Ulcerative Colitis is a chronic condition confined to the colon and rectum, in which inflammation occurs along with ulceration; according to conventional medicine it is incurable. Diagnosis is usually by means of colonoscopy and mucosal biopsy, but may extend to an abdominal X-ray, barium enema, full blood count and Liver enzyme tests. Initial treatment for flare-ups is usually administration of steroids such as prednisolone.

The hallmark symptom is blood and mucus in the stools, along with abdominal pain, urgency, tenesmus, frequent bowel movements and diarrhoea. Patients may also experience

• fatigue
• weight loss
• loss of appetite
• rectal bleeding
• loss of body fluids and nutrients

Symptoms outside the bowel may also be in evidence (see Figure above).

About 50% of patients with ulcerative colitis have mild symptoms while others suffer frequent fever, bloody diarrhoea, nausea, and severe abdominal cramps. Ulcerative colitis may also induce problems such as arthritis, osteoporosis, skin rashes, and anemia. It is not known why problems occur outside the colon but scientists think such complications may occur when the immune system triggers inflammation in other parts of the body. Some of these problems go away when the colitis is treated.

There are cycles of attack (flare ups) and healing (remission) which result in the narrowing of the intestinal tract, causing complications.
Theories about what causes this condition abound, but none have been conclusively proven. The most popular theory is that the body's immune system reacts to a virus or a bacterium by causing ongoing inflammation in the intestinal wall. People with ulcerative colitis have abnormalities of the immune system, but it is not known whether these abnormalities are the cause or a result of the disease.

• About 50% of relapses of UC are associated with pathogens, and it is good practice for a stool culture to be taken in all cases of flare ups.

It seems likely that UC is an autoimmune condition characterised by an inflammatory response to colonic flora. It is associated with auto-antibodies including epithelial auto-antibodies. 60% of patients test positive for perinuclear anti-neutrophil cytoplasmic antibody (pANCA). There is also an association with genes of the human leukocyte antigen region. These genes have a role in the regulation of the immune system.

Environmental factors implicated in UC include:

• Smoking
• NSAID's - non-steroidal anti-inflammatory drugs can cause flare ups in some patients
• Stress - around 40% of patients cite this as a cause of flare ups.

Long standing inflammation in the colon can lead to the formation of 'pseudopolyps'. These are benign lesions that can be quite large and difficult to distinguish from adenomas (which have the potential to become cancerous).

If a patient suffers from a flare up, it is important to assess the severity. If more than six bloody stools are passed in a day, and systemic symptoms such as night sweats, fever and nausea are present, then this is a significant flare up requiring medical treatment.

As a result of the condition, water and minerals are not well absorbed, so there is an escalation of ill health, loss of appetite, weight loss, and possible dehydration and anemia, as well as general fatigue.

Ulcerative colitis affects only the innermost lining of the colon, and is continuous throughout the colon. In addition, UC can cause inflammation in the eyes, skin and joints, liver disease, kidney stones and colon cancer.

No single test is sufficient to diagnose this condition, and sufferers are often put through an endless round of endoscopic, radiological and histological assessments, laboratory testing and bowel studies in order to come up with a definitive diagnosis. Diagnosis can be complicated by the fact that ulcerative colitis mimics several other conditions such as intestinal bacterial tuberculosis, endometriosis of the bowel, diverticulitis, lymphoma, and food allergy. Certain drugs like NSAID’s, sulphasalazine and gold salts can all cause inflammatory symptoms.
Ulcerative colitis affects approx 95,000 people in the UK - that's about 1 in 600, with about 5,500 new cases are diagnosed each year.

The aims in treating UC are firstly to induce remission, and then to maintain remission.

• Intravenous corticosteroids are used for severe flare ups.
• Oral prednisolone, starting at a dose of 40mg per day is used to induce remission. This is tapered down to zero over 8-10 weeks. Long term use is avoided due to side effects.
• It is important to note that although natural formulas may be useful in maintaining remission, they do not help to induce remission.
• Mesalazine (also known as 5-ASA or Pentasa) can be used to induce and maintain remission.
• Azathioprine is an immunosuppressant that is used when there is intolerance to corticosteroids, or there is requirement of more than two corticosteroid courses within the same calendar year. It is also used if there is a relapse within 6 weeks of stopping steroid use.
• Infliximab is a monoclonal antibody for use against the pro-inflammatory cytokine TNF-alpha. It is used in moderate to severe cases of UC when conventional treatments have failed.

One of the current theories regarding Ulcerative Colitis revolves around a particular immune system cytokine, IL-17. This cytokine was only discovered in 2006, but is found in almost all autoimmune pathologies or diseases. We have known for some time that some probiotic bacteria can help reduce the severity of the inflammation in many cases of UC, without really knowing the specific mechanism. Now it appears that researchers in Japan have discovered a potential explanation. IL-17 is a very potent pro-inflammatory cytokine, that is it causes inflammation. When it is over produced in the colon, a chronic inflammatory condition can result. Administration of Bifidobacteria inhibited IL-17 production by producing IL-10, another cytokine which has a ‘cancelling’ effect on IL-17. 

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