Ulcerative colitis is a chronic inflammatory disorder affecting the colon. The disease will always affect the last part of the colon, with the proximal extent of involvement of the colon being variable, but always continuous. The whole colon may be involved. The severity of UC also varies – from mild disease requiring minimal medication to severe disease requiring surgical removal of the colon. Severe UC, if not managed promptly, can be life-threatening.
The diagnosis of ulcerative colitis can be suspected based on the history and clinical picture. However, diagnosis requires colonoscopy with mucosal biopsies and exclusion of other conditions that may mimic it. Such conditions include Crohn’s disease and various infective causes of colitis, amongst others.
Because ulcerative colitis is an inflammatory condition, agents which suppress inflammation are used in its treatment. The most commonly used class of anti-inflammatory agents are called 5-ASA agents (after their chemical structure). These agents do not suppress the immune system.
If 5-ASA agents are ineffective, or expected to be, then immunosuppressant agents are used. These medications weaken the immune system in order to dampen the immune-mediated inflammation in the bowel. Because of this, patients using them may be susceptible to certain infections. They are powerful agents and should only be used by doctors experienced in their use.
In certain situations it is necessary to remove the colon surgically. This may be in life-threatening acute severe ulcerative colitis or in patients where all therapeutic options have been exhausted. Fortunately, due to the constant development of new and effective therapies, this is becoming rare. Surgical resection of the colon can be considered as a curative procedure, but the consequences of surgery often negatively impact on quality of life.
Patients with ulcerative colitis have an increased risk of developing colorectal cancer. It is important that patients that have had ulcerative colitis for more than ten years be assessed for risk of cancer and be surveyed appropriately.