Ulcerative Colitis

Ulcerative colitis is an inflammatory bowel disease (IBD). IBD is a general term for noninfectious conditions that involve chronic inflammation of the intestines, causing symptoms such as diarrhea, abdominal pain, fevers, bleeding and growth problems.

Crohn's disease is another kind of IBD, as is a more unusual form called microscopic colitis. Although ulcerative colitis and Crohn's disease are often difficult to distinguish from each other because they have many of the same symptoms, they affect the digestive tract differently.

Ulcerative colitis is limited to the colon. In 80 percent of children, it affects the entire colon, but in some it is limited to the lower part and called left-sided colitis or proctitis. Crohn's disease, on the other hand, may involve any part of the digestive tract, from the mouth to the anus. Another difference is that the inflammation doesn't extend as deeply into the intestinal wall in ulcerative colitis as it does in Crohn's disease.

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About 25 percent of IBD cases begin in childhood, even in children under age 2. Diagnosis is often delayed because IBD is confused with other conditions, such as lactose intolerance, a stomach virus or school avoidance behavior.

The condition can be inherited and is common in some families. About 20 to 25 percent of people — and up to 40 percent of very young children — with ulcerative colitis have a close relative with ulcerative colitis or Crohn's disease. The immune system's response to certain bacteria in the gut and the patient's genetic makeup are believed to be the primary causes.

In UCSF's IBD Program, a medical team of doctors, nurse practitioners, dietitians, social workers and other consultants — including pediatric experts in psychology and psychiatry, infectious diseases, rheumatology, dermatology, ophthalmology and surgery — work together to provide your child and family with optimal and state-of-the-art care. Please feel free to request information about our program at any time.

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The first symptom of ulcerative colitis is often blood in the stool or persistent and sometimes progressively worsening diarrhea. The bloody stool may be accompanied by abdominal pain, cramps and a severe urgency to have a bowel movement.

Other symptoms may include:

  • Anemia
  • Fatigue
  • Fever
  • Joint pain
  • Rectal bleeding
  • Skin or mouth lesions
  • Weight loss

Because blood loss, chronic diarrhea and inflammation can reduce the amount of nutrients absorbed from food, some children with ulcerative colitis have stunted growth and delayed puberty.

Your child's doctor will first do a physical examination and take a medical history. There's no single test for diagnosing ulcerative colitis, so if the doctor suspects ulcerative colitis, a series of tests is required to make a definitive diagnosis. Tests may include:

  • Blood Tests — Blood tests check for anemia, which may be a sign of bleeding in the intestines. They can also detect a high white blood cell count or elevated levels of C-reactive protein, both markers of inflammation.

  • Stool Sample — Shows whether there is bleeding, inflammation, or infection in the intestines.
  • Magnetic Resonance Enterography — Provides detailed images of the small bowel that can pinpoint areas of inflammation, bleeding and other problems. Before the test, your child drinks a contrast material (sometimes just milk is enough) to highlight the small bowel in the images. MR enterography is noninvasive and does not involve radiation or expose your child to any radiation.
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Treatment for ulcerative colitis varies depending on the seriousness of the disease. Most people need long-term medication to relieve symptoms and control the problems. In severe cases, surgery may be required to remove the diseased colon, which cures the disease.

Medications and Nutritional Therapies

Medications for ulcerative colitis may improve your child's quality of life by inducing and maintaining remission, or at least provide symptom-free periods. The four most commonly prescribed types of medications — aminosalicylates, corticosteroids, immunomodulators and biologic medicines — all work by reducing inflammation. Newer medications, such as biologics, are under investigation to see if they help children with ulcerative colitis.

Nutritional therapies are mainly used to supplement the diet and medications, and are not effective alone.

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Reviewed by health care specialists at UCSF Benioff Children's Hospital.

Related Information

UCSF Clinics & Centers

Gastroenterology & Nutritional Disorders

Inflammatory Bowel Disease Program
1825 Fourth St., Sixth Floor
San Francisco, CA 94158
Phone: (415) 353-2813
Urgent Appointment Requests:: (415) 353-1235
Fax: (415) 476-1343
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