Ulcerative colitis (UC) symptoms improve during periods of remission and worsen during periods of relapse, or flare-ups. More frequent or severe flare-ups may indicate that UC is progressing or that someone’s treatment is not working as well as it should.
The main goal of treatment is to bring the condition into remission and keep it there.
Ulcerative Colitis Progression Guide
Increased
flare-ups
Systemic
inflammation
Extraintestinal manifestations
Treatment
changes needed
Surgery
UC may cause more systemic inflammation throughout the body as it progresses. This may lead to new or worsening gastrointestinal symptoms, as well as symptoms in other
parts of the body.
It may also cause higher erythrocyte sedimentation rate
(ESR) and C-reactive protein (CRP) levels, which are
markers of inflammation that a doctor measures with blood tests. Doctors can also measure inflammation using a stool
test called fecal calprotectin.
These symptoms may worsen when UC is more active. The risks of certain types of kidney disease, liver disease, anemia, and osteoporosis also increase in people with UC.
Increased
flare-ups
Systemic
inflammation
Extraintestinal manifestations
Treatment
changes needed
surgery
Colorectal
cancer risk
Colorectal
cancer risk
About 10–30% of people with UC develop extraintestinal manifestations, which are signs of inflammation outside the intestines. For example, you may develop:
eye redness and discomfort
joint pain and swelling
a skin rash or sores
Sometimes, surgery is needed to treat moderate to severe UC.
biologics
small molecule therapies — Janus kinase (JAK) inhibitors and sphingosine-1 phosphate (S1P) receptor modulators
immunosuppressants
Your doctor may prescribe aminosalicylates or corticosteroids to treat mild to moderate UC. If the condition progresses or does not respond well to these treatments, the doctor may recommend a change in treatment. Medications for moderate to severe UC include:
have widespread or severe inflammation
develop UC younger than 40 years
Roughly 10–15% of people with UC need a colectomy within 5–10 years of developing the condition. A colectomy is a type of surgery that removes part or all of the colon. People are more likely to need a colectomy if they:
have signs or symptoms of inflammation outside
the intestines
People with UC are 2–3 times more likely than average to develop colorectal cancer. The risk may depend on a person's age at diagnosis, the duration and severity of disease, and any comorbid conditions.
The American College of Gastroenterology recommends that people with UC that extends beyond the rectum get a colonoscopy to screen for colorectal cancer every 1–3 years, starting 8 years after diagnosis.