Overview of Ulcerative Colitis

In ulcerative colitis, inflammation occurs on the lining (mucosa) of the large intestine or colon. The inflammation is usually located in the rectum and lower colon but may involve other parts of the colon and sometimes even the entire colon. Tiny open sores or 'ulcers' form on the surface of the lining and these may bleed. The inflamed lining also produces a larger than normal amount of intestinal lubricant or mucus which sometimes contain pus. Inflammation in the colon reduces its ability to reabsorb fluid from the faeces which causes diarrhoea. Inflammation in the rectum can lead to a sense of urgency to have a bowel movement.

Most people with ulcerative colitis (80-90%) respond well to treatment and never develop any complications. In more severe cases where inflammation has penetrated deeper into the walls of the colon, serious complications may arise. These include:

• profuse bleeding from deep ulcers
• perforation (rupture) of the colon
• fulminant colitis/toxic megacolon (partial or full shutdown of normal intestinal contractions).

These complications can occur over a short period of time and usually require immediate medical attention.

In people with severe disease that is not responding adequately to medication or in those with long-standing disease (>10 years duration) who are at higher risk of colorectal cancer, surgical removal (resection) of the colon may be the most appropriate long-term solution. Surgical resection eliminates the symptoms of ulcerative colitis and the need for ongoing use of medications to control inflammation. This can greatly enhance quality of life.

Surgery for ulcerative colitis generally involves removing the large intestine and creating a pouch from the end of the small intestine which is then joined directly to the anus, Alternatively, the end of the small intestine can be redirected to empty into a bag attached to an opening (stoma) on the outside of the abdomen.

Although there is no clinical evidence to suggest that specialist diets benefit persons with ulcerative colitis, good nutrition is essential to the healing process. When disease is active, many people lose their appetite or try to avoid eating in order to prevent further symptoms. Lack of adequate nutrition worsens the tiredness and fatigue and eventually leads to weight loss. Children with ulcerative colitis may fail to develop or grow properly, particularly if they have long periods of active disease and/or receive frequent or prolonged treatment with high doses of corticosteroids.