Understanding Ulcerative Colitis: Causes, Symptoms, Diagnosis, and Treatment

The colon stores digested food and waste before elimination, making it a favorable environment for bacterial growth. This environment can lead to damage in the form of inflammation, known as ulcerative colitis.

Ulcerative colitis not only causes significant discomfort in daily life but also carries the risk of serious complications if not detected and treated in time. So how can this condition be effectively managed?

This article, prepared by the H PLUS International Medical Center, provides a comprehensive overview of ulcerative colitis.

What is ulcerative colitis?

Ulcerative colitis is a chronic inflammatory bowel disease that primarily affects the mucosal and submucosal layers of the colon. It typically begins in the rectum and may spread continuously to other areas of the colon.

Based on the extent of inflammation, the disease is categorized into:

• Ulcerative proctitis: inflammation confined to the rectum

• Left-sided colitis: inflammation extending from the rectum to the left side of the colon, including the splenic flexure

• Extensive colitis: inflammation affecting the entire colon, including the transverse colon

The exact cause of ulcerative colitis remains unclear. However, environmental triggers, genetic predisposition, and immune system overreactions are considered major contributing factors.

Common symptoms of ulcerative colitis

Recognizable symptoms of ulcerative colitis include:

Gastrointestinal symptoms

• Blood and mucus in the stool

• Diarrhea or frequent loose bowel movements

• Abdominal pain, nighttime diarrhea

• Urgency to defecate, often immediately after using the toilet

Systemic symptoms

• Weight loss, loss of appetite, persistent fatigue

• Fever, exhaustion, or sensations of constipation despite bowel urgency

These symptoms may last for weeks or even months and tend to worsen with more intense diarrhea, abdominal pain, and systemic effects.

In some cases, extraintestinal manifestations may occur, affecting the joints, eyes, skin, liver, bile ducts, or kidneys.

How is ulcerative colitis diagnosed?

Ulcerative colitis is difficult to diagnose using a single method. Diagnosis typically involves a combination of medical history, clinical symptoms, and multiple diagnostic tests. These include blood tests, stool tests, colonoscopy, and biopsy:

Blood tests

Elevated white blood cell count, increased erythrocyte sedimentation rate (ESR), and high C-reactive protein (CRP) indicate inflammation. Anemia may also be present due to chronic blood loss.

Stool tests

Used to detect bacteria, toxins, and especially fecal calprotectin, a marker useful for identifying inflammation, monitoring treatment response, and distinguishing ulcerative colitis from irritable bowel syndrome.

Colonoscopy

This is the most important diagnostic tool, allowing visualization of the intestinal mucosa, and determining the extent and severity of inflammation.

Biopsy

Histopathological analysis helps confirm chronic inflammation and provides a more accurate diagnosis.

Combining these methods offers a comprehensive assessment, ensuring accurate diagnosis and effective treatment planning.

How is ulcerative colitis treated?

The main goals of treatment are to relieve symptoms, reduce inflammation, and improve the patient’s quality of life. Treatment aims to achieve and maintain remission.

Treatment strategies are chosen based on disease severity, extent, and individual clinical characteristics. There are two main approaches:

Medical therapy

Medications are used to control inflammation and regulate the immune response, including:

• Anti-inflammatory drugs

• Corticosteroids for acute flare-ups

• Immunomodulators to suppress excessive immune activity

• Biologic agents targeting specific inflammatory molecules

• Small-molecule therapies like tofacitinib that target immune signaling pathways

Surgical intervention

Surgery is considered when medical treatments fail or complications arise, such as bowel perforation, severe bleeding, or suspected malignancy.

Choosing the best treatment requires careful evaluation of each case to ensure optimal disease management.

Important considerations for ulcerative colitis patients

Ulcerative colitis is a chronic and relapsing condition. Symptoms may flare up unpredictably or remain silent for extended periods. However, if left untreated, the disease can lead to serious complications such as toxic megacolon or bowel perforation.

Disease progression and complications

• Localized inflammation in the colon usually responds well to treatment

• Extensive disease involving the upper colon may increase the risk of colorectal cancer

• Non-rectal involvement carries a higher risk of cancer development

Risk factors for complications

Patients with the following characteristics are at higher risk of severe complications:

• Diagnosis before age 40

• Deep or widespread ulceration

• Left-sided or extensive colitis

Surveillance recommendations

For patients with left-sided or extensive colitis lasting more than eight years, regular colonoscopy is recommended to monitor cancer risk. Proper disease management requires ongoing monitoring and timely intervention.

H PLUS Gastrointestinal Endoscopy Department: Trusted Care for Colitis Patients

The Gastroenterology Department at H PLUS International Medical Center is a trusted destination for high-quality care for patients with colitis, from mild to severe cases.

Our experienced team of gastrointestinal specialists is supported by advanced medical equipment including digital X-ray systems, endoscopes, CT scanners, and MRI — all imported from leading international manufacturers — to meet every diagnostic and treatment need.

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