Understanding ulcerative colitis: symptoms, causes, and treatment options

Ulcerative colitis is an Immune-Mediated Inflammatory Disease (IMID), a condition where the immune system mistakenly attacks healthy tissue, leading to inflammation. In ulcerative colitis, the immune system targets the colon (large intestine), causing long-term inflammation and sores (ulcers) in the lining of the colon and rectum. This results in symptoms such as diarrhoea, abdominal pain, and rectal bleeding. It is one of the two main types of Inflammatory Bowel Disease (IBD), the other being Crohn’s disease. The condition often develops gradually and can vary in severity, with periods of flare-ups and times when symptoms improve or go into remission.

Symptoms of ulcerative colitis

Symptoms can vary from person to person, but common ones include:

• Diarrhoea, often with blood or pus
• Abdominal pain or cramps
• Rectal pain and bleeding
• A sudden and urgent need to use the bathroom
• Fatigue (feeling tired all the time)
• Unexplained weight loss
• Fever (in more severe cases)

Symptoms can range from mild to severe and may change over time. Some people experience long periods of remission, while others may have frequent flare-ups.

Causes and diagnosis of ulcerative colitis

Ulcerative colitis can affect anyone, but it most commonly starts in people between the ages of 15 and 30. It can also develop later in life, typically between the ages of 50 and 70. The exact cause of ulcerative colitis is still not fully understood, but it is believed to be linked to the body’s immune system. Normally, the immune system protects the body, but in people with this condition, the immune system may mistakenly attack the colon. A family history of the disease increases the risk, suggesting that genetics play a role. Additionally, a malfunctioning immune system may cause inflammation in the colon, even in the absence of an infection.

People who live in urban areas or in developed countries are more likely to be diagnosed, suggesting that factors such as diet, stress, and other lifestyle choices, might also trigger or worsen the condition.

To diagnose ulcerative colitis, doctors usually perform:

• A review of your medical history and a physical check-up
• Blood and stool tests to look for signs of inflammation or infections
• Endoscopic procedures like colonoscopies, where doctors use a small camera to look inside the colon and take tissue samples if necessary
• Imaging tests, such as X-rays or CT scans, to see the extent of the inflammation

Treating ulcerative colitis

The goal of treatment is to reduce inflammation, relieve symptoms, and help achieve periods when the disease is less active (remission). Common treatment options include medications such as anti-inflammatory drugs, steroids (for short-term use during flare-ups), immunosuppressants (to lower the immune system’s activity), and biologic therapies that target specific immune system pathways. In severe cases, surgery may be necessary to remove the colon. Treatment plans are personalized based on how severe the disease is and how the person responds to different treatments.

Managing ulcerative colitis involves more than just medical treatment. Here are a few tips for living well with the condition:

• Diet and Nutrition: Figuring out which foods can trigger symptoms and avoiding them can help control ulcerative colitis flare-ups.
• Regular Check-ups: Ongoing visits to the doctor are important to monitor the disease and adjust treatments if needed.
• Mental Health: Living with a long-term illness can be emotionally challenging. Support groups or speaking to a counsellor can help manage stress.
• Healthy Lifestyle: Finding ways to manage stress and maintaining regular physical activity can improve overall health.

Many women with ulcerative colitis are able to have healthy pregnancies. Planning for pregnancy during a time of remission and working closely with healthcare providers helps ensure that both mother and baby stay healthy during pregnancy and breastfeeding.

About the DocTIS Project

The DocTIS project is an EU-funded initiative aiming to improve the treatment of immune-mediated inflammatory diseases (IMIDs) like ulcerative colitis. Alongside ulcerative colitis, the project also focuses on Crohn’s disease, psoriasis, psoriatic arthritis, rheumatoid arthritis, and systemic lupus erythematosus. By using advanced technologies and systems biology, DocTIS seeks to discover treatment combinations that are safer and more effective than current single-drug therapies. The ultimate goal is to create more personalised and effective care for people living with these chronic conditions.

(Above image by Freepik)