Ulcerative colitis is chronic inflammatory bowel disease (IBD) that affects the large intestine or colon. The inflammation of the large intestine is limited to the mucous membrane at the surface of the colon and rectum, i.e. the two last portions of the digestive system. This represents the main difference of ulcerative colitis to another IBD, Crohn’s disease that may affect the entire digestive system.  

Ulcerative colitis is an intermittent disease. In the most cases, almost symptom-free periods – so-named remission phases – alternate with periods of exacerbated symptoms (attacks). Depending on the degree of severity of the disease, some patients may suffer from a chronic-acute colitis for which each attack passes over into the next. During these pathological episodes patients often suffer from diarrhoea mixed with blood. Severe bleeding of the affected colon may even lead to anaemia. Additional symptoms may be pains in the left upper abdomen and more unspecified symptoms, such as weight loss, lack of appetite or fever.    

Despite extensive research and analyses the causes of ulcerative colitis could not be unambiguously defined. However, a genetic component for an increased immune response is frequently discussed. If a particular gene is corrupt due to mutation, defensive reaction will be triggered against one’s own intestinal flora. It has been found that this disease is often hereditary with families. Environmental aspects are also regarded to have a certain influence on triggering the disease. In industrial countries the occurrence of the disease is more frequent than in less developed or industrialised countries. Yet, no evidence has been found for an infectious trigger. 

In general, everybody may contract ulcerative colitis however, there are indications that there is an aggregation of the disease within families. In Germany, the disease currently affects 40 to 80 persons per 100,000 inhabitants. Mostly it is diagnosed in young adults between 25 and 35 years of age. However, in some cases the disease can also be contracted by children or elderly people.   

Obtaining this diagnosis often involves an extensive process beginning with examination of the stool and with blood analyses. If these initial analyses reveal indications for an inflammation, ultrasonic test may yield information about the exact location of the inflammation. Ulcerative colitis must be carefully differentiated from other diseases or disorders in the intestines, such as Crohn’s disease or various forms of irritable bowel syndrome (IBS). Definitive certainty of the diagnosis can only be achieved by means of coloscopy. During this process and after thorough intestinal cleansing the colon is examined by means of a rectally introduced endoscope and small tissue samples are taken and examined.   

Nowadays the possibilities for treatment and therapy of ulcerative colitis are varied. However, the disease cannot be cured completely. The methods for therapy can be fine-tuned to the existing activity of the disease, the propagation of the inflamed portion of the intestine and the response of the patient to a specific therapy. Depending on the respective situations drug therapy may elongate a symptom-free phase, alleviate and remit acute attacks, relieve the symptoms or change the immune system in the long run; in addition to systemic administration of tablets local administration of medicine (i.e. enema) may be recommended by the physician in specific cases. During therapy, the attending physician should determine which drugs will be administered for what duration and in what dosage, particularly with regard to possible adverse events or side effects. In specific cases, surgical measures may improve the long-term progress of the disease. 

The diagnosis of ulcerative colitis involves extensive and long-term changes for those affected. Lifelong taking of medicine and regular medical examinations must be permanently integrated in patients’ lives. Yet, many patients with ulcerative colitis fully take part in all aspects of life, both in private and at work. Generally, this disease does not shorten life expectancy and it is also possible to have children. A large number of options for support and information provided by physicians and self-support groups are available for those affected and their families.