Center for Digestive Diseases

UNM Hospitals Center
for Digestive Diseases

1001 Martin Luther King Ave. NE
Albuquerque, New Mexico 87106

(505)272-2530 or

UNMH: (505)272-6839
CDD: (505)925-7849

Ulcerative Colitis

What is Ulcerative Colitis?

Ulcerative Colitis is a chronic inflammatory condition of the colon (large intestine). Chronic inflammation can result in ulcerations in the colon.  If ulcerative colitis is left untreated scarring narrowing (called strictures) and colon cancer may develop.

What are the symptoms of Ulcerative Colitis?

Patients with ulcerative colitis frequently develop chronic diarrhea, rectal bleeding, urgency to defecate, and chronic abdominal pain.  Other symptoms can include fevers or chills, rashes and joint pain. 

What are the complications of Ulcerative Colitis?

Some patients with ulcerative colitis develop scarring in the colon that causes strictures (narrowing) that may cause increased abdominal pain, nausea and distension.  After many years of ulcerative colitis cancer in the colon may develop and for this reason periodic colon cancer screening via colonoscopy may be recommended by your doctor.  Patients can develop anemia and may require iron supplementation or blood transfusion. Prevention of complications of ulcerative colitis is a major goal in the treatment approach. Strict adherence to a medical regimen is vital in the prevention of these complications.

What causes Ulcerative Colitis?

The underlying cause of ulcerative colitis is not known. Ulcerative colitis involves several factors: inherited genes, the immune system, and the environment.  It is likely the result of an abnormal reaction by the body’s immune system to bacteria, foods, and other substances that are actually harmless or beneficial. During this process, white blood cells accumulate in the lining of the colon, producing chronic inflammation (swelling, redness and ulceration). High levels of a protein produced by the immune system, called tumor necrosis factor (TNF), are present in people with ulcerative colitis and several effective treatments are directed at decreasing the levels of TNF.

How is Ulcerative Colitis diagnosed?

A careful history and physical examination by a doctor is the first step in evaluating a person for suspected ulcerative colitis. Stool tests, blood tests, colonoscopy and CT scan may be part of your doctor’s recommendations in the workup.  Colonoscopy findings typically include redness, swelling, ulcerations or erosions.  Biopsy of the lining of the colon performed during colonoscopy shows findings of chronic inflammation that allow your doctor to make the diagnosis of ulcerative colitis.

What is the treatment for Ulcerative Colitis?

Treatment may include medications and/or surgery.  The specific treatment depends on the extent and severity of ulcerative colitis. Medications used in Ulcerative Colitis include anti-inflammation medications, steroids, immune modulators, biologics, antibiotics and antidiarrheal medications. 

Anti-inflammation medications: These medications are frequently used in mild, moderate and severe cases of ulcerative colitis. Examples of these medications include: sulfasalazine, mesalamine, Asacol, Pentasa, Lialda, Apriso, Olsalazine, balsalazide.

Steroids: These potent medications decrease inflammation acutely and are frequently used initially during periods of moderate or severe inflammation.  Patients are typically started on large doses and have improvement in their symptoms fairly quickly and then the dose is slowly decreased over a few months.  Due to significant long-term side effects of infections, diabetes, bone thinning and fracture and weight gain these medications should not be used long-term.  Examples of commonly used steroids include prednisone, budesonide (entocort) and solu-medrol.  

Immune modulators: These are medications that suppress the immune system and thereby decrease inflammation. Examples of these medications include azathioprine and 6-mercaptopurine (6-MP).  These medications are slower to act, taking up to 3-4 months to be fully active. Therefore, steroids are often used in the short-term until these medications become effective.  Side effects of these medications include nausea, vomiting, risk of infection, pancreatitis, hepatitis and rare instances of lymphoma.

Biological therapies. These are medications that decrease or prevent inflammation by binding to a protein produced by the immune system, called tumor necrosis factor (TNF).  Examples of these medications include infliximab (Remicade), adalimumab (Humira), and certolizumab (Cimzia). These medications are given either at an infusion center through the vein or as an injection into the skin at home. Possible side effects of these medications include infusion reactions, rash and rare infections.

Anti-diarrheal medications: Your doctor may recommend medications that slow your GI tract in order to provide relief of diarrhea.  Examples of medications commonly used include: diphenoxylate (Lomotil), loperamide (Immodium), and codeine.


Indications for surgery in ulcerative colitis include severe colitis (inflammation of the colon) that does not respond to medications, and development of colon cancer or precancerous lesions.  Surgery is usually directed at removing the entire colon and creating an ileostomy (in this procedure the small intestine is sewn to the abdominal wall and a bag is applied to the opening).  Sometimes the ileostomy bag can be permanently removed in a procedure called a J pouch.  This allows the patient to again pass stool through the anus. In this procedure the small intestine is sewn into a pouch and then connected to the anus.

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