Children's Hospital Colorado

Ulcerative Colitis

What is ulcerative colitis?

Ulcerative colitis (UC) is a chronic disease of the large intestine, also known as the colon, in which the lining of the colon becomes inflamed and develops tiny open sores called ulcers. The combination of inflammation and ulceration can cause abdominal discomfort and bloody diarrhea.

Ulcerative colitis is the result of an abnormal response by the body's immune system. Normally, the cells and proteins that make up the immune system protect from infection. In people with UC, however, the immune system mistakes food, bacteria and other materials in the intestine for foreign or invading substances. When this happens, the body sends white blood cells into the lining of the intestines, where they produce chronic inflammation and ulcers.

It’s important to understand the difference between ulcerative colitis and Crohn’s disease (CD). Crohn’s disease can affect any part of the gastrointestinal (GI) tract, but ulcerative colitis affects only the colon. Additionally, while Crohn’s disease can affect all layers of the bowel wall, ulcerative colitis only affects the lining of the colon.

While both UC and CD are types of Inflammatory Bowel Diseases (IBD), they should not be confused with Irritable Bowel Syndrome (IBS), a disorder that affects the muscle contractions of the colon. IBS does not involve intestinal inflammation.

What causes ulcerative colitis?

Doctors and researchers do not yet know what causes UC. Studies indicate that the inflammation in IBD involves a complex interaction of factors: the genes the person has , the immune-inherited system and something in the environment that triggers the condition.

Foreign substances (antigens) in the environment may be the direct cause of the inflammation, or they may stimulate the body's defenses to produce an inflammation that continues without control. Researchers believe that once the IBD patient's immune system is "turned on" it does not know how to properly "turn off" at the right time. As a result, inflammation damages the intestine and causes the symptoms of IBD. That is why the main goal of medical therapy is to help patients regulate their immune system better.

Who gets ulcerative colitis?

Ulcerative colitis may affect as many as 700,000 Americans. Males and females are equally likely to be affected. In pediatrics, the typical age is 12-14 years, although cases in children under 10 years old are on the rise.

While UC tends to run in families, researchers have been unable to establish a clear pattern of inheritance. Studies show that up to 20% of individuals with UC will also have a close relative with the disease. The disease is more common among white people of European origin and among people of European Jewish heritage.

Helpful resources

What are the signs and symptoms of ulcerative colitis?

Symptoms related to inflammation of the GI tract:

  • Persistent diarrhea
  • Rectal bleeding
  • Urgent need to move bowels
  • Abdominal cramps and pain
  • Sensation of incomplete evacuation

General symptoms that may also be associated with IBD:

  • Fever
  • Loss of appetite
  • Weight Loss or poor weight gain
  • Fatigue
  • Night sweats

People suffering from ulcerative colitis often experience loss of appetite and may lose weight as a result. A feeling of low energy and fatigue is also common. Among younger children, ulcerative colitis may delay growth and development.

The symptoms of ulcerative colitis do tend to come and go, with fairly long periods in between flare-ups in which patients may experience no distress at all. These periods of remission can span months or even years, although symptoms do eventually return. The unpredictable course of ulcerative colitis may make it difficult for physicians to evaluate whether a particular treatment has been effective or not

What tests are used to diagnose ulcerative colitis?

In order to diagnose ulcerative colitis, physicians combine information gathered from several different tests. Normally UC is diagnosed by a combination of:

  • History and physical exam: A doctor will examine your child and ask about his or her health in the past.
  • Growth curves: These are a measurement of how children are growing compared to their peers.
  • Blood tests
  • Upper intestinal endoscopy and colonoscopy with biopsies: A surgeon will use a tiny camera to examine the insides of your child’s GI tract, then take a small amount of tissue from the areas affected by Crohn’s to look at the cells under a microscope.
  • MRI
  • CT Scan

How do doctors at Children’s Hospital Colorado make a diagnosis?

The doctors at Children’s Colorado make a diagnosis by assessing a combination of information including medical history and physical exam, blood tests, upper intestinal endoscopy and colonoscopy with biopsies and some form of radiologic evaluation such as MRI or CT scan.

How is ulcerative colitis treated?

Ulcerative colitis is treated in a variety of ways depending on the severity of the disease. In general the goal is to decrease inflammation and damage to the colon. These therapies could include medication by mouth or injection or, ultimately, surgery to remove the colon.

At Children’s Hospital Colorado we try to use the most effective methods with the least amount of unwanted side effects. We use oral as well as injected anti-inflammatory medications to bring the disease under control. Because ulcerative colitis is a lifelong or chronic disease, frequently these medications will be needed life long and proper monitoring and dosing is crucial. If the disease remains persistent we will enlist the assistance of our pediatric surgeons for removal of the colon (colectomy) as a curative procedure

In addition, to more traditional approaches to the treatment of ulcerative colitis we also participate in clinical trials to evaluate new treatments and perform research to help find new therapies for the treatment of the inflammatory bowel diseases.

Why choose Children’s Hospital Colorado for your child’s ulcerative colitis?

The Children’s Colorado Inflammatory Bowel Diseases Center at the Digestive Health Institute is the only center in the region to provide comprehensive pediatric-specific multidisciplinary care in a team comprised of board certified pediatric gastroenterology physicians, advance practice nurses, a nurse coordinator, social worker, nutritionist, pediatric radiologist, pediatric surgeon, psychologist and child life specialists. The center provides a platform for a seamless continuum of care for children with IBD. Our focus on nutrition and its role in pediatric IBD stands out as an example for other practices in the treatment of IBD.

With a combined 50 years of experience caring for patients with IBD, our physicians treat children with IBD and are leaders in research, education and improving quality of care. Our program participates in the Improve Care Now network for collaborative work in continuous quality improvement, innovation and discovery to improve the health and well being of children and adolescents with IBD. Within this international consortium our center performs in the top for remission rates, nutrition and growth status.

Our physicians and support staff aim to provide compassionate patient centered care including comprehensive evaluation and a complete care plan in order to provide children with IBD the opportunity to flourish without having to focus on their condition. We also aim to provide the skills and understanding of their disease to make the transition to adulthood and adult medical care as simple as possible for our patients.

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