VIDA LAB by Rowan Albritton
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gastrointestinal

Ulcerative Colitis

A chronic inflammatory bowel disease causing inflammation and ulcers in the colon and rectum.

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In this report
  1. Overview
  2. Symptoms
  3. Diagnosis
  4. Treatments
  5. Medical Resources
  6. Your Care Plan

Overview

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes inflammation and ulcers in the lining of the large intestine (colon) and rectum. Unlike Crohn's disease, which can affect any part of the digestive tract, UC is limited to the colon and rectum, and the inflammation is continuous rather than patchy.

UC affects about 900,000 people in the United States and typically develops between ages 15 and 30, with a second peak between 50 and 70. The disease ranges from mild to severe and is characterized by periods of active symptoms (flares) and periods of remission.

The inflammation in UC starts in the rectum and may extend continuously through the colon. The extent of inflammation — proctitis (rectum only), left-sided colitis, or pancolitis (entire colon) — affects treatment choices and cancer risk. Long-standing UC increases the risk of colon cancer, making regular surveillance colonoscopy essential. With modern treatment, many patients achieve and maintain remission.

Symptoms

  • Diarrhea, often with blood or mucus
  • Abdominal pain and cramping
  • Urgent need to have a bowel movement
  • Tenesmus — feeling the need to pass stool even when the bowel is empty
  • Rectal bleeding and pain
  • Fatigue
  • Weight loss
  • Fever during flares
  • Joint pain, skin rashes, or eye inflammation (extraintestinal manifestations)
  • Anemia from chronic blood loss

Diagnosis

  1. Blood tests — CBC, CRP, ESR
  2. Stool tests — to rule out infection, check fecal calprotectin
  3. Colonoscopy with biopsy — the gold standard; shows continuous inflammation starting from the rectum
  4. Flexible sigmoidoscopy — for diagnosis and monitoring
  5. CT or MRI — to assess extent and complications

A gastroenterologist makes the diagnosis.

Treatments

  • Aminosalicylates (5-ASAs) — mesalamine, sulfasalazine; first-line for mild to moderate UC
  • Corticosteroids — for flares; not for maintenance
  • Immunomodulators — azathioprine, 6-MP, cyclosporine for severe cases
  • Biologic agents — anti-TNF (infliximab, adalimumab, golimumab), anti-integrin (vedolizumab), anti-IL-12/23 (ustekinumab); for moderate to severe disease
  • JAK inhibitors — tofacitinib, upadacitinib
  • Surgery — proctocolectomy with ileal pouch-anal anastomosis (IPAA); can be curative for UC
  • Lifestyle — stress management, nutrition, avoiding trigger foods
  • Regular monitoring — surveillance colonoscopy for dysplasia and cancer screening
  • Vaccinations — up-to-date immunizations, avoiding live vaccines during immunosuppression

Your Care Plan

A step-by-step guide to navigating your condition, from finding the right doctors to advocating for the care you deserve.

Step 1: Doctors to See

Start with: Your primary care physician for initial tests.

Then seek: A gastroenterologist for colonoscopy and treatment.

Build your team:

  • Gastroenterologist — for disease management
  • Colorectal surgeon — if surgery is considered
  • Registered dietitian — for nutrition
  • Mental health professional — for emotional support
  • Rheumatologist — for joint symptoms
  • Ophthalmologist — for eye involvement

Step 2: Advocate for Yourself

If you have persistent diarrhea with blood, ask for a colonoscopy — don't let it be attributed to hemorrhoids or IBS without evaluation. If you're diagnosed with UC, ask about the extent of your disease — proctitis, left-sided, or pancolitis — as this affects treatment and cancer risk. If you have long-standing UC, make sure you're getting regular surveillance colonoscopy. If medications aren't controlling your symptoms, ask about biologics or JAK inhibitors — there are many options.

Step 3: Your Action Plan

  1. See your primary doctor for blood and stool tests.
  2. Get a colonoscopy with biopsies.
  3. See a gastroenterologist for diagnosis and treatment.
  4. Start medication as prescribed — mesalamine or biologics.
  5. Discuss maintenance therapy to prevent flares.
  6. Get regular colonoscopy screening for dysplasia.
  7. Identify and manage dietary triggers.
  8. Have a plan for managing flares — know when to seek urgent care.

Important: This report is educational information, not medical advice. Always consult a qualified healthcare professional for diagnosis and treatment decisions.

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