Inflammatory bowel disease - ulcerative colitis; IBD - ulcerative colitis
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.
Mount Sinai has a unique and rich tradition of specialized and individualized treatment and scientific research and discovery in ulcerative colitis. The physicians/scientists in the Mount Sinai Health System are constantly conducting clinical trials and are developing new drug therapies to help patients manage their disease. To learn more please click here.
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 can begin in the rectal area. It may involve the entire large intestine over time. It may also start in the rectum and other parts of the large intestine at the same time.
Risk factors include a family history of ulcerative colitis or other autoimmune diseases, or Jewish ancestry.
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:
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:
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:
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 on your to manage your stress.
Medicines that may be used to decrease the number of attacks include:
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:
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.
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.
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:
Call your provider if:
There is no known prevention for this condition.
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
D'Haens GR, Panaccione R, Higgins PD, et al. The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn's and Colitis Organization: when to start, when to stop, which drug to choose, and how to predict response? Am J Gastroenterol. 2011;106(2):199-212. PMID: 21045814
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
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
Osterman MT, Lichtenstein GR. Ulcerative colitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & 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
Last reviewed on: 8/14/2015
Reviewed by: Subodh K. Lal, MD, gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.