Chronic inflammation and ulceration of the lining of the rectum and colon, or, particularly at the start of the condition, of the rectum alone. The cause of ulcerative colitis is not known, but the condition is most widespread among young and middle aged adults.
The key symptom of ulcerative colitis is bloody diarrhoea; the faeces can also contain mucus. In extreme cases, the diarrhoea and bleeding are extensive, and there can be abdominal pain, weight loss, malaise, and fever.
The incidence of attacks differs considerably from person to person. Most frequently, the attacks occur in intervals of a few months. However, in certain cases, there is only a single episode.
Ulcerative colitis can lead to anaemia, due to blood loss. Other complications include a toxic form of megacolon (an abnormally enlarged colon), which can become life-threatening; rashes; mouth ulcers; conjunctivitis (inflammation of the membrane covering the eyeball); arthritis; and uveitis (inflammation of the choroid or iris of the eye). In addition, people whose entire colon has been affected for more than ten years are at increased risk of developing cancer of the colon.
Diagnosis is based on examination of the rectum and the lower colon or of the entire colon, or is made by a barium enema. During sigmoidscopy or colonoscopy, a biopsy (removal of tissue sample) can be carried out. Samples of faeces can be taken for analysis in a labatory to count out the possibility of infection by parasites or bacteria. Blood tests can also be required.
In many cases, treatment with drugs successfully controls the disease by relieving symptoms and preventing complications from arising. For ulcerative colitis occurring in the last part of the colon or the rectum, the drugs can be administered locally, as suppositories for example. If the condition occurs higher up the intestine or I diffuse (affecting a number of areas of the rectum and/or colon), the drugs are consumed orally.
In mild to moderate ulcerative colitis, acute attacks are treated with sulfasalazine, mesalazine, or corticosteroid drugs. In extreme cases or those that do not respond effectively to treatment with these drugs, treatment may be with intravenous corticosteroids and, in certain cases, the immunosuppressant drugs ciclosporin or infliximab. Once the disease is under control, mesalazine, sulfasaline, and azathioprine or infliximab can be used to prevent relapses.
Colectomy (surgical removal of the colon) can be needed for a severe attack that fails to respond to other treatments, for those with complications such as toxic megacolon, or to avoid colon cancer in those people who are at a high risk of developing this kind of cancer. This operation generally produces a dramatic improvement in health, although the person is often left with an ileostomy (an opening in the surface of the abdomen through which faeces are passed).