Ulcerative Colitis

Ulcerative Colitis (UC) is a disease where the large intestine or bowel (colon) mucosal lining develops chronic inflammation. It affects only the colon and is associated with formation of ulcers. In some cases, only the rectum or lowest most end of the colon is involved and this is called ulcerative proctitis.

A long-term complication of UC is the development of colon cancer. This risk is higher in patients where the entire colon is diseased and in patients who have suffered UC for longer period of time. For early detection of colon cancer, you may be recommended to undergo screening colonoscopy.

In our local Singapore population, UC is uncommon and occurs in 6 out of 100,000 individuals.

There are general symptoms, specific bowel symptoms and others that affect distant sites other than the bowel.

• General symptoms are fatigue, tiredness, loss of appetite and sometimes fever.
• Specific symptoms related directly to the bowel include diarrhoea containing mucous and / or blood with abdominal pain. Some patients may experience nausea and vomiting. The bowel inflammation may result in loss of blood which is not obvious to us, however over time, this ongoing blood loss will result in anaemia.
• Extra-intestinal symptoms means other body parts are affected other than the bowel. There may be arthritis or inflammation of the larger and smaller joints of the arms and legs, as well as the spine and pelvis bone. The skin may also react in the form of painful purplish-red areas of thickening, most commonly occurring on the arms and legs (erythema nodosum). The eyes could also become inflamed but this symptom is not as common.

The doctor will perform a thorough physical examination of your entire body, particularly the abdomen and the rectum. The skin, mucous membranes, eyes or joints will also be checked to assess for signs of inflammation.

The investigations may include blood tests and colonoscopy.

During the colonoscopy, tissue samples of the inflammed colon can be taken for further testing.

It is important for you to understand that UC is a chronic disease and can remain inactive with careful medical attention and ongoing monitoring.

There may be frequent visits to the doctor initially to bring the disease under control. Long-term monitoring is required.

The treatment will depend on the severity and type of the disease. Medical treatment options include oral 5-aminosalicylic acid (5-ASA) drugs, antibiotics, corticosteroids, immunosuppressive agents and immunomodulators such as infliximab.

Surgery is also indicated in UC with severe complications.

In general, patients with UC do not require a special diet. A balanced diet providing the necessary nutrients, vitamins and minerals should be the goal.