregnancy, so informing the gastroenterologist of plans for pregnancy is important. There may be instructions to avoid certain medications during pregnancy to decrease the infant’s infection risk after birth, as well as the infant’s type of immunizations allowed after certain biologics.

However, stopping medications without consulting the gastroenterologist can be harmful since active IBD increases pregnancy complications.

Finally, there are guidelines regarding which medications may be continued during lactation.

What are pouch problems after surgery?

For patients who had had IPAA surgery, inflammation of the pouch may occur (pouchitis). Presentation includes rectal bleeding, abdominal pain, diarrhea, fevers. Your gastroenterologist will evaluate for different causes for pouch disease. Treatment depends on the cause and may include antibiotics.

What is the Long-Term Outcome For Ulcerative Colitis?

Long-term complications may include infections, nutritional problems, and cancer.

Colorectal cancer risk is greatest in the person with pancolitis (entire colon involved), but even patients with left-sided colitis are at increased risk. Patients should be enrolled in a colonoscopy screening program to monitor for precancerous changes.

The goal for treatment is to achieve as normal a quality of life and functional status as possible. This is achievable for many patients and even more so given the different medications that have been FDA approved since Remicade was approved in 2005 for Ulcerative Colitis.

Ulcerative Colitis patients should have regular clinical, blood, and endoscopy monitoring by a gastroenterologist. Even if the patient is not on medications, monitoring for active disease is important.

Preventative health measures include recommendations of vaccinations and monitoring for osteoporosis skin cancers.

All our physicians evaluate and manage patients with Ulcerative Colitis. If you would like to schedule a consultation visit or have questions about potential IBD research studies, please call our office at 864-232-7338.