Diagnosis and treatment of ulcerative colitis

Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) that causes long-term inflammation and ulcers in the lining of the colon and rectum. It can significantly impact quality of life, but with early diagnosis and effective treatment, many people are able to manage their symptoms and avoid complications.

What are the symptoms of ulcerative colitis?

The condition often develops gradually. Recognising symptoms early is crucial to preventing disease progression. Common signs include:

Persistent diarrhoea, often with blood or mucus
Abdominal pain and cramping
Urgency to pass stool
Fatigue
Unintended weight loss

Some people may also experience joint pain, skin problems or inflammation in the eyes. These symptoms can be mistaken for other digestive issues, which is why timely assessment is important.

Why is early diagnosis important?

Early recognition of UC symptoms allows for earlier intervention, which often leads to better long-term outcomes. Uncontrolled inflammation over time can result in complications such as:

Increased risk of colon damage
Need for more aggressive treatment later
Higher chance of surgery
Greater risk of developing colorectal cancer

By identifying and confirming the diagnosis early, treatment can begin promptly to control inflammation, relieve symptoms and reduce the risk of flare-ups.

How is ulcerative colitis diagnosed?

Diagnosis is based on clinical assessment, blood and stool tests, and imaging such as:

Colonoscopy with biopsy – to assess the severity and location of inflammation
Blood tests – to look for anaemia or markers of inflammation
Stool tests – to rule out infection and monitor inflammation

The goal is to distinguish UC from other causes of bowel symptoms, such as Crohn’s disease or irritable bowel syndrome (IBS).

What is the approach to treatment?

A proactive, not reactive, approach to managing ulcerative colitis. Treatment plans are tailored to each patient and focus on achieving and maintaining remission. Options may include:

Aminosalicylates (5-ASAs): For mild to moderate disease
Corticosteroids: To control moderate to severe flares
Immunomodulators: To reduce the immune system’s overactivity
Biologic therapies: Such as anti-TNF or anti-integrin agents for moderate to severe cases
Novel treatments: Emerging therapies that target the gut immune system in more specific ways, offering options for patients who may not respond to standard medications

Surgery may be considered in severe or treatment-resistant cases.

What is involved in long-term management?

Living with UC involves more than treating symptoms during flares. Long-term management includes:

Regular monitoring to assess disease control and check for complications
Lifestyle advice on diet, stress management and exercise
Screening for colorectal cancer in long-term disease
Patient education to empower individuals to recognise symptoms and manage flares early

It’s important to review treatment effectiveness and adjust plans proactively, aiming for long-term remission and an improved quality of life.