Ulcerative colitis

Ulcerative colitis is a chronic, episodic, inflammatory disease of the large intestine and rectum characterized by bloody diarrhea.

Causes, incidence, and risk factors

The cause is of ulcerative colitis is unknown. It may affect any age group, although there are peaks at ages 15 to 30 and then again at ages 50 to 70.

The disease usually begins in the rectal area and may eventually extend through the entire large intestine. Repeated episodes of inflammation lead to thickening of the wall of the intestine and rectum with scar tissue. Death of colon tissue or sepsis may occur with severe disease.

The symptoms vary in severity and their onset may be gradual or sudden. Attacks may be provoked by many factors, including respiratory infections or stress.

Risk factors include a family history of ulcerative colitis or Jewish ancestry. The incidence is 10 to 15 out of 100,000 people.


  • Diarrhea, from only a few episodes to very frequently throughout the day (blood and mucus may be present)  
  • Abdominal pain and cramping that usually subsides after a bowel movement  
  • Abdominal sounds (borborygmus, a gurgling or splashing sound heard over the intestine)  
  • Fever  
  • Weight Loss  
  • Foul-smelling stools  
  • Tenesmus  
  • Jaundice

Additional symptoms that may be associated with ulcerative colitis include the following:

  • nausea and vomiting  
  • Joint pain  
  • Gastrointestinal bleeding

Signs and tests

  • Colonoscopy with biopsy is used to diagnose ulcerative colitis  
  • Barium enema

Your doctor may also order the following blood tests:

  • CBC  
  • Sedimentation rate (ESR)  
  • CRP (C-reactive protein)


The goals of treatment are to control the acute attacks, prevent recurrent attacks, and promote healing of the colon. Hospitalization is often required for severe attacks. Corticosteroids may be prescribed to reduce inflammation.

Medications that may be used to decrease the frequency of attacks include 5-aminosalicylates such as mesalamine and immunomodulators such as azathioprine and 6-mercaptopurine.

Surgery to remove the colon will cure ulcerative colitis and removes the threat of Colon cancer. Patients may need an ostomy or an ileal pouch-anal anastomosis, a procedure that connects the small intestine to the anus to help the patient gain more normal bowel function.

Support Groups

Social support can often help with the stress of dealing with illness, and support group members may also have useful tips for finding the best treatment and coping with the condition.

The Crohn’s and Colitis Foundation of America (CCFA) may be accessed at http://www.ccfa.org.

Expectations (prognosis)

The course of the disease generally varies, with remissions and exacerbations over a period of years. Sometimes ulcerative colitis can be a fulminant (quickly progressing) disease. A permanent and complete cure is unusual.

The risk of Colon cancer increases in each decade after ulcerative colitis is diagnosed.


  • Perforation of the colon  
  • Carcinoma  
  • Massive colonic hemorrhage  
  • Colon stricture  
  • Inflammation of the joints  
  • Ankylosing spondylitis  
  • Lesions in the eye  
  • Mouth ulcers  
  • Liver disease  
  • Impaired growth and sexual development in children  
  • Pyoderma gangrenosum  
  • Complications of corticosteroid therapy

Calling your health care provider

Call your health care provider if you develop persistent Abdominal pain, new or increased bleeding, persistent fever, jaundice (yellowing of the skin or eyes), or other symptoms of ulcerative colitis.

Call your health care provider if you have ulcerative colitis and your symptoms worsen or do not improve with treatment, or if new symptoms develop.


Because the cause is unknown, prevention is also unknown.

In patients with ulcerative colitis, nonsteroidal anti-inflammatory drugs (NSAID’s) may exacerbate symptoms.

Due to the risk of Colon cancer associated with ulcerative colitis, screening with colonoscopy is recommended after 8 years of disease.

Johns Hopkins patient information

Last revised: December 6, 2012
by Dave R. Roger, M.D.

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