Ulcerative colitis is a condition characterized by swelling and sores in the colon. People with this problem often end up having to arrange their lives around having quick access to a bathroom. It’s a miserable problem, but fortunately, a variety of treatments can help, sometimes dramatically.

An estimated 3 million people in the United States have ulcerative colitis or Crohn’s disease, another form of inflammatory bowel disease (IBD). Yale Medicine is highly regarded for our treatment of IBD. We offer team-based care from doctors, surgeons, nurses, a social worker and a dietitian. Additionally, we offer opportunities for patients to participate in research studies evaluating mood disorders and IBD, and multi-center new drug treatment protocols.

“Ulcerative colitis is a chronic disease and if someone is feeling poorly, it really affects their life and it can be very frustrating,” says Deborah Proctor, MD, a Yale Medicine gastroenterologist and medical director of the Yale Medicine Inflammatory Bowel Disease Program. “We aim to get patients into clinical remission so they will be able to live just like anyone else.”

Yale School of Medicine is one of only six genetic research centers supported by the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) seeking to advance the discovery of genes influencing an individual’s risk for developing ulcerative colitis and Crohn’s disease. 

A chronic inflammatory condition, ulcerative colitis affects the large intestine (colon). Symptoms include abdominal pain, diarrhea and blood in the stool.

The colon is responsible for absorbing salt and excess water from waste material, or what remains after food is digested.  Bacteria in the colon breaks down this waste material, which  hen moves to the rectum. 

People with ulcerative colitis typically have inflammation in the rectum and lower colon, but the problem can occur anywhere in the colon. No matter where it is located, inflammation limits the colon’s ability to absorb water. This results in loose stool, causing persistent diarrhea.

There are several types of ulcerative colitis, based on where the colon is inflamed. 

• Ulcerative proctitis: Limited to the rectum, this tends to be a milder form of inflammation.
• Pancolitis: The entire colon is inflamed.
• Distalcolitis: The left side of the colon is inflamed.

Ulcerative colitis is a chronic disease, which means there is no cure. It’s common, though, for people to have remissions, where they go years without any symptoms. Others might more frequent “flares” or “flare-ups,” or an increase in symptoms. 

Diarrhea isn’t the only problem that ulcers in your colon can cause. Some people also have mucus or blood in their stool. Yet other potential symptoms include:

• Urgency to have a bowel movement
• Cramping
• Abdominal pain

These symptoms can then lead to: 

• Fatigue
• Weight loss
• Low blood cell count (anemia)
• Appetite loss 

Most doctors believe that ulcerative colitis is an autoimmune disease, which means the body’s immune system wrongfully attacks harmless bacteria in the colon. This inflames healthy tissue. As a result, additional symptoms could include: 

• Mouth sores
• Redness, pain and itchiness in the eyes
• Osteoporosis
• Swelling and pain in joints
• Kidney stones

The cause of ulcerative colitis is unclear, but it’s thought that a combination of genetics and environmental factors are at play. Up to 20 percent of people with ulcerative colitis have a parent, sibling or child with the disease.

Ulcerative colitis is more common for people living in urban, industrialized areas compared to undeveloped countries, which indicates that highly refined diets may play a role. Although all ethnic groups are affected, the problem is most common among Caucasians and people of Eastern European (Ashkenazi) Jewish descent.

Lastly, there appears to be a connection to nonsteroidal anti-inflammatory medications. It’s not that these medications cause the disease but, because they inflame the bowel, they can worsen symptoms. This category of medication includes ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, Anaprox) and diclofenac sodium (Voltaren, Solaraze). 

To make a diagnosis, a physician begins by obtaining a complete patient and family medical history and performing a physical examination. Standard tests and procedures include: 

• Blood tests: These check for inflammation and antibodies.
• Stool samples: These look for blood, to rule out infection.
• Colonoscopy: Performed under general anesthesia, a doctor uses a small camera mounted to the end of a lighted tube to examine the interior of the colon.Imaging: The patient drinks a contrast dye and has an X-ray, Computed Tomography (CT) Enterography (imaging of the small intestine), or Magnetic Resonance Imaging (MRI) Enterography.
• Sigmoidoscopy: This test is similar to a colonoscopy, but the doctor only examines the rectum and the lower (sigmoid) colon.
• Capsule endoscopy: The patient swallows a capsule that contains a tiny camera. It travels through the small intestine, taking pictures and transmitting them to a receiver belt. The camera is expelled through a bowel movement (and can be flushed down the toilet).

Though this is unquestionably a long list of tests, Yale Medicine is unique in that we can offer all of them on-site, says Dr. Proctor, who is also a professor of medicine (digestive diseases) at Yale School of Medicine. 

There are many available treatments that help control symptoms in people with ulcerative colitis, often even triggering a remission (with no signs of disease). Most treatments work in a similar way, aiming to lower inflammation inside the intestinal lining, allowing the colon to heal and lessening symptoms.

The hope is that a medication can not only achieve remission for a patient, but will help maintain it. But if remission doesn’t occur, medications can ease symptoms and improve quality of life. 

Medication options include:  

• Aminosalicylates: These reduce inflammation in the intestinal lining. 
• Steroids and immunosuppressants: These can slow the disease’s progression, allowing the intestinal tissues to heal and decreasing flare-ups.
• Immunomodulatory treatment: These reduce inflammation by controlling and weakening the immune system. They might be used in concert with a biologic, which is a medication that blocks proteins that contribute to inflammation.
• Biologic medications: These block the body’s inflammation response and can be given by infusion therapy—when medication is delivered directly into the body through a blood vessel, a muscle or the spinal cord. A medication called infliximab binds to and prevents the activity of a specific protein produced by the body that is known to create inflammation.

Plus, promising new treatments are on the horizon and Yale Medicine patients are often eligible to participate in clinical trials that give them earlier access. 

If medications fail to control the disease and symptoms cannot be managed—or if there is severe bleeding or a ruptured colon—surgery may be required. Our highly trained and experienced surgical colleagues work to restore a patient’s digestive tract through bowel-conserving surgery. When appropriate, we use minimally invasive procedures. 

The surgeon may perform a proctolectomy, in which the entire rectum and colon are removed. Additional procedures may be performed so that waste can still be removed from the body. Ulcerative colitis is considered cured once the colon is removed, but since it is believed to be an autoimmune disease, other symptoms such as joint pain or skin conditions may still occur.

At our Inflammatory Bowel Disease Program, we know the key to properly managing a patient’s disease is coordinating care among our specially trained physicians. Our program offers expertise in gastroenterology, surgery, pathology and radiology.

“We have a team approach with doctors, physician associates, nurses and surgeons all working together,” Dr. Proctor says. “Plus, we have more than 25 years of experience to help our patients.”

A goal is to empower people with ulcerative colitis to take an active role in their health care and improving their quality of life. To this end, Yale Medicine care providers work hard to educate patients about their disease. In our Inflammatory Bowel Disease Program, a dedicated APRN works closely with patients to offer nutritional resources, medication and surgical options and discuss topics like pregnancy and IBD and depression and chronic disease.