Colitis Ulcerosa

Information on ulcerative colitis

What is ulcerative colitis?

Ulcerative colitis is a chronic inflammatory bowel disease (IBD). Gastroenterologists refer to colitis as an inflammation (-itis) of the large intestine (colon). Ulcerative means ulcerating, i.e. it is associated with crater-shaped mucosal defects. The inflammation is limited to the large intestine and spreads continuously from the rectum towards the small intestine. The rectum is always affected, the entire large intestine only in 25% of cases.

Alongside Crohn's disease, ulcerative colitis is the most common chronic inflammatory bowel disease. Around 4 out of 100,000 people develop it every year. Most of them are people between the ages of 20 and 40.

Causes of ulcerative colitis

Not much is known about what triggers ulcerative colitis. Various environmental factors are suspected. The only thing that is certain is that this disease can be inherited. A familial cluster of cases is associated with a 15-fold higher risk of the disease.

In contrast to Crohn's disease, smoking leads to a less frequent occurrence of ulcerative colitis, so it has a positive effect. It is suspected that a disturbed immune regulation of the body, possibly triggered by inflammation, leads to the defense cells attacking the body's own intestinal cells.

Ulcerative colitis symptoms

The main symptom of ulcerative colitis is bloody, mucous diarrhea. This is often accompanied by abdominal pain, which can occur in cramps before bowel movements (technical term: tenesmus). Fever is also possible.

In addition to intestinal involvement, other inflammations also occur frequently in ulcerative colitis. These include skin symptoms such as aphthae (small defects in the oral mucosa with a whitish coating), as well as inflammation of the eyes, joints and bile ducts.

In most cases, ulcerative colitis is chronic and recurrent. This means that the recurrence can be triggered by physical or psychological stress. In between, there are years of freedom from symptoms. In 10% of cases, ulcerative colitis is chronic and continuous. There are no symptom-free periods.

Acute fulminant cases are rare (5%). The sudden onset of the disease is accompanied by cholera-like diarrhea, dehydration, fever and shock. Dangerous complications such as extreme bloating of the intestine with the risk of perforation are not uncommon. The fatality rate is therefore around 30%.

How is ulcerative colitis diagnosed?

The gastroenterologist obtains initial clues from the medical history. After the patient interview, the physical examination follows. In particular, inspection and palpation of the rectum can provide further clues. This is followed by an ultrasound examination and a blood sample, as well as a stool test to rule out intestinal infection as the cause.

To confirm the diagnosis, a colonoscopy (large intestine and beginning of the small intestine) is performed with several tissue samples taken. These are examined by the pathologist for specific changes. In 10% of cases, however, Crohn's disease cannot be distinguished from ulcerative colitis.

How is ulcerative colitis treated?

The treatment depends on the extent of the ulcerative colitis. It can be carried out with medication or surgery.

Medication therapy

The primary treatment (except in fulminant cases) is medication. The medication (5-ASA, cortisone, immunosuppressants) is administered locally (as a foam, enema or suppository) or, in the case of a larger infection, systemically. The latter has the disadvantage that the side effects can also affect the whole body. The medication leads to the disease subsiding, but must be taken permanently to prevent it from recurring.

Ulcerative colitis surgery

The surgical removal of the entire colon is necessary in the case of acute and serious complications such as a perforation of the intestine. Otherwise, the operation can be carried out in the case of recurrent, severe attacks, poor general health and precursors of malignant cell changes. Partial resection of the colon is not advisable due to the risk of re-infection.

Surgical removal of the colon by an abdominal surgeon is the only way to cure ulcerative colitis. In order to maintain stool continence, part of the small intestine is formed into a reservoir and connected to the anus.

What are the chances of recovery and the course of the disease with ulcerative colitis?

If left untreated, ulcerative colitis can lead to complications such as growth disorders in childhood, weight loss, massive bleeding, intestinal perforation and death.

Complications are associated with a 30% risk of fatality. Therefore, if drug therapy fails, surgery should be performed as early as possible (necessary in 25% of cases). If the intestinal infection caused by ulcerative colitis is only limited, drug treatment is sufficient. Those affected can then expect a normal life expectancy.

How often should you have a colonoscopy for ulcerative colitis?

As ulcerative colitis is associated with an increased risk of colon cancer (colorectal carcinoma), annual check-ups with colonoscopy and tissue sampling are sometimes necessary in order to diagnose the cancer as early as possible. After 20 years, the risk of cancer is 8%, after 30 years it is 18%.

As such a disease is often associated with great psychological stress, many sufferers find active participation in a self-help group helpful.

Which specialists are specialists in treating ulcerative colitis?

If you have ulcerative colitis, you want the best medical care for yourself. That is why patients ask themselves, where can I find the best clinic for the diagnosis and treatment of intestinal diseases?

As this question cannot be answered objectively and a reputable doctor would never claim to be the best doctor, you can only rely on a doctor's experience. The more patients a doctor treats with chronic bowel diseases, the more experienced he becomes in his specialty.

IBD specialists are therefore clinics and gastroenterology doctors who specialize in the diagnosis and treatment of chronic bowel diseases. Visceral surgeons are the right people to contact for ulcerative colitis surgery.

If you have any further questions or would like a second opinion regarding the treatment of ulcerative colitis, please contact our gastroenterology or visceral surgery specialists at the University Hospital Bonn.