Ulcerative Colitis

Ulcerative colitis is an inflammatory bowel disease (IBD) that affects the innermost lining of the large intestine. It causes inflammation, ulcers, and painful open sores in the digestive tract.

People with ulcerative colitis often experience bloody diarrhoea and cramping. It is a condition that develops slowly over time and is usually diagnosed when the symptoms become too severe.

If left untreated, ulcerative colitis can lead to life-threatening complications.

Ulcerative colitis symptoms can vary from person to person, depending upon the severity of the condition. The symptoms are generally mild when they start and become more severe with time.

Some common symptoms are:

• Urgent bowel movements
• Diarrhoea (with blood or pus)
• Abdominal cramping
• Fatigue
• Anaemia
• Nausea
• Unintentional weight loss
• Rectal pain
• Rectal bleeding
• Fever
• Skin rashes
• Mouth sores
• Eye pain
• Liver disease
• Joint pain

It is not known for certain what exactly causes ulcerative colitis.

While a poor diet and stress may aggravate already existing colitis, they don’t cause it in the first place. Immune system malfunction could be one possible cause, and heredity may also play a role.

Doctors generally classify ulcerative colitis according to the areas affected. The symptoms of different types of the disease tend to overlap.

Here are the common types of ulcerative colitis:

• Ulcerative proctitis

In this type of disease, bowel inflammation happens only in the area closest to the anus (also called the rectum). Symptoms may include rectal pain, rectal bleeding, and urgency to defecate.

• Proctosigmoiditis

When bowel inflammation affects the rectum and the lower end of the colon – the sigmoid colon – it is known as proctosigmoiditis. Patients who suffer from this type are likely to experience diarrhoea with blood or pus, abdominal pain, and a constipated sensation.

• Left-sided colitis

In left-sided colitis, bowel inflammation extends to several parts, from the rectum to the descending portions of the colon. Those with this condition experience pain on the left side, an urgency to defecate, and diarrhoea with pus or blood.

• Pancolitis

Pancolitis affects the entire colon. It causes severe bloody diarrhoea, intense abdominal pain, significant weight loss, and fatigue.

Ulcerative colitis shares many symptoms with other common diseases. So, an extensive set of tests is required to diagnose the disease properly. These tests may include:

• Blood tests

Our doctors may recommend certain blood tests to check for anaemia, signs of infection, or inflammation.

• Stool tests

The presence of certain proteins or white blood cells in the patient’s stool can indicate ulcerative colitis. Stool tests also help us rule out infections caused by parasites, bacteria, and viruses.

• Colonoscopy 

A colonoscopy enables us to view the patient’s entire colon using a colonoscope. If ulcerative colitis is suspected, tissue samples are taken for laboratory analysis. A tissue biopsy is necessary to make the diagnosis.

• Flexible sigmoidoscopy

In this procedure, we use a thin, flexible tube called the sigmoidoscopy to examine the sigmoid colon and rectum. This test is preferred in severe cases where the patient’s colon is badly inflamed, and a full colonoscopy is not possible.

• X-ray

If patients present with severe symptoms associated with ulcerative colitis, we may use a standard X-ray of the abdominal area to examine them. X-ray procedures help rule out ulcerative colitis symptoms like a megacolon or a perforated colon.

• CT scan

We may recommend a CT scan of the patient’s abdomen if we suspect a complication from ulcerative colitis. CT scans are also helpful in determining the extent of bowel inflammation.

• Computerized tomography (CT) enterorrhaphy and magnetic resonance (MR) enterorrhaphy

We may perform these non-invasive procedures to rule out any inflammation in the small intestine. These tests are highly sensitive and can detect bowel inflammation with more precision than conventional imaging tests.

There is no cure for ulcerative colitis currently. However, with proper medical care from an experienced doctor, the disease can be managed effectively so that patients can live a normal, fulfilling life.

The following forms of ulcerative colitis treatment are usually prescribed:

• Aminosalicylates

Aminosalicylates are medicines used to treat gut inflammation. Patients with mild to moderate ulcerative colitis may be prescribed sulfasalazine.

Those allergic to sulfa may be given a sulfa-free aminosalicylate instead. These medicines can be administered orally or in the form of an enema.

• Corticosteroids

People with more severe forms of ulcerative colitis may be given corticosteroids, such as prednisone or budesonide. However, corticosteroids have serious side effects and are used only for short-term treatment. 

• Immunomodulators

Immunomodulators are drugs used to stimulate or suppress the immune response in the body. They calm the overactive immune system and are sometimes used to treat ulcerative colitis.

Immunomodulators include 6-mercaptopurine, azathioprine, and methotrexate.

• Biologics

These medicines target proteins the immune system uses to stimulate inflammation and help calm it down.

Biologics are usually used to treat moderate to severe cases of ulcerative colitis. These include medicines like infliximab, adalimumab, golimumab certolizumab pegol and ustekinumab.

• Janus kinase (JAK) inhibitors

These medicines contain active substances that inhibit the action of enzymes known as Janus kinases, which trigger inflammation. The drug tofacitinib belongs to this category. 

• Surgery

In case of extremely severe ulcerative colitis, we may recommend a procedure called proctocolectomy. This surgery involves the removal of the entire colon and rectum. This is an invasive surgical procedure and is recommended only in extreme cases. 

• Cancer surveillance

If ulcerative colitis is present only in the rectum, it doesn’t affect the patient’s cancer risk. However, if bowel inflammation is found in the colon as well, then one faces a higher risk of colon cancer.

Therefore, if the disease involves more than the rectum, we recommend getting a surveillance colonoscopy every one to two years. 

There are no known methods to prevent the occurrence of ulcerative colitis. However, taking these steps can help manage symptoms in those already diagnosed with the disease:

• Avoiding high-fibre foods like nuts, vegetable skins, and popcorn.
• Avoiding carbonated drinks and alcohol.
• Drinking more fluids.
• Eating smaller, more frequent meals.

The thought of living with ulcerative colitis can be intimidating since it has no known cure. However, patients can manage the disease very well with the support of experienced specialists who are equipped to provide them with the cutting-edge treatment they require.

With proper treatment, ulcerative colitis can even go into remission, allowing patients to live life the way they want.

At the CK Birla Hospital, we are committed to providing patients with customized treatment plans tailored to cater to their unique medical needs. Book an appointment with Dr. Anukalp Prakash to avail of the best treatment for different types of ulcerative colitis.