Ulcerative colitis (UC)

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by inflammation and ulcers in the lining of the colon and rectum. It is one of the two main types of IBD, the other being Crohn's disease. Ulcerative colitis primarily affects the colon (large intestine) and rectum, causing symptoms such as abdominal pain, diarrhea, and rectal bleeding. The severity and course of the disease can vary widely among individuals, with periods of active disease (flare-ups) alternating with periods of remission.

Causes and Risk Factors:

1. Immune System Dysfunction: The exact cause of ulcerative colitis is not fully understood, but it is believed to involve an abnormal immune response in which the immune system attacks the cells lining the colon and rectum, leading to inflammation.
2. Genetics: There appears to be a genetic component to ulcerative colitis, as it tends to run in families. Certain genetic variations may increase the risk of developing the condition.
3. Environmental Factors: Environmental factors such as diet, stress, and exposure to certain infections or toxins may play a role in triggering or exacerbating ulcerative colitis in susceptible individuals.

Symptoms:

• Diarrhea: Diarrhea is a hallmark symptom of ulcerative colitis, often with blood or pus in the stool.
• Abdominal Pain and Cramping: Persistent abdominal pain and cramping, often in the lower left side of the abdomen, are common symptoms.
• Rectal Bleeding: Blood in the stool or rectal bleeding may occur, especially during bowel movements.
• Urgency and Tenesmus: Urgency to have a bowel movement and a feeling of incomplete evacuation (tenesmus) are common symptoms.
• Fatigue: Chronic inflammation and frequent bowel movements can lead to fatigue and weakness.
• Weight Loss: Loss of appetite and weight loss may occur, particularly during flare-ups of the disease.
• Fever: Some individuals may experience low-grade fever during flare-ups of ulcerative colitis.

Diagnosis:

1. Medical History and Physical Examination: A healthcare provider will take a thorough medical history and perform a physical examination to assess symptoms and signs of ulcerative colitis.
2. Laboratory Tests: Blood tests may be performed to check for signs of inflammation (e.g., elevated C-reactive protein or erythrocyte sedimentation rate) and to rule out other causes of symptoms.
3. Stool Tests: Stool samples may be analyzed for the presence of blood, infection, or inflammation.
4. Colonoscopy: A colonoscopy is the primary diagnostic test for ulcerative colitis. It involves inserting a flexible, lighted tube (colonoscope) into the rectum and colon to visualize the lining of the intestine and obtain tissue samples (biopsy) for examination under a microscope.
5. Imaging Studies: Imaging tests such as X-rays, CT scans, or MRI scans may be performed to assess the extent and severity of inflammation and to rule out complications such as toxic megacolon or perforation.

Treatment:

1. Medications: Medications are the mainstay of treatment for ulcerative colitis and may include:
• Anti-inflammatory drugs: such as mesalamine (5-ASA) or corticosteroids to reduce inflammation.
• Immunomodulators: such as azathioprine, 6-mercaptopurine, or methotrexate to suppress the immune system.
• Biologic therapies: such as infliximab, adalimumab, or vedolizumab, which target specific molecules involved in the inflammatory process.
• Anti-diarrheal agents: such as loperamide to help control diarrhea.
2. Dietary Modifications: Some individuals find relief from symptoms by making dietary changes, such as avoiding trigger foods or following a low-residue or low-FODMAP diet.
3. Lifestyle Modifications: Managing stress, getting regular exercise, and getting enough sleep can help reduce symptoms and improve overall well-being.
4. Surgery: Surgery may be necessary for individuals with severe ulcerative colitis that does not respond to medication or who develop complications such as severe bleeding, perforation, or colon cancer. Surgery may involve removal of the entire colon and rectum (proctocolectomy) with creation of an ileal pouch-anal anastomosis (IPAA or J-pouch) or creation of an ileostomy.

Complications:

1. Colon Cancer: Individuals with long-standing ulcerative colitis have an increased risk of developing colon cancer, especially if the entire colon is affected.
2. Toxic Megacolon: Severe inflammation of the colon can lead to a life-threatening condition called toxic megacolon, in which the colon becomes dilated and paralyzed.
3. Perforation: Inflammation and ulceration of the colon can weaken the intestinal wall, leading to perforation (tear) and leakage of bowel contents into the abdominal cavity, which is a medical emergency.

Prognosis:

The prognosis for ulcerative colitis varies depending on the severity and extent of the disease, the response to treatment, and the presence of complications. With proper management, many individuals with ulcerative colitis are able to achieve long-term remission and lead relatively normal lives.

• Managing ulcerative colitis involves working closely with a healthcare team to develop an individualized treatment plan and making lifestyle modifications to manage symptoms and reduce the risk of flare-ups.
• Regular monitoring and follow-up care are important for detecting any changes in symptoms, monitoring for complications, and adjusting treatment as needed.