What is Ulcerative Colitis?

Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting the colon and rectum. It causes continuous mucosal inflammation, ulceration and bleeding. Symptoms include bloody diarrhoea (often 10–20 times/day during a flare), urgency, cramping and fatigue. Unlike Crohn's disease, UC is confined to the large bowel and is curable by surgery.

Medical Management

• 5-ASA compounds (mesalazine) — first-line for mild-moderate UC; oral and/or rectal formulations
• Corticosteroids — prednisolone, IV hydrocortisone for acute flares; not for long-term maintenance
• Immunomodulators — azathioprine, 6-mercaptopurine for maintenance of remission
• Biologic therapy — infliximab, adalimumab, vedolizumab, ustekinumab for moderate-severe UC
• Small molecule inhibitors — tofacitinib, filgotinib for refractory UC

When is Surgery Needed?

• Acute severe colitis unresponsive to IV steroids (toxic megacolon, perforation, haemorrhage)
• Medically refractory disease — persistent symptoms despite optimal medical therapy including biologics
• Dysplasia (precancerous change) or colon cancer on surveillance colonoscopy
• Side effects of long-term steroids or immunosuppressants
• Growth failure in children

Surgery for UC (restorative proctocolectomy with IPAA) is curative. See the Surgery for Ulcerative Colitis page for details.