Ulcerative colitis:
symptoms, causes and treatment

Like Crohn’s disease, ulcerative colitis is a chronic inflammatory bowel disease (IBD). Around 25,000 people in Switzerland suffer from IBD.

In ulcerative colitis, the mucous membrane of the colon becomes inflamed, causing ulcers and bleeding. Acute relapses alternate with periods with few symptoms (remission).

Unlike Crohn’s disease, ulcerative colitis does not affect the entire gastrointestinal tract, but only occurs in the large intestine.

Ulcerative colitis causes symptoms typical of intestinal inflammation:

• Bloody diarrhoea with mucus
• Abdominal pain, cramps
• Painful urge to defecate

Anaemia, fever, fatigue, palpitations and weight loss may also occur, and children and adolescents might experience growth disorders.

Outside the intestine, ulcerative colitis also sometimes causes symptoms such as inflammation of the eyes, joints, mouth, skin and anus, as well as diseases of the liver, kidney, gall bladder, pancreas or bones (osteoporosis).

In order to detect ulcerative colitis, the doctor and patient first discuss the symptoms and medical history in detail (medical history).

This is followed by a physical examination, in which the doctor examines the patient’s mouth and anus. The doctor also checks whether there are any symptoms outside the intestine (e.g. eye inflammation).

A rectal examination is performed at the latest during a colonoscopy.

Blood tests (e.g. blood count, iron levels, inflammatory parameters such as CRP), ultrasound and histological findings (by taking tissue from the intestine) can help to verify the diagnosis.

If the suspicion of ulcerative colitis is confirmed, it is classified according to how extensive it is:

• In proctitis, only the end of the intestine (rectum) is inflamed.
• Left-sided colitis refers to inflammation up to the left curvature of the colon.
• Pancolitis can affect the entire colon.

Chronic inflammatory bowel diseases cannot be cured. The aim of treatment for ulcerative colitis is therefore to achieve remission quickly and to extend it for a long time.
If you notice that a flare-up is imminent, consult your doctor immediately in order to prevent the inflammatory response as quickly as possible.

Anti-inflammatory drugs for ulcerative colitis

Drug therapy is based on the extent of the ulcerative colitis, the severity of the symptoms and the measures to which the patient has responded well so far. Medicines may be administered as suppositories, foams, enema, tablets or intravenously as needed.

5-aminosalicylates (e.g. mesalazine) are considered the standard therapy for ulcerative colitis. They alleviate inflammation during a flare-up and also serve to maintain remission. E. coli Nissle is a probiotic and has also been proven for maintaining remission.

If the above-mentioned remedies are not sufficiently effective, they can be combined with other anti-inflammatory medicines:

• Corticosteroids (cortisone)
• Other immunosuppressants: thiopurine (azathioprine, 6-mercaptopurine), cyclosporine, tacrolimus, ozanimod (a novel S1P receptor modulator approved in the EU in 2021)
• Antibodies (biologics), such as anti-TNF therapy (e.g. adalimumab, infliximab) or vedolizumab
• JAK inhibitors (tofacitinib, filgotinib) block certain pro-inflammatory enzymes

Anti-diarrhoea products, antibiotics and antispasmodics are sometimes used to relieve the symptoms of ulcerative colitis.