Ulcerative Colitis

Last Updated: November 28, 2022

Ulcerative Colitis (UC) is a type of Inflammatory Bowel Disease (IBD) in which the immune system attacks the intestinal tract, resulting in inflammation and ulcers of the colon and rectum.

Ulcerative Colitis falls under theGut HealthandAutoimmune Diseasecategories.

What is ulcerative colitis?

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that causes inflammation and ulcers in the mucosa of the digestive tract. These ulcers usually begin in the rectum and spread to other parts of the large intestine (colon). The symptoms of UC typically begin between the ages of 15 and 30.[1]

What are the main signs and symptoms of ulcerative colitis?

The most common symptom of UC is bloody diarrhea with or without mucus. People may also experience an increased urge to defecate, abdominal pain, weight loss, fever, anemia, and fatigue. Symptoms can wax and wane: people can experience periods free of symptoms (known as remission), followed by flare-ups (known as relapse).

How is ulcerative colitis diagnosed?

To diagnose UC, a healthcare provider must rule out other conditions based on a physical exam, blood tests, and stool tests. A biopsy may be needed through a colonoscopy (a procedure that examines the entire large intestine) or sigmoidoscopy (a procedure that examines the lower part of the large intestine) to confirm a diagnosis.

What are some of the main medical treatments for ulcerative colitis?

There is no cure for UC, but receiving appropriate care from a gastroenterologist and medications can help manage symptoms. Medications containing 5-aminosalicylates (5-ASA) are the first-line treatment. If 5-ASA medications fail, immunosuppressants, including a multitude of newer antibody medications, or corticosteroids may be given.

In severe cases, surgically removing parts or all of the large intestine may be necessary. If the entire large intestine must be removed, most people prefer to have a restorative proctocolectomy ileal pouch-anal anastomosis (RPC-IPAA) procedure, which involves removing the rectum as well as the large intestine, and creating a pouch from the small intestine that attaches to the anus to allow normal defecation. If a person's anal sphincter function is poor, the small intestine may be routed outside the body, where stool is collected with a small pouch.[2]

Have any supplements been studied for ulcerative colitis?

Vitamin D has been shown to reduce inflammatory biomarkers related to UC and improve intestinal barrier function when used as an adjunctive treatment to 5-ASA medications.[3] Curcumin may also help achieve remission, but more robust studies are needed.[4]

There is some evidence to support the use of probiotics, prebiotics, and synbiotics (a supplement containing both probiotics and prebiotics) in achieving remission and lowering inflammatory biomarkers related to UC.[5][6]

Since people with IBD are susceptible to nutritional deficiencies, the European Society for Clinical Nutrition and Metabolism recommends supplementation with nutrients such as iron, vitamin D, and folic acid in those who are deficient.[7]

How could diet affect ulcerative colitis?

There is no evidence that people with UC benefit from restrictive diets, and long-term use may result in nutritional deficiencies.[8] Although some evidence suggests that the low-FODMAP diet can help reduce symptoms of IBD, it does not improve stool consistency or reduce mucosal inflammation.[9]

Are there any other treatments for ulcerative colitis?

There is emerging evidence that fecal microbiota transplants can help people with UC achieve remission.[10] Helminth therapy — an experimental treatment that involves purposely infecting someone with a parasite — has also been investigated, but there is conflicting evidence regarding its efficacy.[11] There is some research examining treatments commonly used in traditional Chinese medicine, like moxibustion and acupuncture, but the poor quality of these studies casts doubt on the positive findings.[12][13]

What causes ulcerative colitis?

The specific cause of UC is unknown. It does appear, however, that a dysfunction in the immune system causes immune cells and inflammatory molecules to damage the digestive tract. It is considered an autoimmune disease. Additionally, genetics, lifestyle, and the gut microbiome also play a role in the development of UC.[2]

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  1. ^Ulcerative Colitis: MedlinePlus; Bethesda, MD: National Library of Medicine US, cited October 20, 2022
  2. ^Kobayashi T, Siegmund B, Le Berre C, Wei SC, Ferrante M, Shen B, Bernstein CN, Danese S, Peyrin-Biroulet L, Hibi TUlcerative colitis.Nat Rev Dis Primers.(2020-Sep-10)
  3. ^Guo X, Liu C, Huang YEfficacy and Safety of Vitamin D Adjuvant Therapy for Ulcerative Colitis: A Meta-Analysis.Comput Math Methods Med.(2022)
  4. ^Kocvara STreatment of unusually resistant prostato-urethritis.Rozhl Chir.(1989-Jun)
  5. ^Marcos Natal Rufino, Airan Lobo da Costa, Eloisa Nascimento Jorge, Viviane Ferreira Paiano, Marjori Leiva Camparoto, Rogéria Keller, Hermann Bremer-NetoSynbiotics improve clinical indicators of ulcerative colitis: systematic review with meta-analysisNutr Rev.(2021 May 19)
  6. ^Xiao-Feng Zhang, Xiao-Xian Guan, Yu-Jun Tang, Jin-Feng Sun, Xiao-Kai Wang, Wei-Dong Wang, Jian-Ming FanClinical effects and gut microbiota changes of using probiotics, prebiotics or synbiotics in inflammatory bowel disease: a systematic review and meta-analysisEur J Nutr.(2021 Feb 8)
  7. ^Bischoff SC, Escher J, Hébuterne X, Kłęk S, Krznaric Z, Schneider S, Shamir R, Stardelova K, Wierdsma N, Wiskin AE, Forbes AESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease.Clin Nutr.(2020-Mar)
  8. ^Limketkai BN, Iheozor-Ejiofor Z, Gjuladin-Hellon T, Parian A, Matarese LE, Bracewell K, MacDonald JK, Gordon M, Mullin GEDietary interventions for induction and maintenance of remission in inflammatory bowel disease.Cochrane Database Syst Rev.(2019-Feb-08)
  9. ^Peng Z, Yi J, Liu XA Low-FODMAP Diet Provides Benefits for Functional Gastrointestinal Symptoms but Not for Improving Stool Consistency and Mucosal Inflammation in IBD: A Systematic Review and Meta-Analysis.Nutrients.(2022-May-15)
  10. ^Imdad A, Nicholson MR, Tanner-Smith EE, Zackular JP, Gomez-Duarte OG, Beaulieu DB, Acra SFecal transplantation for treatment of inflammatory bowel disease.Cochrane Database Syst Rev.(2018-Nov-13)
  11. ^Victoria Emma Shields, Jan CooperUse of helminth therapy for management of ulcerative colitis and Crohn's disease: a systematic reviewParasitology.(2021 Sep 28)
  12. ^Wang X, Zhao NQ, Sun YX, Bai X, Si JT, Liu JP, Liu ZLAcupuncture for ulcerative colitis: a systematic review and meta-analysis of randomized clinical trials.BMC Complement Med Ther.(2020-Oct-14)
  13. ^Lee DH, Kim JI, Lee MS, Choi TY, Choi SM, Ernst EMoxibustion for ulcerative colitis: a systematic review and meta-analysis.BMC Gastroenterol.(2010-Apr-07)
Examine Database References
  1. Ulcerative Colitis Symptoms - Tang T, Targan SR, Li ZS, Xu C, Byers VS, Sandborn WJRandomised clinical trial: herbal extract HMPL-004 in active ulcerative colitis - a double-blind comparison with sustained release mesalazineAliment Pharmacol Ther.(2011 Jan)
  2. Ulcerative Colitis Symptoms - Sandborn WJ, Targan SR, Byers VS, Rutty DA, Mu H, Zhang X, Tang TAndrographis paniculata Extract (HMPL-004) for Active Ulcerative ColitisAm J Gastroenterol.(2013 Jan)
  3. Ulcerative Colitis Symptoms - Seyed-Amir Mirbagheri, Behtash-Ghazi Nezami, Solmaz Assa, Mannan HajimahmoodiRectal administration of d-alpha tocopherol for active ulcerative colitis: a preliminary reportWorld J Gastroenterol.(2008 Oct 21)
  4. Ulcerative Colitis Symptoms - Joanna Giang, Xiao Lan, Megan Crichton, Wolfgang Marx, Skye MarshallEfficacy and safety of biophenol-rich nutraceuticals in adults with inflammatory gastrointestinal diseases or irritable bowel syndrome: A systematic literature review and meta-analysisNutr Diet.(2021 May 7)
  5. Blood Pressure - Guo XF, Li JM, Tang J, Li DEffects of resveratrol supplementation on risk factors of non-communicable diseases: A meta-analysis of randomized controlled trials.Crit Rev Food Sci Nutr.(2018)
  6. TNF-Alpha - Melodi Omraninava, Bahman Razi, Saeed Aslani, Danyal Imani, Tannaz Jamialahmadi, Amirhossein SahebkarEffect of resveratrol on inflammatory cytokines: A meta-analysis of randomized controlled trialsEur J Pharmacol.(2021 Oct 5)
  7. Superoxide Dismutase Activity - Omidian M, Abdolahi M, Daneshzad E, Sedighiyan M, Aghasi M, Abdollahi H, Omidian P, Dabiri S, Mahmoudi MThe Effects of Resveratrol on Oxidative Stress Markers: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.Endocr Metab Immune Disord Drug Targets.(2020)
  8. Superoxide Dismutase Activity - Koushki M, Lakzaei M, Khodabandehloo H, Hosseini H, Meshkani R, Panahi GTherapeutic effect of resveratrol supplementation on oxidative stress: a systematic review and meta-analysis of randomised controlled trials.Postgrad Med J.(2020-Apr)
  9. Ulcerative Colitis Symptoms - F Fernández-Bañares, J Hinojosa, J L Sánchez-Lombraña, E Navarro, J F Martínez-Salmerón, A García-Pugés, F González-Huix, J Riera, V González-Lara, F Domínguez-Abascal, J J Giné, J Moles, F Gomollón, M A GassullRandomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Spanish Group for the Study of Crohn's Disease and Ulcerative Colitis (GETECCU)Am J Gastroenterol.(1999 Feb)
  10. Ulcerative Colitis Symptoms - Irving PM, Iqbal T, Nwokolo C, Subramanian S, Bloom S, Prasad N, Hart A, Murray C, Lindsay JO, Taylor A, Barron R, Wright SA Randomized, Double-blind, Placebo-controlled, Parallel-group, Pilot Study of Cannabidiol-rich Botanical Extract in the Symptomatic Treatment of Ulcerative ColitisInflamm Bowel Dis.(2018 Mar 19)
  11. Ulcerative Colitis Symptoms - Hanai H, Iida T, Takeuchi K, Watanabe F, Maruyama Y, Andoh A, Tsujikawa T, Fujiyama Y, Mitsuyama K, Sata M, Yamada M, Iwaoka Y, Kanke K, Hiraishi H, Hirayama K, Arai H, Yoshii S, Uchijima M, Nagata T, Koide YCurcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trialClin Gastroenterol Hepatol.(2006 Dec)
  12. Ulcerative Colitis Symptoms - Khan Z, Macdonald C, Wicks AC, Holt MP, Floyd D, Ghosh S, Wright NA, Playford RJUse of the 'nutriceutical', bovine colostrum, for the treatment of distal colitis: results from an initial studyAliment Pharmacol Ther.(2002 Nov)
  13. Depression Symptoms - Sajjad Moradi, Mehdi Zobeiri, Awat Feizi, Cain C T Clark, Mohammad Hassan EntezariThe effects of spirulina (Arthrospira platensis) supplementation on anthropometric indices, blood pressure, sleep quality, mental health, fatigue status and quality of life in patients with ulcerative colitis: A randomised, double-blinded, placebo-controlled trialInt J Clin Pract.(2021 Jun 9)