Survival and Cause-Specific Mortality in Ulcerative Colitis

Most people with ulcerative colitis live a normal lifespan when the disease is properly managed. For the small number for whom ulcerative colitis is fatal, the main causes include secondary cancers and autoimmune problems.

Ulcerative colitis is a chronic condition in which the large intestine (colon) becomes inflamed with sores (ulcers), resulting in diarrhea and bleeding. It typically affects the lower part of the colon and the rectum, but can affect the entire colon. 

Ulcerative colitis is related to Crohn's disease, another inflammatory condition of the intestines. While ulcerative colitis only affects the colon, Crohn's disease can affect any portion of the gastrointestinal tract from the mouth to the anus, including the bowels. Both ulcerative colitis and Crohn's disease are referred to as inflammatory bowel disease (IBD).

Symptoms of ulcerative colitis include:

• Rectal bleeding
• Abdominal pain
• Abdominal cramps
• Diarrhea (may be bloody)
• Rectal pain 
• Urgency (sudden feeling of having to defecate immediately)
• Painful urge to move the bowels caused by the inflammation (tenesmus)
• Weight loss
• Fatigue
• Fever
• Night sweats
• Dehydration 

Patients with ulcerative colitis usually experience periods of relapse when inflammation and symptoms worsen, followed by periods of remission, lasting months to years when symptoms subside. 

The cause of ulcerative colitis is unknown, but the condition is believed to involve an abnormal activation of the immune system in the intestines, which causes chronic inflammation and ulceration in portions of the large intestine. 

This susceptibility to abnormal activation of the immune system is genetically inherited. Having a first-degree relative (brother, sister, child, and/or parent) who has ulcerative colitis is a risk factor for developing ulcerative colitis.

Ulcerative colitis is diagnosed with a physical exam and patient history. The following tests may be performed: 

• Stool testing
  • To exclude infection and parasites
  • Calprotectin
• Blood tests 
  • Complete blood count (CBC)
  • Sedimentation rate 
  • Kidney function
  • Liver function tests
  • Iron studies
  • C-reactive protein 
• Colonoscopy or sigmoidoscopy
• Tissue biopsy
• Barium enema X-ray 
• Video capsule endoscopy 
• CT/MRI enterography

Ulcerative colitis is usually treated with medications. Medications do not cure ulcerative colitis. They are used to induce or maintain remissions and improve quality of life. Surgery is used as a last-resort for patients who have severe inflammation and life-threatening complications. 

Medications used to treat ulcerative colitis include:

• Anti-inflammatory drugs 
  • 5-ASA compounds
    • Mesalamine (Asacol, Pentasa, Rowasa, Lialda, Apriso)
    • Olsalazine (Dipentum)
    • Balsalazide (Colazal)
  • Systemic corticosteroids (prednisone, prednisolone, cortisone)
  • Topical corticosteroids
• Immunomodulators
  • Azathioprine/6-MP (Imuran, Azasan)
  • Methotrexate (Trexall, Otrexup)
  • Cyclosporine (Sandimmune, Neoral)
• Biologic therapies
  • Infliximab (Remicade) 
  • Janus kinase inhibitors (JAK Inhibitors)

Surgery for ulcerative colitis is a last-resort for severe cases and usually involves removing the entire colon and the rectum. Removal of the colon and rectum is the only permanent cure for ulcerative colitis. 

Complications of ulcerative colitis include: 

• Clostridium difficile (C.diff) infection
• Increased risk of developing osteoporosis
• Poor growth and delayed puberty 
• Primary sclerosing cholangitis
• Toxic megacolon
• Increased risk of bowel cancer (rare)

Most people with ulcerative colitis live a normal lifespan when the disease is properly managed. 

For the small number for whom ulcerative colitis is fatal, the main causes include: 

• Colorectal cancer
• Asthma
• Sepsis from infections related to bowel disease
• Non-alcohol-related liver disease
• Other gastrointestinal diseases