About Ulcerative Colitis

About Ulcerative Colitis

Inflammatory bowel diseases (IBD) are chronic inflammatory diseases of the bowel of which Crohn's disease and ulcerative colitis are the most important.

Ulcerative colitis is characterized by an inflammation of the mucosa, the inner layer of the intestines, which can affect the entire colon. This mucosal inflammation begins in the rectum and can spread to the whole colon. The main symptoms are bloody diarrhea, abdominal pain and weight loss. Patients with ulcerative colitis may also experience discomfort outside of the colon due to the extraintestinal manifestations of the disease (e.g. joint pain, skin problems, liver problems).  Episodes of relapse with acute inflammation and remission alternate. Ulcerative colitis is diagnosed by colonoscopy and histological findings.

The exact cause of this complex disease remains unknown. The most accepted theory is that the cause is multifactorial, involving genetic predisposition, barrier defects of the gut, dysregulated immune responses, and environmental factors. In short, ulcerative colitis is the result of an inappropriate immune system response against the normal intestinal flora in genetically predisposed individuals.

The incidence of ulcerative colitis has increased dramatically in recent years. This increase is evident in developing countries where Western lifestyle begin to have a significant impact. Thus, it is thought that a western lifestyle has an impact on the incidence of IBD.

The goal of treatment is to achieve remission without symptoms and endoscopic activity, and to prevent new flare-ups. Treatments for ulcerative colitis include 5-aminosalicylic acid drugs, steroids, immunosuppressants such as azathioprine and advanced therapies, being biologic therapies (e.g. infliximab, adalimumab, golimumab, vedolizumab, ustekinumab) and small molecules (tofacitinib). Some patients require surgery. This surgery is a colectomy, or the removal of the entire colon with the insertion of a duodenal pouch. Colectomy may be necessary for medication-resistant colitis or to treat neoplasia of the colon.

Outside of this treatment, an active lifestyle and healthy diet with plenty of fruits and vegetables is still recommended.

Many new treatments are currently being tested and treatment options will only increase in the future.