Ulcerative colitis: Information & ulcerative colitis specialists

15.11.2023
Leading Medicine Guide Editors
Author
Leading Medicine Guide Editors

Ulcerative colitis is a chronic inflammation of the intestinal mucosa of the large intestine that usually occurs in episodes. It is typically characterized by cramp-like abdominal pain as well as bloody and mucousy diarrhoea. Ulcerative colitis mainly affects young adults between the ages of 15 and 30. Here you will find further information and selected ulcerative colitis specialists and centers.

ICD codes for this diseases: K51

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Brief overview:

  • What is ulcerative colitis? A chronic, inflammatory inflammation of the lining of the large intestine that mainly affects young adults between the ages of 15 and 30.
  • Causes: As the disease runs in families, it is thought to be hereditary. Other risk factors: Immune system disorders and psychosomatic factors, diet, viruses and bacteria.
  • Symptoms: Cramp-like abdominal pain, also before or after bowel movements, bloody and slimy diarrhea, fatigue, loss of appetite, nausea, anemia and others.
  • Forms: Chronic-relapsing (most common form, intermittent course, lasts for years), chronic-continuous (steady complaints, no phases), acute-fulminant (very sudden, violent onset of illness).
  • Complications: The disease can cause serious complications, including: Intestinal perforation, severe intestinal bleeding, scarring, fistulas and abscesses, inflammation of the bile ducts, liver damage and others.
  • Diagnosis: A medical history and physical examination are often followed by a colonoscopy, blood and stool tests, ultrasound and an X-ray.
  • Treatment: A cure is not possible; instead, symptoms should be alleviated. Medication, a change in diet and surgery are possible options.

Article overview

What is ulcerative colitis and how does the disease manifest itself?

Ulcerative colitis and Crohn's disease are chronic inflammations of the intestinal mucosa of the large intestine that usually occur in episodes. Both diseases are classified as chronic inflammatory bowel diseases.

While Crohn's disease usually occurs in the small intestine, but can also occur in the entire gastrointestinal tract, ulcerative colitis only occurs in the large intestine.

The intestinal inflammation usually begins in the rectum. It then often spreads initially to the left side of the colon, but can also extend to the entire colon. A transition to the small intestine is very rare.

Chronisch-entzündliche Darmerkrankungen
Like Crohn's disease, ulcerative colitis is an inflammatory bowel disease © bilderzwerg | AdobeStock

Ulcerative colitis in figures

Ulcerative colitis is one of the most common chronic inflammatory bowel diseases:

  • Around 120 to 200 of every 100,000 inhabitants suffer from ulcerative colitis.
  • Every year, between 5 and 10 people per 100,000 inhabitants in Central Europe develop ulcerative colitis.
  • In principle, the disease can occur at any age. However, young adults between the ages of 15 and 30 are most frequently affected by ulcerative colitis. In around 25 percent of all sufferers, the first symptoms appear before the age of 20, in some cases even as early as infancy.
  • Ulcerative colitis occurs slightly more frequently in women than in men.

Causes of ulcerative colitis

The causes of ulcerative colitis are not known. However, due to the familial clustering of the disease, it is assumed that there is a hereditary predisposition. Furthermore, disorders of the immune system could lead to pathological interactions with the intestinal mucosa and thus to inflammation in the colon.

Further causes are

  • Psychosomatic factors (e.g. psychological strain, stress),
  • nutritional factors,
  • but also viruses and bacteria

are also assumed.

Diagnosis of ulcerative colitis

The diagnosis of ulcerative colitis usually begins with an interview about existing symptoms and medical history(anamnesis). This is followed by a physical examination.

Further examinations may include

  • Colonoscopy to visually assess the bowel and take tissue samples of the intestinal mucosa
  • Blood test with inflammation test to rule out a bacterial infection
  • Stool examination to rule out intestinal inflammation caused by pathogens
  • Ultrasound (sonography) for an overview of the anatomical situation in the abdominal cavity
  • X-ray contrast examination for a better assessment of the colon

An endoscopy of the rectum (rectoscopy) is required before a planned colitis ulcerosa operation.

Darmspiegelung
A colonoscopy allows a close examination of the bowel © phonlamaiphoto | AdobeStock

Symptoms of ulcerative colitis

Ulcerative colitis is typically characterized by cramp-like abdominal pain

  • in the left lower abdomen,
  • in the middle of the lower abdomen or
  • in the sacrum

characterized. Patients often have pain before or immediately after passing stools.

The bowel disease is also characterized by bloody and mucous, sometimes watery diarrhoea. The amount of diarrhea depends directly on how severely the colon is affected by the disease. Diarrhea can occur up to 20 times a day and in severe cases even up to 30 times a day.

Depending on the severity, other symptoms of ulcerative colitis may occur:

  • fatigue, physical weakness, tiredness
  • Loss of appetite and nausea
  • Anemia
  • fever
  • weight loss
  • Increase in white blood cells (leukocytosis)

Course of ulcerative colitis

The disease usually has a chronic and relapsing course, but can also run a more constant course. Three forms can be distinguished:

Chronic relapsing ulcerative colitis is the most common form, affecting around 85 percent of patients. The intestinal disease progresses in phases with no symptoms, which can last up to several years. However, this can be followed by repeated relapses.

Chronic continuous ulcerative colitis occurs in around 10 percent of patients. Those affected suffer continuously from symptoms and have no phases without signs of illness.

Acute fulminant ulcerative colitis affects around 5 percent of patients. This form is characterized by a very sudden and severe onset of the disease with

  • severe diarrhea,
  • abdominal pain and
  • fever

characterized.

Complications of ulcerative colitis

Depending on the extent and duration of the inflammation, complications can occur. However, most patients are spared complications. The occurrence of a complication is often an indication for ulcerative colitis surgery.

The most important complications of ulcerative colitis in the colon are

  • Toxic megacolon: overstretched colon due to wall weakness and gas accumulation.
  • Intestinal perforation: An intestinal perforation in ulcerative colitis is a life-threatening complication and must be treated immediately by surgery.
  • Severe intestinal bleeding: Blood loss can often be compensated for by blood transfusions. It is rarely necessary to remove the affected section of bowel as part of an operation for ulcerative colitis.
  • Scarring (strictures): Scarring can lead to narrowing of the bowel and intestinal obstruction, which requires immediate surgery.
  • Fistulas and abscesses
  • Colon cancer: Patients with ulcerative colitis have an increased risk of colon cancer. The risk increases significantly with the duration of the disease. For example, it is around 40 percent after 25 years of illness.
Darmkrebs
Ulcerative colitis can also cause colon cancer © peterschreiber.media | AdobeStock

The most important complications of ulcerative colitis outside the colon are

  • Inflammation of the eye
  • Inflammation of the bile ducts
  • Joint pain, joint inflammation
  • liver damage
  • painful skin changes (erythema nodosum)

Treatment of ulcerative colitis

As the causes for the development of ulcerative colitis are not known, the disease cannot be cured. Treatment therefore aims to alleviate the symptoms and reduce the risk of complications.

Depending on the severity and course of the disease, various options are available for the treatment of ulcerative colitis:

  • In mild cases, usually drug therapy (e.g. immunosuppressants, cortisone, 5-aminosalicylic acid) and dietary changes
  • Surgical treatment(ulcerative colitis surgery) in severe cases, in the event of complications or if drug therapy is not effective enough
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