Ulcerative Colitis

Ulcerative colitis is a less frequent autoimmune inflammation of the large intestine, in some ways similar to the Crohn’s disease. However, both diseases have significant differences. The most crucial difference is the fact that ulcerative colitis affects only the large intestine, while Crohn’s disease can occur in virtually any part of the digestive tract.


As is other autoimmune diseases, even in ulcerative colitis we do not know its real cause. We assume that there is some genetic predisposition, which may start the disease when triggered by any outer factors. The result is an autoimmune inflammation affecting the wall of the large intestine.


We do not know a really efficient prevention, but it is predicted that the risk of the disease is lower in people with sufficient intake of dietary fiber. In addition, it is reported that there is a lower risk of ulcerative colitis in smokers. However, the negative effects of smoking clearly outweigh the positives.


The typical symptoms include frequent diarrhea, often associated with abdominal cramps, abdominal pain, anal pain, pain during defecation and presence of blood and mucus in stool. The patient may suffer even from extraintestinal and general signs such as the weight loss, elevated body temperature, fatigue and joint pain. Patients with ulcerative colitis have a significantly increased risk of primary sclerosing cholangitis.


Chronic inflammation in ulcerative colitis increases the risk of colorectal cancer. In addition, the wall of the intestine may be damaged by the inflammation and narrow or lose peristalsis. Both situations lead to dangerous intestinal obstruction. The most severe cases of ulcerative colitis may cause an urgent condition known as toxic megacolon.


In addition to the patient’s symptoms and clinical examination, the blood tests show elevated sedimentation rate, CRP and white blood cells number. The severity of the disease and the length of affected intestine may be evaluated by colonoscopic examination. The colonoscopy also allows the doctor to take a sample for histological examination. Quite modern examination is measuring a substance known as calprotectin in stool.


The disease is treated with a range of anti-inflammatory drugs; the medications of first choice are drugs containing the substance mesalazine. They may be used as oral tablets, suppositories or even enemas. Serious cases need drugs as corticosteroids (rather long-term) or azathioprine (rather long-term). The most modern from of therapy is the biological treatment specifically targeting the malfunctioning immune system.


Severe complicated cases must be sometimes solved surgically. The operation usually includes removal of a part of the large intestine or even whole large intestine. The operation can have more parts with creation of a temporary colostomy. The patients frequently demand keeping the rectum intact, but it is a little bit risk as the rectum may become a source of colorectal cancer. Therefore, the classic operation includes removal of the large intestine with the rectum and creation of the so-called ileo-anal pouch. When the pouch can not be created, the surgeons may create a permanent ileostomy.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources