What is Ulcerative colitis?
Ulcerative colitis (UC) is one of the two main types of inflammatory bowel disease (IBD) which are characterised by chronic intestinal inflammation. UC primarily affects the large intestine (colon) and rectum, with the inflammation tending to be continuous and only affecting the inner lining. In UC, small open sores (or ulcers) form on the surface of the lining which may bleed, and the colon produces a larger amount of intestinal mucus which may contain pus.
In severe cases of UC, where the inflammation has penetrated deeper into the intestinal wall, complications may arise and require immediate medical attention. These may include profuse bleeding from deep ulcers, perforation (rupture) of the colon and the shutdown of normal intestinal contractions.
It is estimated that approximately 33,000 Australians have UC (although numbers are expected to be higher), with women and men affected equally. UC can affect anyone of any age but usually first presents between 15 and 30 years of age.
Symptoms
UC presents with a number of symptoms which can range from mild to severe including:
People affected by UC may go through periods of remission where they experience no, or very mild, symptoms. However, they can then also relapse, where symptoms flare up once more. UC patients may also experience additional complications with their joints, skin, eyes, kidneys, liver and bones.
What causes Ulcerative colitis?
Despite extensive research the exact cause of UC remains unknown, but it is thought to involve a complex combination of interacting factors including genetics, the immune system, microbial factors and environmental factors.
Genetics
Genetics do have a role in UC, and a family history of IBD is associated with an increased risk of an individual developing the disease. Numerous genes have been linked to increased UC risk with research being heavily focused on why mutations in these genes may predispose an individual to UC.
Immunological factors
An abnormal immune response to normal substances and bacteria found in the intestine is characteristic of UC and causes the inflammatory injury in the bowel. What triggers this inappropriate immune reaction currently remains unknown.
Microbial factors
The normal balance of healthy gut bacteria is disrupted in UC and the role of the gut microbiota (population of microbes/bacteria that live in our intestines) in IBD has become a hot topic over recent years. There has also been a lot of research into specific bacterial infections including Fusobacterium varium contributing to UC development however research is still ongoing.
Environmental factors
Surprisingly, unlike for Crohn's disease (the other major IBD), smoking has been suggested to decrease the risk of UC. Diet is also thought to play an important role in the development of UC, and living in a Western society is also associated with increased prevalence of the disease.
Diagnosis
UC can be difficult to diagnose due to its similarities to other gastrointestinal disorders such as Crohn's disease. There is no single test for UC and a number of investigations may be required to determine a correct diagnosis including:
Treatment
UC treatment depends on disease location, severity, complications and response to previous treatment. There is no cure for UC and current treatments focus on controlling inflammation, relieving symptoms and correcting nutritional deficiencies. Common treatments include:
Anti-inflammatory agents
Aminosalicylates (5-ASA) are used to treat mild to moderate inflammation in UC by controlling inflammation, inducing and maintaining remission of disease. Corticosteroids may be used in moderate to severe cases but due to potential side effects, are only recommended as a short-term treatment.
Immunosuppressive agents
Immunosuppressive agents suppress the immune system to control inflammation by suppressing the release of inflammation-inducing chemicals.
Antibiotic agents
Research suggests that certain bacterial infections may contribute to the development and persistence of UC, and targeting these pathogens may initiate remission of the disease.
Nutritional supplementation
As UC can lead to nutritional deficiencies, supplements may be recommended, particularly for children with impeded growth and development.
Surgery
People with severe UC may at some point require a surgical procedure such as a resection (removal of the colon). Generally this involves removing the colon and creating a pouch from the end of the small intestine and joining it directly to the anus, or alternatively to an opening (stoma) on the surface of the abdomen to which a bag can be attached to collect faecal matter. Surgery is generally a very successful treatment for UC.
Resources
Crohn's and Colitis Australia
https://www.crohnsandcolitis.com.au/about-crohns-colitis/
IBD support Australia
http://www.ibdsupport.org.au/
Gastroenterological Society of Australia
http://www.gesa.org.au/resources/patients/inflammatory-bowel-disease/
Centre for Digestive Diseases
http://www.cdd.com.au/pages/disease_info/ulcerative_colitis.html
Ulcerative colitis (UC) is one of the two main types of inflammatory bowel disease (IBD) which are characterised by chronic intestinal inflammation. UC primarily affects the large intestine (colon) and rectum, with the inflammation tending to be continuous and only affecting the inner lining. In UC, small open sores (or ulcers) form on the surface of the lining which may bleed, and the colon produces a larger amount of intestinal mucus which may contain pus.
In severe cases of UC, where the inflammation has penetrated deeper into the intestinal wall, complications may arise and require immediate medical attention. These may include profuse bleeding from deep ulcers, perforation (rupture) of the colon and the shutdown of normal intestinal contractions.
It is estimated that approximately 33,000 Australians have UC (although numbers are expected to be higher), with women and men affected equally. UC can affect anyone of any age but usually first presents between 15 and 30 years of age.
Symptoms
UC presents with a number of symptoms which can range from mild to severe including:
- Diarrhoea (which is often bloody)
- Abdominal pain
- Vomiting
- Rectal Bleeding
- Loss of appetite
- Weight loss
- Anaemia
- Weakness and fatigue
People affected by UC may go through periods of remission where they experience no, or very mild, symptoms. However, they can then also relapse, where symptoms flare up once more. UC patients may also experience additional complications with their joints, skin, eyes, kidneys, liver and bones.
What causes Ulcerative colitis?
Despite extensive research the exact cause of UC remains unknown, but it is thought to involve a complex combination of interacting factors including genetics, the immune system, microbial factors and environmental factors.
Genetics
Genetics do have a role in UC, and a family history of IBD is associated with an increased risk of an individual developing the disease. Numerous genes have been linked to increased UC risk with research being heavily focused on why mutations in these genes may predispose an individual to UC.
Immunological factors
An abnormal immune response to normal substances and bacteria found in the intestine is characteristic of UC and causes the inflammatory injury in the bowel. What triggers this inappropriate immune reaction currently remains unknown.
Microbial factors
The normal balance of healthy gut bacteria is disrupted in UC and the role of the gut microbiota (population of microbes/bacteria that live in our intestines) in IBD has become a hot topic over recent years. There has also been a lot of research into specific bacterial infections including Fusobacterium varium contributing to UC development however research is still ongoing.
Environmental factors
Surprisingly, unlike for Crohn's disease (the other major IBD), smoking has been suggested to decrease the risk of UC. Diet is also thought to play an important role in the development of UC, and living in a Western society is also associated with increased prevalence of the disease.
Diagnosis
UC can be difficult to diagnose due to its similarities to other gastrointestinal disorders such as Crohn's disease. There is no single test for UC and a number of investigations may be required to determine a correct diagnosis including:
- Medical history
- Physical examination
- Blood tests
- X-rays
- Examination of stools
- Colonoscopy (direct visualisation of the bowel using a miniature camera attached to a long flexible tube that is inserted inside the anus)
- Biopsy
Treatment
UC treatment depends on disease location, severity, complications and response to previous treatment. There is no cure for UC and current treatments focus on controlling inflammation, relieving symptoms and correcting nutritional deficiencies. Common treatments include:
Anti-inflammatory agents
Aminosalicylates (5-ASA) are used to treat mild to moderate inflammation in UC by controlling inflammation, inducing and maintaining remission of disease. Corticosteroids may be used in moderate to severe cases but due to potential side effects, are only recommended as a short-term treatment.
Immunosuppressive agents
Immunosuppressive agents suppress the immune system to control inflammation by suppressing the release of inflammation-inducing chemicals.
Antibiotic agents
Research suggests that certain bacterial infections may contribute to the development and persistence of UC, and targeting these pathogens may initiate remission of the disease.
Nutritional supplementation
As UC can lead to nutritional deficiencies, supplements may be recommended, particularly for children with impeded growth and development.
Surgery
People with severe UC may at some point require a surgical procedure such as a resection (removal of the colon). Generally this involves removing the colon and creating a pouch from the end of the small intestine and joining it directly to the anus, or alternatively to an opening (stoma) on the surface of the abdomen to which a bag can be attached to collect faecal matter. Surgery is generally a very successful treatment for UC.
Resources
Crohn's and Colitis Australia
https://www.crohnsandcolitis.com.au/about-crohns-colitis/
IBD support Australia
http://www.ibdsupport.org.au/
Gastroenterological Society of Australia
http://www.gesa.org.au/resources/patients/inflammatory-bowel-disease/
Centre for Digestive Diseases
http://www.cdd.com.au/pages/disease_info/ulcerative_colitis.html
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