Ulcerative colitis is a chronic inflammation of the large intestine (colon). The colon is the part of the digestive system where water is removed from undigested material, and the remaining waste material is stored. The rectum is the end of the colon adjacent to the anus. In patients with ulcerative colitis, ulcers and inflammation of the inner lining of the colon lead to symptoms of abdominal pain, diarrhea, and rectal bleeding.

Ulcerative colitis is closely related to another condition of inflammation of the intestines called Crohn\'s disease. Together, they are frequently referred to as inflammatory bowel disease (IBD). Ulcerative colitis and Crohn\'s diseases are chronic conditions that can last years to decades. Men and women are affected equally. They most commonly begin during adolescence and early adulthood, but they also can begin during childhood and later in life.

It is found worldwide, but is most common in the United States, England, and northern Europe. It is especially common in people of Jewish descent. Ulcerative colitis is rarely seen in Eastern Europe, Asia, and South America, and is rare in the population. For unknown reasons, an increased frequency of this condition has been observed recently in developing nations.

First degree relatives of people with ulcerative colitis have an increased lifetime risk of developing the disease, but the overall risk remains small.

Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs. Signs and symptoms may include:

• Diarrhea, often with blood or pus
• Abdominal pain and Cramping
• Rectal pain
• Rectal bleeding — passing small amount of blood with stool
• Urgency to defecate
• Inability to defecate despite urgency
• Weight loss
• Fatigue
• Fever
• In children, failure to grow

Most people with ulcerative colitis have mild to moderate symptoms. The course of ulcerative colitis may vary, with some people having long periods of remission.

Types

Doctors often classify ulcerative colitis according to its location. Types of ulcerative colitis include:

• Ulcerative proctitis. Inflammation is confined to the area closest to the anus (rectum), and Rectal bleeding may be the only sign of the disease. This form of ulcerative colitis tends to be the mildest.
• Proctosigmoiditis. Inflammation involves the rectum and sigmoid colon (lower end of the colon). Signs and symptoms include bloody Diarrhea, Abdominal cramps and pain, and an inability to move the bowels in spite of the urge to do so (tenesmus).
• Left-sided colitis. Inflammation extends from the rectum up through the sigmoid and descending colon. Signs and symptoms include bloody Diarrhea, abdominal Cramping and pain on the left side, and unintended Weight loss.
• Pancolitis. Pancolitis often affects the entire colon and causes bouts of bloody Diarrhea that may be severe, Abdominal cramps and pain, Fatigue, and significant Weight loss.
• Acute severe ulcerative colitis. This rare form of colitis affects the entire colon and causes severe pain, profuse Diarrhea, bleeding, Fever and inability to eat.

When to see a doctor

See your doctor if you experience a persistent change in your bowel habits or if you have signs and symptoms such as:

• Abdominal pain
• Blood in your stool
• Ongoing Diarrhea that doesn\'t respond to over-the-counter medications
• Diarrhea that awakens you from sleep
• An unexplained Fever lasting more than a day or two

Although ulcerative colitis usually isn\'t fatal, it\'s a serious disease that, in some cases, may cause life-threatening complications.

The exact cause of ulcerative colitis remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate but don\'t cause ulcerative colitis.

One possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too.

Heredity also seems to play a role in that ulcerative colitis is more common in people who have family members with the disease. However, most people with ulcerative colitis don\'t have this family history.

Common symptoms of ulcerative colitis include rectal bleeding, abdominal pain, and diarrhea, but there is a wide range of symptoms among patients with this disease. Variability of symptoms reflects differences in the extent of disease (the amount of the colon and rectum that are inflamed) and the intensity of inflammation. Generally, patients with inflammation confined to the rectum and a short segment of the colon adjacent to the rectum have milder symptoms and a better prognosis than patients with more widespread inflammation of the colon. The different types of ulcerative colitis are classified according to the location and the extent of inflammation:

1. Ulcerative proctitis refers to inflammation that is limited to the rectum. In many patients with ulcerative proctitis, mild intermittent rectal bleeding may be the only symptom. Other patients with more severe rectal inflammation may, in addition, experience rectal pain, urgency (sudden feeling of having to defecate and a need to rush to the bathroom for fear of soiling), and tenesmus (ineffective, painful urge to move one\'s bowels caused by the inflammation).
2. Proctosigmoiditis involves inflammation of the rectum and the sigmoid colon (a short segment of the colon contiguous to the rectum). Symptoms of proctosigmoiditis, like that of proctitis, include rectal bleeding, urgency, and tenesmus. Some patients with proctosigmoiditis also develop bloody diarrhea and cramps.
3. Left-sided colitis involves inflammation that starts at the rectum and extends up the left colon (sigmoid colon and descending colon). Symptoms of left-sided colitis include bloody diarrhea, abdominal cramps, weight loss, and left-sided abdominal pain.
4. Pancolitis or universal colitis refers to inflammation affecting the entire colon (right colon, left colon, transverse colon and the rectum). Symptoms of pancolitis include bloody diarrhea, abdominal pain and cramps, weight loss, fatigue, fever, and night sweats. Some patients with pancolitis have low-grade inflammation and mild symptoms that respond readily to medications. Generally, however, patients with pancolitis suffer more severe disease and are more difficult to treat than those with more limited forms of ulcerative colitis.
5. Fulminant colitis is a rare but severe form of pancolitis. Patients with fulminant colitis are extremely ill with dehydration, severe abdominal pain, protracted diarrhea with bleeding, and even shock. They are at risk of developing toxic megacolon (marked dilatation of the colon due to severe inflammation) and colonic rupture (perforation). Patients with fulminant colitis and toxic megacolon are treated in the hospital with potent intravenous medications. Unless they respond to treatment promptly, surgical removal of the diseased colon is necessary to prevent colonic rupture.

While the intensity of colon inflammation in ulcerative colitis waxes and wanes over time, the location and the extent of disease in a patient generally stays constant. Therefore, when a patient with ulcerative proctitis develops a relapse of his or her disease, the inflammation usually is confined to the rectum. Nevertheless, a small number of patients (less than 10%) with ulcerative proctitis or proctosigmoiditis can later develop more extensive colitis. Thus, patients who initially only have ulcerative proctitis can later develop left-sided colitis or even pancolitis.

Ulcerative colitis affects about the same number of women and men. Risk factors may include:

• Age. Ulcerative colitis usually begins before the age of 30. But, it can occur at any age, and some people may not develop the disease until after age 60.
• Race or ethnicity. Although whites have the highest risk of the disease, it can occur in any race. If you\'re of Ashkenazi Jewish descent, your risk is even higher.
• Family history. You\'re at higher risk if you have a close relative, such as a parent, sibling or child, with the disease.

Ulcerative colitis is an inflammatory bowel disorder. The mucosal and submucosal layers of the colon and rectum of the diseased person undergo inflammation. The disease initiates at the rectum and spreads proximally in a continuous manner.
A person with first-degree relative suffering from the disease is 25% more likely to develop the disease.
Treatment

• With a remission rate of 50%, the first-line treatment is oral or rectal administration of sulfasalazine and 5-aminosalicylates. Medication is augmented with glucocorticoids, for those patients who fail to achieve remission within two weeks. After achieving remission, the medication devoid of corticoids is for maintenance of remission.
• Some patients might be refractory to glucocorticoids. In that case, thiopurines or biological compounds can be an alternative.
• Thiopurines include immunosuppressants such as azathioprine or 6-mercaptopurine. Biological drugs such as anti-TNF-alpha drugs; infliximab, adalimumab, and golimumab.
• Probiotics are nutraceuticals based on microbes beneficial to human health. Probiotics are food-supplements to enrich gut microbiota, which influences every physiological activity. In patients with the disease helps reduce inflammation and alleviates its effects.
• Gut microbiota transplantation is a means to fix the gut microbiome with immediate effectiveness.
• A failure of medical therapy, intolerable side effects of medications, and complications such as intractable fulminant colitis, toxic megacolon, perforation, uncontrollable bleeding, strictures, unresectable high-grade or multifocal dysplasia, cancer, or growth retardation in children indicate colectomy.
• Proctocolectomy with ileal pouch-anal anastomosis is the choice of procedure. In the ineligible patients, the same procedure with ileostomy is the option.

Conditions
Bowel inflammation,Bleeding in GI tract,Weight loss,Growth delays
Drugs
Sulfasalazine and 5-aminosalicylates; anti-TNF-alpha drugs, such as infliximab, adalimumab, and golimumab; immunosuppressants such as azathioprine or 6-mercaptopurine
Symptoms
Diarrhea, often with blood,Abdominal pain and cramping,Rectal pain,Rectal bleeding — passing small amount of blood with stool,Urgency to defecate,Inability to defecate despite urgency,Weight loss,Fatigue,Fever,Developmental delays in children