Medically Reviewed On: July 18, 2008

ANNOUNCER: Ulcerative colitis is an inflammatory bowel disease or IBD that causes chronic inflammation of the colon or large intestine.

DAVID RUBIN, MD: Patients who have ulcerative colitis develop inflammation and erosions, or destruction, of the lining of the large intestine, and because of that, they have symptoms of loose stools and diarrhea with urgency, and often bleeding.

ANNOUNCER: Ulcerative colitis is closely related to another IBD, called Crohn’s disease. They can share similar symptoms, but they also have distinct differences.

DAVID RUBIN, MD: Ulcerative colitis is characterized primarily by involvement of the large intestine. Crohn’s disease, on the other hand, is a condition in which you can have this type of inflammation, but it may involve any portion of the GI tract, from the mouth all the way through the stomach, small intestine, large intestine and even perianal area, around the anus.

ANNOUNCER: More than 500,000 Americans have been diagnosed with ulcerative colitis. While it affects people of all races, it seems to be more prevalent in certain populations.

STEPHEN HANAUER, MD: Primarily the upper socioeconomic groups develop ulcerative colitis. So, for instance, in third world countries, we only see it in the affluent, and in the evolving countries it’s the city people and the more affluent people who develop ulcerative colitis first. That means, we think, that being exposed to bacteria or poor sanitation is probably protective against the development of ulcerative colitis.

DANIEL PRESENT, MD: This is a disease one sees in the late teens, early 20s, and this is what makes it a terrible disease, in that those are the times when people are forming their personality, going off to school, starting to date, and so it impinges on what will be their quality of life, having to deal with an illness while they're dealing with growing up.

ANNOUNCER: Although the exact cause of the disease is unknown, researchers believe that a combination of factors is involved.

STEPHEN HANAUER, MD: We believe that there are two components to ulcerative colitis. The first is a genetic disposition to getting the condition, and then the second is a trigger from the environment. And when we talk about the environment, we talk about what’s inside our intestine, which is probably some form of a bacteria or other infectious agent that starts the inflammation, and then the body continues it or perpetuates it and is unable to shut down the inflammation as it would in an infection.

DAVID RUBIN, MD: The biggest risk factor for ulcerative colitis is having a sibling, a brother or sister, who also has inflammatory bowel disease. So we would identify that as being something that would be predictive of an increased risk. Having said that, it’s still a rare condition even among siblings. Even if you looked at two people who were identical twins, meaning they have the genetic makeup, the likelihood that both twins have ulcerative colitis is less than 10 percent. So this isn’t all about genetics at all.

ANNOUNCER: Symptoms may vary and are often marked by periods of flares and remissions.

LAWRENCE BRANDT, MD: Most people with ulcerative colitis develop diarrhea, bloody diarrhea, rectal bleeding, lower abdominal cramps and a general feeling of illness. That’s where we start.

ANNOUNCER: The extent of involvement in the colon is often related to the severity of symptoms and the course of disease.

DANIEL PRESENT, MD: The main types that we classify are, first, proctitis. And that involves just the rectum, which is about anywhere from five to seven inches. And those patients, they can have bleeding and urgency, but they don't get sick systemically. We then talk about proctosigmoiditis, where it involves the sigmoid and that's pretty close to proctitis, similar type symptoms, perhaps a little bit more severe, a little bit more discomfort. Then, we classify it as left-sided colitis, where it goes from the rectum up to the splenic flexure with no skip areas. And, finally, we classify it as extensive or universal disease where the whole colon is involved. These are the patients, in the short term, that are at risk for being sicker, for developing more severe disease, and unfortunately with these patients, eight to ten years later if they've had extensive disease, there is now suddenly an increased risk for developing colorectal cancer.

Fulminant disease is usually associated with extensive disease, occasionally left-sided. But, in this situation, the patient is systemically sick. They're usually running fevers, they've lost a lot of weight, their bellies are very tender and they are at high risk for complications such as perforation or the development of something called toxic megacolon.

ANNOUNCER: Diagnosing ulcerative colitis can be complicated and takes many factors into consideration.

DAVID RUBIN, MD: The diagnosis is made by a combination of a variety of important things, starting with a patient who has symptoms of an inflamed rectum, usually with blood in their stool, and supported further by laboratory tests, which are blood tests, and it is very important that the patient have some type of endoscopy, usually a colonoscopy, where biopsies are obtained and looked at by an experienced pathologist.

ANNOUNCER: Ulcerative colitis is a chronic disease that requires ongoing treatment. Serious complications can occur including an increased risk for colorectal cancer. Although there is no known cure for the disease, therapies are available that may significantly reduce the signs and symptoms and even bring about long-term remission.

STEPHEN HANAUER, MD: We’ve known about ulcerative colitis for well more than 100 years. The vast majority of patients can be treated successfully and can expect to have normal lifestyle and live a normal life expectancy.