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Ulcerative Colitis
Ulcerative colitis (UC) is a lifelong condition characterised by inflammation and ulcers in the lining of the colon (large intestine) and rectum. UC often presents with periods of flare-ups, where symptoms are active, followed by periods of remission, where symptoms subside.
Crohn’s disease and ulcerative colitis are the main forms of inflammatory bowel disease (IBD).
Currently over 20,000 people are affected by IBD in New Zealand; approximately the same number as those who have type 1 diabetes.
The number of people with UC is rising in New Zealand.
Diagnosis of UC is typically confirmed by taking a small sample (biopsy) from the lining of the bowel wall. This is typically done by colonoscopy or flexible sigmoidoscopy.
Symptoms of Ulcerative Colitis
Symptoms can vary from mild to severe and often change over time.
Common symptoms include change in the bowel motions, which may be looser and may contain blood or mucous. You may find that you need to open your bowels more often, open your bowels at night, or get less warning (urgency).
More serious disease may also result in abdominal pain, fatigue, weight loss or fever.
Some people with UC will also experience symptoms affecting other parts of the body such as joint pain and swelling, eye irritation and skin issues.
Over time, inflammation of the colon is associated with an increased risk of bowel cancer. This means that it is important that the inflammation is well treated, and that patients with UC undergo colonoscopy.
Treatment for Ulcerative Colitis
Treatment is individualised and aims to reduce inflammation, relieve symptoms, achieve healing and maintain remission.
Management of UC is typically overseen by a specialist gastroenterologist. It includes both medications, colonoscopy, and, for some patients, surgery.
UC typically involves periods of flare-ups and remission. Most people manage their condition effectively with medication.
Gastroenterologists are experts in caring for people with ulcerative colitis. Your specialist will explain the treatment options that may be right for you and will ensure that you have appropriate treatment, monitoring and surveillance.
Medications
There are five main groups of medications used to manage UC. Usually these medications are taken by mouth or as an infusion, but for patients with disease limited to their lower bowel (rectum) enemas or suppositories may be advised. Your gastroenterologist will discuss which treatment options may be right for you.
Aminosalicylates: For mild to moderate UC (e.g., mesalamine).
Corticosteroids: For severe cases (e.g., prednisone).
Immunosuppressants: To calm the immune response (e.g., azathioprine, methotrexate).
Biologics: Target specific immune responses (e.g., vedolizumab (VDZ) or infliximab).
JAK Inhibitors: (e.g. Upadacitinib) Small molecule drugs to reduce inflammation.
Surgery
Surgery may be advised for patients whose UC is cannot be well controlled with medication, or who develop a complication of UC.
Your gastroenterologist will work closely with you and with your colorectal surgeon if surgery is being considered.
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