Ulcerative Colitis Treatment

What is Ulcerative Colitis?

Ulcerative colitis is an inflammatory disease of the large intestine that occurs without any identifiable infectious cause. It is a chronic condition characterized by flare-ups and significantly affects quality of life.

What causes Ulcerative Colitis?

Ulcerative colitis is a multifactorial disease. Although the exact cause is still unknown, it is believed to result from an exaggerated immune response triggered by environmental factors in genetically predisposed individuals.

Which part of the body does Ulcerative Colitis affect?

Ulcerative colitis is characterized by ulcers that damage the mucosal lining of the large intestine. It can affect the entire colon or just a portion of it, most commonly involving the rectosigmoid region (the part of the colon closest to the anus).

What are the types of Ulcerative Colitis and why are they important?

Ulcerative colitis is classified based on the extent of intestinal involvement and the severity of the disease.

By location:

Proctitis: involves only the last 8–10 cm near the anus
Rectosigmoiditis: involves the last 30–40 cm of the colon
Left-sided (Distal) Colitis: extends up to the splenic flexure (the first sharp bend of the colon)
Extensive Colitis: extends beyond the splenic flexure
Pancolitis: involves the entire colon

By severity:

Mild
Moderate
Severe
Fulminant (very severe)

What are the symptoms of Ulcerative Colitis?

In ulcerative colitis, abdominal pain—especially in the lower left side—is common. This pain is often accompanied by frequent bowel movements with blood and mucus (diarrhea),although significant abdominal pain may not always be present. In some cases, diarrhea may consist only of blood or mucus. Frequent but small-volume bowel movements are one of the key symptoms. In severe and extensive disease, more widespread abdominal pain, bloating, nausea and vomiting, weight loss, loss of appetite, malnutrition, and general deterioration in health may occur. Fever is uncommon, but it can appear in severe (fulminant) colitis cases even without infection.

Which conditions can mimic Ulcerative Colitis?

In cases of sudden-onset bloody and mucous diarrhea accompanied by fever, infectious colitis should first be ruled out. Amoebic dysentery is particularly often confused with ulcerative colitis. In organ transplant patients who are on immunosuppressive therapy, CMV colitis, certain antibiotic-associated colitis (e.g., pseudomembranous colitis),and some parasitic infections can cause symptoms similar to those of ulcerative colitis.

In patients who have received radiation therapy to the pelvic area, frequent bloody stools without mucus may be mistaken for ulcerative proctitis. Therefore, especially in middle-aged and older patients, a history of radiation therapy should always be investigated.

How is Ulcerative Colitis diagnosed?

Early diagnosis and treatment are essential to prevent complications. The diagnostic process includes:

Stool tests to rule out infectious causes
Colonoscopy showing widespread superficial ulcers, inflammatory discharge, and mucosal damage beginning from the rectum
Biopsy samples taken during colonoscopy revealing histopathological findings consistent with ulcerative colitis
Elevated levels of inflammatory markers in blood tests (e.g., ESR and CRP)
Elevated fecal calprotectin levels
Anemia due to iron deficiency
Abdominal ultrasound performed by an experienced specialist
CT or MRI imaging of the abdomen in severe cases

As can be seen, ulcerative colitis is not diagnosed by a single test. Diagnosis is based on a combination of clinical, endoscopic, and histopathological findings. The key to diagnosis is clinical suspicion of the disease.

At what age is Ulcerative Colitis most common?

Most patients are young adults. The first peak typically occurs in the second decade of life (in the 20s). A second, smaller peak occurs in the fifth and sixth decades of life (ages 40–60).

What is the treatment for Ulcerative Colitis? Is there a definitive cure?

Currently, none of the available treatments for ulcerative colitis can completely eliminate the disease from the body. The main goal of treatment is to suppress the inflammatory process responsible for active disease and to bring the condition into remission.

Treatment options vary depending on the type, severity, and extent of the disease. These may include medications, dietary modifications, stress management, and when necessary, endoscopic or surgical interventions. Commonly used medications include:

Mesalazine preparations (available in tablet, granule, enema, foam, and suppository forms)
Corticosteroids
Immunomodulators
Biological agents (e.g., Infliximab, Adalimumab, Vedolizumab, Ustekinumab)

What should the diet be like in Ulcerative Colitis?

Dietary restrictions are mostly necessary during active phases of the disease. Once the disease is in remission, it is advisable to avoid overly strict dietary limitations. During flare-ups, restrictions should be made under the supervision of a physician and a dietitian, based on the severity and extent of the disease.

Does stress cause Ulcerative Colitis?

Stress is not a direct cause of ulcerative colitis, but it is one of the major factors that can trigger the onset of the disease and cause flare-ups in patients who are in remission. Therefore, psychological support and, if necessary, psychiatric evaluation are important aspects of disease management.

When is surgery necessary in Ulcerative Colitis?

In cases of severe (fulminant) acute colitis that do not respond to what is known as rescue therapy, surgery may become necessary before the patient’s overall condition and nutritional status deteriorate further. In such situations, surgery can be life-saving.

If the expected response to treatment is not achieved, surgery should be discussed without delay in consultation with the patient and their family. Additionally, even in cases where appropriate treatment has been administered, surgery should be considered for patients with persistently severe disease.

Regardless of the pattern of involvement, if surgery is indicated in ulcerative colitis, it typically involves complete removal of the colon (total colectomy),with the creation of an ileal pouch from the small intestine, which is then connected to the anus.

Does Ulcerative Colitis Affect Other Organs?

Patients with ulcerative colitis may experience involvement of organs outside the intestines. These are referred to as extraintestinal manifestations.

The most common associated conditions include:

Joint involvement, particularly affecting the lower back joints (known as ankylosing spondylitis),but other joints can also be involved
Skin lesions such as pyoderma gangrenosum and erythema nodosum
Eye involvement including dry eyes, uveitis, and episcleritis
Bile duct narrowing, known as primary sclerosing cholangitis

Which Medications Should Be Avoided in Ulcerative Colitis?

Patients should always consult their doctor before using medications prescribed for other conditions. In particular, certain antibiotics (other than specific ones advised) and anti-rheumatic painkillers (NSAIDs) may trigger flare-ups of the disease and should be avoided unless approved by a healthcare professional.

How Should Ulcerative Colitis Be Monitored?

The frequency, duration, and severity of flare-ups vary from patient to patient. Since ulcerative colitis is a lifelong disease characterized by periods of remission and relapse, strict adherence to treatment and regular monitoring is crucial. Follow-up intervals differ among individuals. If a patient in remission begins to experience symptoms suggesting a flare-up, it is very important to contact their physician without waiting for the next scheduled visit. This allows for early intervention before the disease worsens.

Does Ulcerative Colitis Cause Colon Cancer?

Because ulcerative colitis is a chronic inflammatory disease, the risk of developing colon cancer increases over time, especially in patients whose inflammation is not well controlled. Therefore, patients diagnosed with ulcerative colitis (excluding those with only proctitis) should begin annual screening colonoscopies 8–10 years after diagnosis. The aim is to detect pre-cancerous lesions or early-stage colon cancer to enable timely treatment.