What Causes Ulcers in Ulcerative Colitis?
For our Mini Med School video series, we break down how and why ulcers form when you have UC, plus the newest thinking on treatment.
Ulcerative colitis is a painful form of inflammatory bowel disease, a chronic condition where the lining of your large intestine becomes inflammed, leading to open sores known as ulcers. We'll take a closer look at what causes these ulcers to form, the role of your immune system in UC, and the latest thinking on how best to manage symptoms so you can keep living your life.
Open sores in your colon called ulcers are a classic sign of ulcerative colitis, a chronic disease that causes damaging inflammation to the mucus layer that forms the innermost lining of the large intestine. UC is a type of inflammatory bowel disease, or IBD. The most common symptoms of ulcerative colitis are a change in bowel habits that can include any of the following: diarrhea, rectal bleeding, severe abdominal pain, weight loss, fever, and fatigue. These symptoms, combined with intestinal ulcers, can lead to severe pain.
But what causes UC ulcers in the first place? Simply put, they are the result of an overzealous immune response. In people with healthy immune systems, inflammation can help fight off foreign invaders like bacteria. But in those with UC, the immune system wrongly perceives the microbiome, a community of germ-fighting microorganisms that live in your gut, as a threat.
As a result, it creates a state of constant or chronic inflammation that damages healthy tissue in your colon and rectum. Severe inflammation can destroy the cells that line your colon. As those dead cells slough off prematurely and rapidly, they cause open sores, a.k.a. ulcers. Exposed blood vessels beneath an ulcer can bleed, producing pus and mucus and such damage to the mucosal lining means your intestine may not absorb food and water like it should, causing frequent diarrhea, often with blood and mucus in your stool.
To get painful UC ulcers under control, your doctor may prescribe a short-term course of steroids to bring down inflammation quickly. Once your ulcers have healed, the goal is to prevent future flares and ulcers with the right medications. If your UC is mild, your doctor may prescribe aminosalicylate, an oral pill or a rectal suppository, to help reduce inflammation. For moderate to severe cases your physician may prescribe an immunomodulator, which is taken as a pill or an oral injection and works by slowing your body's immune response to reduce the inflammatory cascade.
Biologics are another option. These medications, administered via injection or IV, block key proteins and immune cells from triggering inflammation in your intestine. Sometimes ulcers form during active treatment. But once you're in remission, meaning you are symptom-free, your doctor may take you off your medication, tweak your dosage, or switch to another treatment to prevent future flares.
For severe cases, surgical removal of the colon and rectum may be necessary, replacing it with either an internal J-pouch or an external pouch called an ostomy bag, to collect waste outside your body. Fortunately, due to the effective new drug treatments, including biologics, such surgeries are not common.
To learn more about ulcerative colitis, visit HealthCentral.com.