Ulcerative Colitis: Symptoms, Diagnosis, and Treatment

Ulcerative colitis (UC) falls under the umbrella of inflammatory bowel diseases (IBD), which comprise a group of disorders affecting the gastrointestinal (GI) tract. UC specifically targets the large intestine (colon) and rectum, resulting in inflammation and the formation of ulcers on the colon’s lining. This comprehensive guide will explore the symptoms, diagnosis, and treatment options for UC.

UC’s onset varies, with most individuals experiencing symptoms between the ages of 15 and 30, although a small uptick in diagnoses occurs after the age of 50, predominantly in men. The disease’s severity fluctuates, encompassing periods of remission, where symptoms abate or disappear, and flare-ups, characterized by intensified symptoms.

Recognizing UC Symptoms

UC manifests differently among individuals, ranging from mild to severe symptoms. Common symptoms include abdominal pain, increased abdominal sounds, bloody stools, diarrhea, fever, rectal pain, weight loss, and malnutrition. Additional symptoms may emerge, such as joint pain, joint swelling, nausea, decreased appetite, skin problems, mouth sores, and eye inflammation.

Researchers attribute UC to an overactive immune system, although the precise trigger remains unclear. Factors contributing to UC development encompass genetic predisposition, other immune disorders, and environmental factors such as bacteria, viruses, and antigens.

Classifying UC Types

UC’s classification depends on the parts of the GI tract it affects:

1. Ulcerative Proctitis: In this mild form of UC, only the rectum undergoes inflammation.
2. Left-sided Colitis: This variant inflames the area between the splenic flexure (near the upper colon) and the distal colon (including the descending and sigmoid colon).
3. Proctosigmoiditis: A subtype of left-sided colitis, proctosigmoiditis targets the rectum and sigmoid colon.
4. Extensive Colitis: Also known as pancolitis, this severe form of UC induces inflammation throughout the entire colon.

Diagnosing Ulcerative Colitis

Diagnosing UC entails a series of tests to differentiate it from similar GI conditions like Crohn’s disease:

1. Blood tests: These assess anemia indicators and inflammation markers.
2. Stool test: Examines stool for inflammatory markers, blood, bacteria, and parasites.
3. CT scan: Provides a detailed X-ray of the abdomen and pelvis.
4. Endoscopy: A flexible tube inspects the stomach, esophagus, and small intestine.
5. Biopsy: Tissue samples from the colon are analyzed.
6. Flexible sigmoidoscopy: This variant of endoscopy examines the rectum, sigmoid colon, and part of the descending colon.
7. Colonoscopy: A colonoscope explores the colon’s interior, crucial for both diagnosis and monitoring.

Treatment Approaches

UC treatment aims to alleviate inflammation, manage symptoms, and extend remission periods. Medications vary based on symptom severity:

• Mild Symptoms: Medications like 5-aminosalicylates (5-ASA drugs) such as mesalamine, sulfasalazine, balsalazide, or olsalazine reduce inflammation and swelling.
• Moderate to Severe Symptoms: Biologics (e.g., adalimumab, golimumab, infliximab, tofacitinib, ustekinumab, vedolizumab) made from antibodies block inflammation. Corticosteroids and antibiotics may be necessary if infection occurs.
• Immunomodulators: Changing immune system function, though not recommended as standalone treatments.
• Recent Advancements: Tofacitinib (Xeljanz) is an oral medication approved by the FDA for long-term UC treatment.

Hospitalization for Severe Symptoms

Severe UC necessitates hospitalization to address dehydration, electrolyte loss, and potential complications. Researchers continually explore novel treatments for UC.

Surgery for UC

Surgery becomes imperative for substantial blood loss, chronic and debilitating symptoms, colon perforation, or severe blockage. Different procedures involve removing portions of the colon, sometimes the entire colon and rectum. Surgical interventions range from total colectomy with an external pouch for waste elimination to partial colectomy.

Exploring Natural Remedies

Some individuals with UC explore natural remedies when traditional treatments are unsuitable. These remedies include Boswellia, bromelain, probiotics, psyllium, and turmeric. However, these alternatives have not undergone clinical trials and may not be endorsed by professional organizations.

Crafting a UC-Friendly Diet

While no specific diet suits everyone with UC, some general dietary principles can help manage symptoms:

1. Low-Fat Diet: Reducing high-fat foods can alleviate diarrhea.
2. Vitamin C Intake: Foods rich in vitamin C may support intestinal healing.
3. Fiber Regulation: During remission, fiber may aid regular bowel movements.
4. Food Diary: Tracking your diet can help identify trigger foods and manage mild symptoms.

Frequently Asked Questions (FAQs)

• UC vs. Crohn’s Disease: Both are common IBD forms with shared symptoms, but they affect different GI tract segments and respond differently to treatment. Crohn’s can occur anywhere from the mouth to the anus, while UC is limited to the colon and rectum. Surgery can cure UC but offers temporary relief for Crohn’s.
• UC vs. Colitis: Colitis generally refers to colon lining inflammation, potentially due to various causes, including UC. Diagnosis depends on test results and symptoms.
• UC Curability: There is no nonsurgical cure for UC; treatments aim to manage symptoms and extend remission periods. Surgery can provide relief for severe cases but carries risks.

In summary, UC is a complex IBD with diverse symptoms, diagnostic tests, and treatment options. Consult a healthcare professional to create an individualized plan that manages your UC effectively.