Ulcerative colitis is a form of inflammatory bowel disease that affects the large bowel. In most patients, it can be kept under control using a planned programme of treatment.

Diagnosing ulcerative colitis

Ulcerative colitis causes inflammation of the colon, the large bowel. This can lead to ulceration of the wall of the bowel, which causes bleeding into the colon and resulting in bloody diarrhoea.

Diagnosis usually includes the following steps:

  • Taking a full medical history about your symptoms such as when they started and how severe they are.
  • Performing a clinical examination.
  • Performing investigations such as blood tests, for example to look for iron-deficiency anaemia, which can be common if you have been losing blood. It is also usual to examine a faecal sample to rule out an infection as a possible cause of your symptoms.
  • Arrange for a colonoscopy. This is an endoscopic examination of your colon done by one of our expert colonoscopists. This identifies how much of your colon is affected by inflammation, and is a key diagnostic tool that helps rule out other possible causes of your symptoms.

Treating ulcerative colitis

Drug treatments available include:

  • Mesalazine in tablet form: mesalazine also known as 5-ASA (5-aminosalicylic acid) and is normally the first line treatment for ulcerative colitis. The drug works by being in contact with the bowel lining.
  • Mesalazine suppositories, foam, or liquid enema (topical therapy): inserting the drug directly into the colon can give better results, as the drug is concentrated on the area where it is needed most. Often tablets and topical treatment are used together.
  • Steroids are sometimes needed to control flare-ups of inflammation for short periods. If recurrent courses of steroids are required, an immunosuppressant is normally introduced to try to keep the disease under control.
  • Immunosuppressants: strong medicines that decrease the activity of the body's immune system. Azathioprine and mercaptopurine are the most commonly used drugs in ulcerative colitis. Ciclosporine and methotrexate are also sometimes used.
  • Biological therapies: infliximab (Remicade®) is an inhibitor of tumour necrosis factor alpha (TNF-alpha), which is a molecule that stimulates inflammation. Infliximab is sometimes used as a ‘rescue therapy’ in people with acute severe ulcerative colitis in an attempt to avoid surgery.

During your treatment you will be seen for regular checks to monitor your progress, and to adjust your drug treatment as required.
Some patients may require surgical treatment. This is usually only necessary in the most severe cases or in patients who don’t respond to drug treatment. We work closely with excellent colorectal surgeons within The London Clinic, who will assess your needs and discuss the surgical options that are available to you.

Reducing your risk of colon cancer

Some sort of colon cancer screening is thought to be a good idea for everyone over 50 but people who have ulcerative colitis are known to be at a slightly increased risk of developing colon cancer.

We therefore recommend that most people with ulcerative colitis should have regular screening colonoscopies once you have been diagnosed for approximately 8 years.

Trade names quoted are given as examples only of the drug types described, alternatives may be available.