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Ulcerative colitis

Inflammatory bowel disease - ulcerative colitis; IBD - ulcerative colitis; Colitis; Proctitis; Ulcerative proctitis

Ulcerative colitis is a condition in which the lining of the large intestine (colon) and rectum become inflamed. It is a form of inflammatory bowel disease (IBD). Crohn disease is a related condition.

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Ulcerative colitis

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Causes

The cause of ulcerative colitis is unknown. People with this condition have problems with the immune system. However, it is not clear if immune problems cause this illness. Stress and certain foods can trigger symptoms, but they do not cause ulcerative colitis.

Ulcerative colitis may affect any age group. There are peaks at ages 15 to 30 and then again at ages 50 to 70.

The disease begins in the rectal area. It may stay in the rectum or spread to higher areas of the large intestine. However, the disease does not skip areas. It may involve the entire large intestine over time.

Risk factors include a family history of ulcerative colitis or other autoimmune diseases, or Jewish ancestry.

Symptoms

The symptoms can be more or less severe. They may start slowly or suddenly. Half of people only have mild symptoms. Others have more severe attacks that occur more often. Many factors can lead to attacks.

Symptoms may include:

Children's growth may slow.

Other symptoms that may occur with ulcerative colitis include the following:

Exams and Tests

Colonoscopy with biopsy is most often used to diagnose ulcerative colitis. Colonoscopy is also used to screen people with ulcerative colitis for colon cancer.

Other tests that may be done to help diagnose this condition include:

Sometimes, tests of the small intestine are needed to differentiate between ulcerative colitis and Crohn disease, including:

Treatment

The goals of treatment are to:

During a severe episode, you may need to be treated in the hospital for severe attacks. Your doctor may prescribe corticosteroids. You may be given nutrients through a vein (IV line).

DIET AND NUTRITION

Certain types of foods may worsen diarrhea and gas symptoms. This problem may be more severe during times of active disease. Diet suggestions include:

STRESS

You may feel worried, embarrassed, or even sad or depressed about having a bowel accident. Other stressful events in your life, such as moving, or losing a job or a loved one can cause worsening of digestive problems.

Ask your health care provider for tips about how to manage your stress.

MEDICINES

Medicines that may be used to decrease the number of attacks include:

SURGERY

Surgery to remove the colon will cure ulcerative colitis and removes the threat of colon cancer. You may need surgery if you have:

Most of the time, the entire colon, including the rectum, is removed. After surgery, you may have:

Support Groups

Social support can often help with the stress of dealing with illness, and support group members may also have useful tips for finding the best treatment and coping with the condition.

The Crohn's and Colitis Foundation of America (CCFA) has information and links to support groups.

Outlook (Prognosis)

Symptoms are mild in about half of people with ulcerative colitis. More severe symptoms are less likely to respond well to medicines.

Cure is only possible through complete removal of the large intestine.

The risk of colon cancer increases in each decade after ulcerative colitis is diagnosed.

Possible Complications

You have a higher risk for small bowel and colon cancer if you have ulcerative colitis. At some point, your provider will recommend tests to screen for colon cancer.

More severe episodes that recur may cause the walls of the intestines to become thickened, leading to:

Problems absorbing nutrients may lead to:

Less common problems that may occur include:

When to Contact a Medical Professional

Call your provider if:

Prevention

There is no known prevention for this condition.

Related Information

Chronic
Diarrhea - overview
Sepsis
Respiratory
Stress and your health
Cancer
Ankylosing spondylitis
Mouth ulcers
Liver disease
Ileostomy
Total abdominal colectomy
Total proctocolectomy and ileal-anal pouch
Total proctocolectomy with ileostomy
Low-fiber diet
Ulcerative colitis - discharge
Changing your ostomy pouch
Diarrhea - what to ask your health care provider - adult
Ileostomy - what to ask your doctor
Bland diet
Ileostomy and your child
Ileostomy and your diet
Ileostomy - caring for your stoma
Ileostomy - changing your pouch
Types of ileostomy
Ileostomy - discharge
Living with your ileostomy
Large bowel resection - discharge
Total colectomy or proctocolectomy - discharge

References

Bressler B, Marshall JK, Bernstein CN, et al. Clinical practice guidelines for the medical management of nonhospitalized ulcerative colitis: the Toronto consensus. Gastroenterology. 2015;148(5):1035-1058. PMID: 25747596 www.ncbi.nlm.nih.gov/pubmed/25747596.

Kornbluth A, Sachar DB; Practice Parameters Committee of the American College of Gastroenterology. Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 2010;105(3):501-523. PMID: 20068560 www.ncbi.nlm.nih.gov/pubmed/20068560.

Mowat C, Cole A, Windsor A, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011;60(5):571-607. PMID: 21464096 www.ncbi.nlm.nih.gov/pubmed/21464096.

Osterman MT, Lichtenstein GR. Ulcerative colitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 116.

Ross H, Steele SR, Varma M, et al. Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum. 2014;57(1):5-22. PMID: 24316941 www.ncbi.nlm.nih.gov/pubmed/24316941.

Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF. Ulcerative colitis. Lancet. 2017;389(10080):1756-1770. PMID: 27914657 www.ncbi.nlm.nih.gov/pubmed/27914657.

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Review Date: 2/23/2018  

Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria-Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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