Ulcerative Colitis

Ulcerative colitis is a disease characterized by inflammation in the innermost lining of the large intestine or colon. It belongs to a category of gastrointestinal illnesses called inflammatory bowel disease. The other disease in this category is crohn’s disease. It must be differentiated from another common illness called irritable bowel syndrome. Several patients get confused by the above two terminologies.

We do not yet know the precise cause of ulcerative colitis but it is believed to arise from a combination of genetic and environmental triggers. In this illness, the immune system of the gut is revved up and it targets the innermost lining of the colon called the mucosa. The immune system starts of erroneously regard the body’s own mucosal lining of the colon as foreign and therefore mounts an exaggerated destructive inflammatory response. Several immune mediators or chemicals are released which cause tissue damage. One key such molecule is tumor necrosis factor or TNF. Many new biologic therapies have been devised to target TNF and help reduce inflammation.

Patients with ulcerative colitis usually present with abdominal pain, stomach cramps, diarrhea and rectal bleeding. In severe prolonged colitis, they may become malnourished and lose considerable weight.

Ulcerative colitis is diagnosed by the gastroenterologist by performing a colonoscopy and taking biopsies or sampling the mucosa. Then an expert pathologist helps confirm the diagnosis and differentiate this condition from other inflammatory conditions like crohn’s disease, acute infectious colitis, clostridium difficile colitis and ischemic colitis.

Patients diagnosed with ulcerative colitis improve by avoiding processed foods and having a diet rich in fresh fruit and vegetables. They must avoid a class of anti-inflammatory medications called nonsteroidal anti-inflammatory medications or NSAIDS. These include ibuprofen, naproxen, advil, aleeve etc. Acetaminophen or tylenol is the safest pain medication for them.

Mild cases of ulcerative colitis are treated by oral or rectal mesalamine. Moderately or severely active ulcerative colitis is usually treated with biologic agents like infliximab or adalimumab which target tumor necrosis factor or TNF and vedoluzimab which targets integrin molecule. Other biologic agents approved to treat ulcerative colitis are tofacitinib(janus kinase inhibitor) and ustikinumab (anti interleukin).