What is Ulcerative Colitis (UC)?
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Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that causes chronic inflammation in the mucosal lining of the colon, leading to erosion and ulcers. The disease typically starts in the rectum and may extend throughout the colon. UC is a chronic condition characterized by periods of flare-ups and remission, significantly affecting the patient’s quality of life (QOL).
1. Causes of Ulcerative Colitis
The exact cause of UC remains unknown, but it is believed to be influenced by multiple factors:
(1) Immune System Abnormalities
UC is considered an autoimmune disease in which the immune system mistakenly attacks the colon’s mucosa, causing inflammation.
(2) Genetic Factors
A higher risk of developing UC among family members suggests a genetic component. Certain gene mutations have been linked to IBD, but environmental factors also play a role in disease onset.
(3) Environmental Factors
- Westernized diet (high-fat, high-sugar, processed foods)
- Changes in gut microbiota
- Smoking (unlike Crohn’s disease, UC risk is higher in non-smokers)
- Stress (not a direct cause but may worsen symptoms)
2. Symptoms of Ulcerative Colitis
UC symptoms vary based on the extent and severity of inflammation.
(1) Main Symptoms
- Diarrhea (often with blood): Frequent bowel movements due to abnormal colon function.
- Bloody stool: Inflammation may cause bleeding from the colon lining.
- Abdominal pain: Often felt in the lower left side of the abdomen.
- Fever: In severe cases, inflammation can cause fever.
- Weight loss & Fatigue: Chronic inflammation and malabsorption can lead to weight loss and fatigue.
(2) Types of UC Based on Disease Extent
- Proctitis: Inflammation limited to the rectum; mild symptoms with bloody stool.
- Left-sided colitis: Involves the rectum, sigmoid colon, and descending colon; symptoms include diarrhea and pain.
- Pancolitis: Inflammation affects the entire colon; severe symptoms with fever and weight loss.
3. Diagnosis of Ulcerative Colitis
Several tests are used to diagnose UC:
(1) Endoscopy
- A colonoscopy helps confirm mucosal inflammation and ulcerations.
- A biopsy (tissue sample) is taken for microscopic examination.
(2) Stool Test
- Tests for inflammation markers (e.g., calprotectin).
- Differentiates between bacterial infections and UC.
(3) Blood Test
- C-reactive protein (CRP) & Erythrocyte sedimentation rate (ESR): Indicate inflammation.
- Anemia: May be caused by chronic bleeding.
- Albumin Levels: Decrease due to malnutrition.
4. Treatment of Ulcerative Colitis
The main treatments for UC include:
(1) 5-Aminosalicylic Acid (5-ASA) Drugs
- Mesalazine (Pentasa, Asacol, Lialda)
- First-line treatment for mild to moderate UC; reduces inflammation.
(2) Corticosteroids
- Prednisolone, Budesonide (Entyvio)
- Strong anti-inflammatory effects; used during flare-ups but have side effects.
(3) Immunomodulators (Immunosuppressants)
- Azathioprine (Imuran), 6-Mercaptopurine
- Suppress the immune system to prevent flare-ups.
(4) Biologic Agents
- Infliximab (Remicade), Adalimumab (Humira), Ustekinumab (Stelara)
- Target inflammatory cytokines (TNF-α, IL-12/23) and are used for moderate to severe cases.
(5) JAK Inhibitors
- Tofacitinib (Xeljanz)
- Inhibits JAK signaling pathways to reduce inflammation.
5. Global Ulcerative Colitis Statistics
UC is increasing worldwide. The prevalence (number of cases per 100,000 people) in major countries is as follows:
| Country | Prevalence (per 100,000 people) |
|---|---|
| Norway | 505 |
| USA | 286 |
| Canada | 319 |
| Germany | 322 |
| Japan | 180 |
(Source: https://www.carenet.com/news/journal/carenet/44916)
*This article was published in 2017.
6. Lifestyle Management for UC
Although there is no cure, proper treatment and lifestyle changes can help manage symptoms.
- Balanced diet (low-fat, low-irritant foods)
- Regular exercise and stress management
- Routine check-ups and medication adherence
7. Conclusion
UC is a chronic condition with no definitive cure, but with proper treatment and lifestyle modifications, symptoms can be effectively managed. Ongoing research continues to explore new treatment options, offering hope for better management in the future.
