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Ulcerative Colitis

Ulcerative Colitis is a chronic (lifelong) inflammatory bowel disease (IBD) that affects the colon (large intestine). The inner lining of the colon becomes inflamed and develops ulcers (sores). The inflammation always starts in the rectum and may spread higher up into the colon, sometimes to the left colon and sometimes to the entire colon.

The inflammation in the colon causes bloody diarrhea and abdominal pain. Ulcers form as damaged cells on the lining of the colon slough off, leaving open sores.

Patients with ulcerative colitis are at higher risk of developing colon cancer and are therefore screened more often than the average person.


Great progress has been made in understanding the root causes of ulcerative colitis. The current thinking is that the disease occurs in people who are genetically susceptible to the disease and are exposed to harmful environmental factors (certain foods and NSAIDs). The combination of genes and environment trigger abnormal inflammation in the colon.  White blood cells, which normally function to protect against infection, accumulate in large number in the lining of the colon and release toxic products that kills cells, producing ulcers (sores) on the surface of the colon.


Ulcerative is partly genetic. Approximately 20% of patients with ulcerative have a close relative with Crohn’s disease or ulcerative colitis. If an individual has a parent or sibling with ulcerative colitis, his/her chance of developing the disease increases 4-fold. If an individual has both a parent and a sibling with colitis, his/her chance of developing the disease increases 10-fold. Other definite risk factors include Ashkenazi Jewish ancestry and NSAID use.


The most common symptom is bloody diarrhea. Other symptoms include:

  • Abdominal pain;
  • Non-productive urges to defecate, or “dry heaves of the rectum”;
  • Fatigue;
  • Weight loss;
  • Anemia (due to severe bleeding);
  • Inflammation affecting other organs, including the eyes, joints, liver and skin.


The gastroenterologist performs a thorough history and physical examination before conducting any tests. Important  tests include the following:

  • Blood tests: to rule out anemia and assess nutrition and severity of inflammation
  • Stool tests: to rule out infection
  • Colonoscopy with biopsies:  to determine the presence of the disease, assess its location and severity, and rule out other conditions


No medical cure exists for ulcerative colitis. The disease is well controlled by medications in most patients. These medications are given long-term (so called maintenance therapy); if stopped, the inflammation and symptoms will recur.  Available treatment options include:

  • Mesalamine drugs, which may be given in different forms (pills, suppositories and/or enemas);
  • Steroids, which may be given in different forms (pills, rectal foams, enemas, and intravenous solution);
  • Thiopurines;
  • Anti-TNF drugs, i.e. drugs that block tumor necrosis factor (TNF);
  • Colectomy, i.e. surgically removing the large intestine in patients who have failed medical treatments or have developed colon cancer.

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