Ulcerative colitis

Ulcerative colitis is a chronic inflammation of the lining of the colon. Symptom-free phases typically alternate with periods when pain in the left abdomen, diarrhea and weight loss can be so severe that they stop people from living a normal life. Sometimes they may even need hospital treatment.

Unlike Crohn’s disease, which affects the whole intestine, ulcerative colitis only involves inflammation of the colon.

Medical practitioners refer to ulcerative colitis that is restricted to the last section of the colon as proctitis.

Around 150,000 people in Germany have ulcerative colitis.

A number of symptoms may occur during acute flare-ups. Some are relatively mild or rarely occur but others are recurrent:

• bloody diarrhea
• frequent bowel movement
• abdominal pain in the form of cramps
• high temperature
• swelling and pain in hips and knees
• red, sore eyes
• rash
• ulcers or wounds in the mouth
• weight loss

It is not yet known what causes ulcerative colitis. Symptoms are caused by an inflammation of the intestinal mucosa. The body’s immune system attacks its own mucosa.

People whose close family members have the disease have a greater risk of also developing it. It is not clear what can trigger an acute flare-up. Stress, environmental factors and other diseases are believed to be potential causes of flare-ups.

Most people develop the disease as schoolchildren or students and then suffer from it for the rest of their lives.

Only a very small number of people with the disease have a permanently inflamed colon. It typically involves recurrent flare-ups that alternate with phases of no or mild symptoms. The inflammation also clears up during these dormant phases.

Persistent symptoms can cause malnutrition and can sometimes lead to life-threatening complications. People with ulcerative colitis also have a permanently increased risk of bowel cancer. Doctors advise patients to have regular colonoscopies to identify it early on.

Inflammation of the intestinal mucosa may have a range of causes. Various examinations may be considered to differentiate between other chronic conditions such as Crohn’s disease, acute infection or food intolerances and ulcerative colitis.

First, the doctor asks the patient, for example:

• what type of symptoms they have and when they started
• whether any foods are not tolerated
• what vaccinations they have had
• whether they smoke
• whether any family members have ulcerative colitis

In most cases doctors then suggest an ultrasound scan, blood tests and a colonoscopy, where a tissue sample is taken from the intestinal wall.

The colonoscopy may be repeated after a few months.

Anti-inflammatory medication is used to treat acute flare-ups. The severity of the flare-up and the area of the colon affected will determine which active substances are selected and how they are combined.

5-aminosalicylic acid is often used at the start of treatment. Medications containing cortisone are also used.

Other medication may be useful depending on how effective this treatment is and how it is tolerated. If the usual medication stops working or the side effects are too severe, treatment may be switched to biological medicines (biologics). These include, for example, TNF-alfa inhibitors, which are designed to inhibit the immune system.

Surgery may be required if medication therapy is no longer working or severe complications occur.

Would you like to know more about “biologics”? For useful information, visit gesundheitsinformation.de.

There are lots of services offering support for people with ulcerative colitis in Germany. These include self-help groups and advice centers. These local facilities are organized in various ways. A list of points of contact can help with finding and using the right service.

You can find suitable self-help offers via a database on the National Contact and Information Point For Encouraging and Supporting Self-Help Groups (NAKOS) website.