What is Ulcerative Colitis?

Ulcerative colitis is an autoimmune disorder for which no cure has been found. Let's see what it is and what options exist today to treat it.

Ulcerative colitis occurs when the lining of the large intestine (colon) becomes inflamed. This inflammation creates ulcers that can sometimes release blood and pus. The condition is a type of inflammatory bowel disease (IBD), as is Crohn’s disease, for example.

Its prevalence in the world is very uneven. Studies in this regard indicate that in Europe, there are 505 cases per 100,000 inhabitants, in Canada 208, and the United States 214. These three regions represent the highest incidence of the disease, thus forming a risk factor for its development. Let’s see everything you should know about it ulcerative colitis: The symptoms, causes, types, and how it’s treated.

The causes of ulcerative colitis

Researchers are still not entirely sure what causes ulcerative colitis. The most widely accepted theory today is that it develops as the result of a combination of environmental, genetic, and immune factors. Let’s look at how these come together for the manifestation of the disease.

Genetic predisposition

Evidence indicates that genetic predisposition plays an important role. More than 60 genes related to inflammatory bowel disease have been identified, with just over 20 being specific for ulcerative colitis. Given that cases have been reported without a direct relative with the condition, experts are unsure what percentage is susceptible to it through this route.

Similarly, just because you have the genes doesn’t guarantee that you’ll develop the disease. Scientists believe that these predispose the patient, but it takes interaction with external catalysts to activate them.

Environmental factors

There are many environmental factors that promote the development of this disorder. Our understanding of these is still in progress, so several may be added over the decades. Those identified so far are the following:

• Smoking: Everything seems to indicate that smoking increases the chances of suffering from this disease. This has been shown by several studies, which indicate that nicotine may be the main factor responsible for the inflammatory process. Smoking can also worsen the course of the disease, so patients are advised to quit during treatment.
• Medication Use: There’s evidence that non-steroidal anti-inflammatory drugs can cause or worsen the condition. Also, studies and research show that antibiotics and birth control pills can have the same effect.
• Geographic Distribution: As we noted at the beginning, ulcerative colitis is more common in certain geographic locations. Although researchers agree that its prevalence is on the rise, the condition remains more common in northern countries.
• Bacterial hypothesis: There’s still much to study in this regard, but some evidence suggests that inflammation may be initiated or at least worsened by bacteria. The most studied are Salmonella, Shigella, and Yersinia.

As far as we know, diet isn’t listed as one of the triggers for ulcerative colitis. Yes, it can make symptoms worse, but based on diet alone, you can’t develop the disease. We emphasize this because it’s one of the most widespread myths surrounding the condition.

Immune disorders

The inflammation of the colon produced by this type of colitis is triggered through an autoimmune process. It’s been documented for a couple of decades that having a disorder of this type increases the chances of developing another in the future.

Therefore, patients who’ve been diagnosed with psoriasis, rheumatoid arthritis, lupus, and other conditions may develop this disease in their lifetime.

In addition to this, the American Gastroenterological Association reminds us that ulcerative colitis is most common between 15 and 30 years of age. After turning 60, an increase in cases occurs again. Being between some of these age ranges, therefore, increases the chances of development.

Types of ulcerative colitis

Although its trigger is the same, ulcerative colitis can manifest itself in different ways. These are generally listed according to the part of the large intestine that’s been affected. Crohn’s and Colitis UK indicates the following types:

• Proctitis: This occurs when the inflammation is concentrated only in the rectum. The rest of the intestine doesn’t present lacerations, so its operation is similar to the typical intestine for the most part. Patients with proctitis often develop tenesmus; that is, the physiological need to defecate when in reality the colon is empty.
• Distal ulcerative colitis: This affects the descending colon and rectum. Those who develop this variant feel pain or pressure on the left side. Tenesmus can also appear on a recurring basis.
• Total pancolitis: When the inflammation affects the entire large intestine, it’s diagnosed with pancolitis, also known as total ulcerative colitis. If the inflammation is uneven, but in several places, then it’s called extensive ulcerative colitis.

The fact that you’ve developed one in the present doesn’t prevent you from manifesting another variant in the future. For example, proctitis often progresses to other types over the years (especially if it’s not treated).

The symptoms of ulcerative colitis

The signs that characterize the disease vary greatly. To this we must add that, like other autoimmune disorders, it usually presents pictures of crises and remissions. Crises, also known as relapses or flare-ups, are the worsening of symptoms. For its part, remission is the absence of these temporarily.

Both situations cannot be predicted, so each patient develops them differently. For example, you can last for years in remission or, on the contrary, experience a dozen relapses over the course of a year. In general, we can classify the signs of the disorder as intestinal and extraintestinal.

Intestinal symptoms

The first symptoms usually develop as manifestations in the intestinal area. They usually appear with a mild intensity, although this increases as the inflammation and ulcers worsen. Among the main intestinal symptoms, we can highlight the following:

• Bloody stools
• And increased frequency and intensity of going to the bathroom
• Pain in the abdominal area
• Diarrhea
• Mucous-like stools
• Increased abdominal noise (borborygmi)

Symptoms vary according to the variant that the patient has developed, so constipation or tenesmus may also occur.

Extraintestinal symptoms

It’s not uncommon for symptoms to extend beyond the intestinal region, a feature that often confuses patients. The Crohn’s and Colitis Foundation points to the following among the main extraintestinal symptoms:

• Fever
• Nausea and vomiting
• Weightloss
• Malnutrition
• Loss of appetite
• Fatigue
• Anemia
• Stunted growth or short stature

The patient may also manifest joint pain, mouth ulcers, skin problems, and eye inflammation.

Diagnosis of ulcerative colitis

There are many alternatives for diagnosing ulcerative colitis. At this point, you should bear in mind that it’s a condition that manifests the same symptoms as others, so wrong diagnoses aren’t uncommon. Therefore, specialists perform various tests before informing the patient of their condition. The most common are the following:

• Endoscopy: This technique isn’t used to detect the inflammation of the colon itself, but to rule out other possible gastrointestinal disorders that may be causing the symptoms.
• Colonoscopy: This is the standard test to detect the signs that the patient suffers from ulcerative colitis. It’s usually accompanied by a biopsy to analyze the tissue of the large intestine in greater detail.
• CT scan: Although less common, a CT scan may also be used if suspicions point in another direction.
• Blood tests: These are done to look for signs of anemia and other deficiencies related to the poor absorption of nutrients. They’re also done to assess the presence of C-reactive protein, a sign of an inflammatory process in the body. It’s not uncommon for specific antibodies to be tested.
• Stool tests: These are of great help to rule out bacterial causes, parasites, or determine some inflammatory markers.

With the help of all of the above, in addition to considering the clinical history and symptoms of the patient, the specialist will be able to diagnose the condition. At the same time, they may make a differential diagnosis it fits. Researchers have identified the following as the most common:

• Crohn’s disease
• Irritable bowel syndrome
• Various types of colitis, such as infectious, ischemic, or pseudomembranous

Other possible explanations are parasitic and viral infections. The actual cause will be determined based on the test results.

Treatment options for ulcerative colitis

This autoimmune disorder is considered to be of chronic evolution. That is, its manifestation is usually long-term and can get worse as it progresses. Therefore, your treatment aims to stop progress, counteract symptoms, and increase remission times. A combination of the following can be used for this:

Pharmacological therapies

These are chosen according to each patient, as the characteristics of the disease vary greatly from one case to the next. Among the most commonly used types of drugs, we can highlight the following:

• Immunosuppressants: These help to counteract autoimmune responses. Azasan (azathioprine) and Purinethol (mercaptopurine) are the most used, although Remicade (infliximab), Humira (adalimumab), Simponi (golimumab), Sandimmune (cyclosporine) and Entyvio (vedolizumab) can also be used.
• Antibiotics: As we’ve already indicated, their use is partially contraindicated, as they can exacerbate the episodes. However, if intestinal tract infection is suspected, amoxicillin, azithromycin, and other medications can be used.
• Anti-inflammatories: These are considered the main therapy for the condition, with corticosteroids and 5-aminosalicylates being those most frequently prescribed.

Diet modifications

Although on its own, diet can’t cause the disease, it’s a fact that worsens the symptoms when the ingestion is very disorderly. The specialist will recommend limiting the consumption of dairy, fat, processed foods, spicy, and recommend vegetables, fruits, legumes, fiber, and white meats.

They may also suggest avoiding heavy dishes, as these can have a stressful impact on the digestion process. To prevent this, it’s best for the patient to eat five or six smaller meals during the day.

It’s also a good idea to keep a record of those food groups that cause problems in order to avoid them, as well as to have the help of a nutritionist so as not to unbalance the intake of nutrients.

Surgery

When a person develops chronic symptoms, perforation has occurred, or the bleeding is recurrent, the specialist will recommend surgery. The evidence indicates that up to 20% of those diagnosed will need it during the course of the disease. This means that 1 in 5 could need it in the future.

There are many types of surgery for this setting, although it usually depends on the area of the colon that’s affected. The professional will discuss the options, the pros and cons, and the lifestyle change you’ll face after undergoing the procedure

Natural treatments

Although they haven’t been carefully reviewed by scientists, some patients report improvement with the help of natural treatments. In no context should these replace the treatment prescribed by your doctor and it’s best to notify the specialist before using them in order to evaluate their effectiveness. Some of the most popular are the following:

• Boswellia
• Turmeric
• Aloe vera
• Probiotics
• Plantago ovata seeds

The patient should approach these options with suspicion and have objective expectations regarding their use. The important thing is that you comprehend that the disease has no cure. Therefore, sticking to what’s prescribed by the specialist is the best option to control it. If you do manifest the symptoms outlined above, don’t hesitate to see your doctor in order to begin the diagnostic process.