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In this section you can find out more information regarding Ulcerative Colitis (UC)

Ulcerative colitis (UC) is a condition that causes inflammation and ulceration of the inner lining of the colon and rectum (the large bowel).

The inflammation usually begins in the rectum and lower colon, but it may affect the entire colon.

UC affects people of all ages. It is most often diagnosed in people from 15 to 25 years of age. The main symptoms of UC are recurring diarrhoea (which may contain blood, mucus or pus), pain in the abdomen, emptying bowels more frequently.

In the UK, 570 in every 100,000 people have been diagnosed with UC – this is equivalent to >380,000 cases in the UK.

What is Ulcerative Colitis (UC)?

References
1. Crohn's and Colitis UK. Ulcerative Colitis Your Guide Edition 9d. Available at http://s3-eu-west-1.amazonaws.com/files.crohnsandcolitis.org.uk/Publications/ulcerative-colitis.pdf Accessed October 2022
2. Armando Hasudungan. Inflammatory Bowel Disease. Available at https://armandoh.org/disease/inflammatory-bowel-disease/ Accessed October 2022
3. NHS. Ulcerative Colitis - Overview. Available at https://www.nhs.uk/conditions/ulcerative-colitis/ Accessed October 2022
4. Crohn's and Colitis Care in the UK - The Hidden Cost and a Vision for Change. April 2021
5. King D, et al. Aliment Pharmacol Ther. 2020;51(10):922-934

Causes

The exact cause of UC disease is unknown. It's thought several things could play a role.

In a person with UC, there is a problem with the immune system (the body's defence against infection). The body attacks the colon causing inflammation.

Although a specific diet is not thought to play a role in causing UC, some diet changes can help control the condition.

Risk Factors

Factors that may increase the risk of UC include:

Genetics

UC disease tends to run in families.

Age

UC usually begins before the age of 30. But it can occur at any age, and some people may not develop the disease until after age 60.

Race or ethnicity

UC can occur in any race. However white people of European descent are at highest risk of UC, especially people of Ashkenazi Jewish descent. The condition is rarer in people from Asian backgrounds, although the reasons for this are unclear.

References
1. NHS. Ulcerative Colitis - Causes. Available at https://www.nhs.uk/conditions/ulcerative-colitis/causes/ Accessed October 2022
2. Mayo Clinic. Ulcerative Colitis. Available at https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-20353326 Accessed October 2022

Signs and symptoms of UC can range from mild to severe. They usually develop gradually over time but can come and go.

A flare-up is when symptoms come back - the symptoms will vary from person to person and symptoms are often elsewhere in the body.

The main symptoms of UC are:

  • Diarrhoea (which may contain blood, mucus or pus)
  • Pain in the abdomen
  • Emptying bowels more frequently
  • Extreme tiredness (fatigue)
  • Loss of appetite
  • Weight loss
  • Fever

Some people with UC also experience symptoms outside the gut during a flare-up such as:

  • Joint pain and swelling
  • Skin rashes
  • Mouth ulcers
  • Swelling in the eyes

In severe cases (defined as having to empty bowels 6 or more times a day), additional symptoms may include:

  • Shortness of breath
  • A fast or irregular heartbeat
  • Blood in stools becoming more obvious

What are the symptoms of UC? 1

What are the symptoms of UC? 2

References
1. NHS. Ulcerative Colitis - Overview. Available at https://www.nhs.uk/conditions/ulcerative-colitis/ Accessed October 2022
2. Mayo Clinic. Ulcerative Colitis. Available at https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-20353326 Accessed October 2022

A diagnosis of UC can be confirmed by examining the level and extent of bowel inflammation. This is done by taking a biopsy (to test the tissue in the bowel). Other types of tests can help rule out complications or other forms of inflammatory bowel disease, such as Crohn's disease.

A diagnosis of UC is made by a doctor assessing symptoms experienced, an examination, procedures, scans and blood tests. If UC is suspected, a referral to a specialist (gastroenterologist) is made.

Blood Tests

  • Complete blood count (CBC) to detect infection and anaemia and Inflammation markers such as Creactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR). At present, Crohn’s disease and ulcerative colitis cannot be diagnosed through simple blood tests. However, blood tests are still very important as they may be supportive of the diagnosis and can also be used to monitor the activity of the disease. They may help determine how well medicines are working and/or monitor for complications associated with medicines.

Stool Tests

  • Tests for hidden (occult) blood or organisms, such as infection-causing bacteria.

Procedures

  • Sigmoidoscopy – a thin, flexible tube containing a camera is inserted into the rectum and a biopsy may be taken (a small sample of tissue from the bowel so it can be tested in a laboratory).
  • Colonoscopy – examination of the colon (large intestine). A narrow, flexible tube, long enough to examine the whole of the colon, and, if necessary, the lower end of the small intestine as well. It is inserted through the anus, into the rectum and then on into the colon. A biopsy may be removed during a colonoscopy and checked for signs of UC.

Scans

  • Magnetic Resonance Imaging (MRI) scans – use magnets to look at what is happening inside the body and to exclude any inflammation of the small intestine.
  • Computerised Tomography (CT) scans – use x-rays and a computer to create detailed images of the inside the body (sometimes called a CAT scan).

References
1. NHS. Ulcerative Colitis - Diagnosis. Available at https://www.nhs.uk/conditions/ulcerative-colitis/diagnosis/ Accessed October 2022
2. Mayo Clinic. Ulcerative Colitis. Available at https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/diagnosis-treatment/drc-20353331 Accessed October 2022
3. Crohn's and Colitis UK. Tests and Investigations. Available at https://crohnsandcolitis.org.uk/info-support/information-about-crohns-and-colitis/all-information-about-crohns-and-colitis/healthcare/tests-and-investigations Accessed October 2022

There are a variety of treatments available for UC. There is no cure, but treatments can help control or reduce the symptoms and prevent them from coming back. The main treatments are medicines; however, surgery is sometimes required.

Medications

There are three main groups of medications that are used to treat UC:

  1. Aminosalicylates (also known as 5-ASAs) – medicines that help to reduce inflammation. This in turn allows damaged tissue to heal.

  2. Corticosteroids – a more powerful type of medicine used to reduce inflammation. They can be used with or instead of 5-ASAs to treat a flare-up if 5-ASAs alone are not effective.

  3. Immunosuppressants – reduce the activity of the immune system e.g. tacrolimus, azathioprine. They treat mild or moderate flare-ups or maintain remission if symptoms have not responded to other medicines. In moderate to severe cases of UC, there are three types of other immunosuppressants that are used:

    a. Ciclosporin – works in the same way as other immunosuppressant medicines by reducing the activity of the immune system. However, it's more powerful than the medicines used to treat milder cases of UC and starts to work much sooner (normally within a few days).
    b. Biologics – reduce inflammation of the intestine by targeting proteins the immune system uses to stimulate inflammation. These medicines block these receptors and reduce inflammation.
    c. Tofacitinib – works by targeting the immune system but does this in a different way from other medicines.

Surgery

If medicines aren’t helping and flare-ups keep happening, then surgery may be an option. Surgery for UC involves permanently removing the colon (a colectomy).

References
1. NHS. Ulcerative Colitis - Treatment. Available at https://www.nhs.uk/conditions/ulcerative-colitis/treatment/ Accessed October 2022
2. Mayo Clinic. Ulcerative Colitis. Available at https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/diagnosis-treatment/drc-20353331 Accessed October 2022
3. Crohn's and Colitis UK. Treatments. Available at https://crohnsandcolitis.org.uk/info-support/information-about-crohns-and-colitis/all-information-about-crohns-and-colitis/treatments?parent=23127&page=1&tags=&category=23127&sort=newest Accessed October 2022

Lifestyle changes can help with managing UC and include:

Stress – although stress does not cause UC, successfully managing stress levels may reduce the frequency of symptoms.

Exercise – regular physical exercise has been proved to reduce stress and boost mood.

Healthy eating – there is no specific diet for patients with UC, however a balanced, nutritious diet will help to maintain a healthy weight. It is also important to drink enough fluids to avoid dehydration. Some patients make small changes to their diet to improve symptoms, for example eating smaller more regular meals (5-6 per day). A food diary can help identify if certain foods make symptoms worse.

Low-residue diet – temporarily eating a low-residue or low-fibre diet can sometimes help improve symptoms of UC during a flare-up.

Medication – it is important to take medication as prescribed, even if symptoms reduce.

References
1. NHS. Ulcerative Colitis – Living with Ulcerative Colitis. Available at https://www.nhs.uk/conditions/ulcerative-colitis/living-with/ Accessed October 2022
2. Mayo Clinic. Ulcerative Colitis. Available at https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/diagnosis-treatment/drc-20353331 Accessed October 2022

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