Ulcerative Colitis


Ulcerative colitis is a common condition of the colon that affects approximately 600,000 people in the United States. Ulcerative colitis usually affects young adults (patients in their 20's and 30's) but can affect children and older adults as well. The cause of ulcerative colitis is not known; however, most experts agree that genetics (traits passed on from your parents), the environment, and the patient's immune system (cells that fight off infection) play an important role in the disease. Common symptoms of ulcerative colitis include:

  • Bloody diarrhea

  • Abdominal pain

  • Visual problems (blurred vision, red eyes or painful vision)

  • Joint pain or swelling

  • Skin rashes

  • Liver problems

  • No medicines will cure a patient; therefore patients must deal with the illness for their entire lifetime unless the colon is removed. Patients typically will have periods of active symptoms ("flares") followed by symptom-free periods ("remission"). The symptoms can have a negative impact on quality of life for patients. However, most patients continue to work and have productive lives.


    Medical illustration of a colonoscopy

    Many different tests are used to diagnosis patients with ulcerative colitis. Although blood tests are usually ordered, these alone cannot diagnosis ulcerative colitis without further testing. Blood tests often reveal that inflammation is present in the body. Frequently, patients can have low blood counts (“anemia”) because of bleeding from ulcerative colitis. Some special blood tests are now offered that can help make an accurate diagnosis. A colonoscopy is required to confirm the diagnosis of ulcerative colitis.

    A colonoscopy is a procedure performed when the patient is sedated that allows the doctor to view the entire colon and a portion of the small bowel called the ileum. All patients with ulcerative colitis will have abnormalities in the lining of the colon that can be seen during colonoscopy. Biopsies of the abnormal areas confirm the diagnosis of ulcerative colitis. Other tests used to exclude disorders that cause symptoms similar to ulcerative colitis include: upper endoscopy (EGD), upper GI series and small bowel follow through (X-ray test of intestines), CT (CAT) scan, barium enema, MRI, and capsule endoscopy.


    Photo of multi-colored pills

    Current therapies to treat patients with ulcerative colitis include aminosalicylates (“5-ASA”), steroids, immune suppressants, and biologic therapy (medications that block specific inflammatory molecules important in ulcerative colitis). For some of these drugs, treatments are available in pill form, enemas, injections under the skin, and intravenous infusions. Although medical treatment can be effective in controlling the symptoms of ulcerative colitis, patients must take medications continuously to prevent the symptoms from returning.

    Patients typically receive drugs based on a pyramid or “Step up” approach. For example, if patients have mild symptoms, they receive less powerful therapies lower in the pyramid with fewer side effects. However, as symptoms worsen or if patients are sicker when diagnosed, they receive more aggressive therapies higher in the pyramid. Despite medical therapy, 20-30% of patients will have a colectomy (removal of the colon) during their lifetime. A colectomy relieves the colitis symptoms and is curative.

    Although patients usually require a colostomy (bag attached to the belly wall that collects fecal waste) after colectomy, another surgical procedure can be performed in many patients later to reverse the ostomy called a restorative proctocolectomy or J pouch. This procedure allows patients to have bowel movements without an ostomy. There have been many advances in surgery for ulcerative colitis. The most significant are development of restorative proctocolectomy and use of minimally invasive surgery (laparoscopy).

    Ulcerative Colitis Treatment Pyramid. Patients with mild disease enter the treatment pyramid at the bottom and receive medications appropriate for the level of disease severity.

    Medical illustration of ulcerative colitis treatment pyramid

    Reasons to Consider the University of Maryland Medical Center for Treatment

    Most gastroenterologists and surgeons can provide care for patients with ulcerative colitis. However, the University of Maryland Inflammatory Bowel Disease Program has several unique aspects that set it apart from other providers caring for patients with Crohn's disease:

    • Physician Expertise: Physicians and nurses have a focus and commitment to the care of patients with ulcerative colitis. They have vast experience in diagnosing and treating this disorder.

    • Multidisciplinary Care: Because of the complexity of the disease, patients with ulcerative colitis often require care from multiple providers. Patients in our program are able to see a gastroenterologist and surgeon at the same clinic site, often at the same visit when appropriate. In addition, the Digestive Health Center has nutrition services that will allow patients with ulcerative colitis to have a complete nutrition evaluation at the initial visit. Other resources such as imaging, endoscopy, pathology, ostomy team and consult services are available at the University of Maryland Medical Center.

    • Timely Service: Our physicians strive to see all new patients within two weeks of the referral and to communicate our recommendations to referring physicians within one week of the office visit.

    • Patient Advocacy: Our physicians design treatment plans after extensive discussions with patients to ensure that their concerns are being met. We encourage an ongoing dialogue with our patients throughout the treatment process so that patients are actively involved in their care.

    For more information about our services or treatment options or to refer a patient to the IBD Program, please call 410-706-3387.

    This page was last updated: June 24, 2013

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