Ulcerative Colitis

Overview

Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting the colon and rectum. It causes continuous mucosal inflammation starting from the rectum and extending proximally. While primarily managed medically, 20-30% of patients eventually require surgery for refractory disease, dysplasia, or complications.

Causes

• Autoimmune — immune system attacks colonic mucosa
• Genetic predisposition (family history in 10-25%)
• Environmental triggers
• Gut microbiome dysbiosis
• NOT caused by stress or diet (but these can trigger flares)

Risk Factors

• Age 15-30 (peak onset)
• Ashkenazi Jewish descent
• Family history of IBD
• Non-smokers (paradoxically — smoking may be protective in UC)
• NSAIDs can trigger flares
• Previous appendectomy may be protective

Symptoms

Diagnosis

• Colonoscopy with biopsy (gold standard — continuous mucosal inflammation)
• Stool tests (calprotectin, rule out infection)
• Blood tests (CRP, ESR, CBC, iron studies)
• CT/MRI enterography (extent and complications)
• Differentiate from Crohn's disease

Treatment Options

Surgical Treatment

Recovery

IPAA is typically done in 2-3 stages. Total hospital stay across stages: 10-14 days. Temporary ileostomy for 8-12 weeks, then reversal. Final outcome: 6-8 bowel movements/day, good quality of life, no medications needed.

Prevention

• No known prevention for UC itself
• Regular colonoscopic surveillance for dysplasia (every 1-3 years after 8 years of disease)
• 5-ASA maintenance reduces cancer risk
• Vitamin D supplementation
• Manage stress and sleep

Frequently Asked Questions