Ulcerative colitis: causes, symptoms, diagnosis and treatment

By Cristiano Antonino On May 1, 2023

Ulcerative colitis is a chronic inflammatory bowel disease (IBD, MICI or Inflammatory Bowel Disease) that can cause symptoms of varying severity

Although the exact cause is not yet known, there are several treatment options available to help manage the symptoms and prevent complications.

What is Ulcerative Colitis?

Ulcerative colitis, also known as ‘ulcerative rectocolitis’, is a chronic inflammatory bowel disease that affects the mucous membrane of the large intestine, primarily affecting the rectum, and then possibly extending to involve part or all of the colon.

What are the causes of ulcerative colitis?

The exact causes of ulcerative colitis are still unknown, partly because it is a multifactorial disease with only partially known causes.

The most probable hypothesis is that environmental factors such as bacterial microorganisms constituting the intestinal microbiota, in the presence of a predisposing genetic make-up, may trigger an attack by the immune system on the mucosa of the large intestine.

It is common to find ulcerative colitis in people who have a genetic background or predisposition, however, it is not a hereditary disease.

Ulcerative colitis: what are the symptoms?

Symptoms of ulcerative colitis include:

diarrhoea mixed with blood, even at night;
abdominal pain and cramps;
urgent need to go to the toilet and difficulty controlling the urge;
extreme tiredness not associated with a specific cause, which can have a significant effect on the patient’s daily life.

Joint, skin, eye and liver problems may be related to ulcerative colitis.

These are immune-mediated conditions that go beyond the digestive system and can, in some cases, develop even before the typical symptoms of the disease appear.

The diagnosis of ulcerative colitis is essential to begin to see an improvement in one’s quality of life, and to set up a therapy tailored to each person, which offers a better chance of the disease remaining under control.

In fact, it should be emphasised that, in patients with ulcerative colitis, it often happens that the diagnosis is delayed, perhaps because it is confused with irritable bowel syndrome: in more than 30% of patients, the two pathologies coexist.

Another major problem is that patients often become accustomed to a reduced quality of life, and although they suffer from discomfort (multiple attacks of diarrhoea), they delay going for a check-up.

How to treat ulcerative colitis

The specialist who has to diagnose ulcerative colitis may do so using a series of instrumental tests, such as:

ileocolonoscopy
abdominal ultrasound
magnetic resonance imaging
blood tests

Once ulcerative colitis has been diagnosed, depending on its severity, the specialist will decide whether to prescribe conventional therapies or advanced therapies, the aim of which is to keep ulcerative colitis under control by preventing the progression of intestinal damage.

Whereas in the past the focus of treatment was solely on the symptom, today the focus is also on treating the lesions (such as intestinal ulcerations).

The approach is the so-called ‘treat to target’, i.e. treatment aimed at improving symptoms, test results and restoring the integrity of the intestinal mucosa.

This type of approach is customised during the course of follow-up, if necessary also by modifying the treatment course.

If drug therapy is not sufficient, surgery may be necessary.

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