Chronic Ulcerative Colitis (CUC) is an inflammatory disease involving the distal colon, although it may extend to involve the entire colon. CUC is characterized by diarrhea commonly associated with rectal bleeding and colicky abdominal pain. Urgency is severe and involves the entire colon; colonic dilation may occur, resulting in perforation. Any type of bloody diarrhea requires consultation with a GI specialist.

Extraintestinal manifestations (infections that occur outside of the intestine) of CUC are common. These include arthritis involving the large joints and ocular problems resulting in blurred vision.

Evaluation of possible ulcerative colitis includes laboratory and radiologic imaging. However, the diagnosis will eventually require colonoscopy done by a GI MD who performs colonoscopies. An endoscopy will evaluate the severity and extent of the inflammation. Colon biopsies will be obtained to establish the diagnosis and exclude other causes of colon inflammation.

In the past, treatments of ulcerative colitis were limited to oral mesalamine and corticosteroids. Although treatment of mild CUC often begins with mesalamine, treatment failures are common. Corticosteroids are often used to treat moderate to severe CUC, but again, treatment failures are common, as are side effects.

Even if clinical response occurs, this regimen cannot be used to maintain remission. Fortunately, multiple biologic therapies are now available with new innovative drugs on the horizon. The current goal of treatment is mucosal healing.

If this can be achieved, then complications of this disease, such as an increased risk of colon cancer, can be avoided. A total colectomy due to perforation or toxic megacolon can also be avoided. This therapy requires monitoring by GI specialists.