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Ulcerative colitis:
symptoms, causes and treatment

Ulcerative colitis is a type of chronic inflammation of the colon. Typical symptoms include bloody diarrhoea, abdominal cramps and the feeling of urgently needing to go to the toilet. A kind of inflammatory bowel disease (IBD), ulcerative colitis can often be treated effectively with anti-inflammatory drugs.


Like Crohn’s disease, ulcerative colitis is a chronic inflammatory bowel disease (IBD). Around 25,000 people in Switzerland suffer from IBD.

In ulcerative colitis, the mucous membrane of the colon becomes inflamed, causing ulcers and bleeding. Acute relapses alternate with periods with few symptoms (remission).

Unlike Crohn’s disease, ulcerative colitis does not affect the entire gastrointestinal tract, but only occurs in the large intestine.

Ulcerative colitis causes symptoms typical of intestinal inflammation:

  • Bloody diarrhoea with mucus
  • Abdominal pain, cramps
  • Painful urge to defecate

Anaemia, fever, fatigue, palpitations and weight loss may also occur, and children and adolescents might experience growth disorders.

Outside the intestine, ulcerative colitis also sometimes causes symptoms such as inflammation of the eyes, joints, mouth, skin and anus, as well as diseases of the liver, kidney, gall bladder, pancreas or bones (osteoporosis).

In ulcerative colitis, the intestinal barrier is permeable. Bacteria penetrate the intestinal mucosa and trigger inflammation as a defensive response of the immune system.
The causes have not been fully explained. However, heredity seems to play a major role. Having first-degree relatives with ulcerative colitis increases your own risk by a factor of 10 to 15 times.
An autoimmune disease, in which the immune system attacks the body’s own tissue, may also be present.

In addition, environmental factors such as an unbalanced diet could influence the development of ulcerative colitis.

Several studies have confirmed that breast milk can reduce the risk of ulcerative colitis by 23%. Mothers are advised to breastfeed their babies for at least six months, and if possible longer.

In order to detect ulcerative colitis, the doctor and patient first discuss the symptoms and medical history in detail (medical history).

This is followed by a physical examination, in which the doctor examines the patient’s mouth and anus. The doctor also checks whether there are any symptoms outside the intestine (e.g. eye inflammation).

A rectal examination is performed at the latest during a colonoscopy.

Blood tests (e.g. blood count, iron levels, inflammatory parameters such as CRP), ultrasound and histological findings (by taking tissue from the intestine) can help to verify the diagnosis.

If the suspicion of ulcerative colitis is confirmed, it is classified according to how extensive it is:

  • In proctitis, only the end of the intestine (rectum) is inflamed.
  • Left-sided colitis refers to inflammation up to the left curvature of the colon.
  • Pancolitis can affect the entire colon.

Chronic inflammatory bowel diseases cannot be cured. The aim of treatment for ulcerative colitis is therefore to achieve remission quickly and to extend it for a long time.
If you notice that a flare-up is imminent, consult your doctor immediately in order to prevent the inflammatory response as quickly as possible.

Anti-inflammatory drugs for ulcerative colitis

Drug therapy is based on the extent of the ulcerative colitis, the severity of the symptoms and the measures to which the patient has responded well so far. Medicines may be administered as suppositories, foams, enema, tablets or intravenously as needed.

5-aminosalicylates (e.g. mesalazine) are considered the standard therapy for ulcerative colitis. They alleviate inflammation during a flare-up and also serve to maintain remission. E. coli Nissle is a probiotic and has also been proven for maintaining remission.

If the above-mentioned remedies are not sufficiently effective, they can be combined with other anti-inflammatory medicines:

  • Corticosteroids (cortisone)
  • Other immunosuppressants: thiopurine (azathioprine, 6-mercaptopurine), cyclosporine, tacrolimus, ozanimod (a novel S1P receptor modulator approved in the EU in 2021)
  • Antibodies (biologics), such as anti-TNF therapy (e.g. adalimumab, infliximab) or vedolizumab
  • JAK inhibitors (tofacitinib, filgotinib) block certain pro-inflammatory enzymes

Anti-diarrhoea products, antibiotics and antispasmodics are sometimes used to relieve the symptoms of ulcerative colitis.

Research: new drugs in the pipeline

There is a lot of research into ulcerative colitis, including the development of new therapies. For example, the interleukin-6 inhibitor olamkicept and the tyrosine kinase-2 inhibitor deucravacitinib have shown success in studies. Both active substances block signalling pathways in the body, which reduces inflammation.


If medication does not alleviate ulcerative colitis or if serious complications arise (such as enlargement or perforation (a hole) of the intestine or severe bleeding), surgery may be necessary. In ileoanal pouch surgery, which is often performed as a minimally invasive procedure, surgeons remove the large intestine and rectum. A pouch is formed from the small intestine and connected to the anus, creating a new rectum.

Diet for ulcerative colitis

No special diet is recommended for ulcerative colitis. It is best for patients to avoid foods that cause or aggravate discomfort (these are often dairy products, for example). Micronutrient deficiencies (e.g. iron, zinc, vitamin D) should be specifically rectified with appropriate dietary supplements.

Chronic inflammatory bowel disease such as ulcerative colitis does not necessarily shorten life expectancy if treated quickly and effectively. This enables life-threatening complications to be avoided as effectively as possible.

Many patients worry about developing colon cancer. IBD, such as ulcerative colitis, does indeed increase the risk of malignant tumours in the intestine. Patients should therefore undergo colonoscopy screening regularly.

Chronic illnesses like ulcerative colitis can severely restrict patients’ everyday lives. Many prefer to stay at home because they are afraid of not making it to the toilet in time. The constant diarrhoea impairs sleep and many sufferers feel tired and exhausted. Some patients need to be treated in hospital again and again.

Reduced ability to perform and regular sick leave often have an impact on their working lives. The strong urge to defecate and the associated feelings of shame can sometimes impact patients’ private lives, too.

As a result, it is no wonder that chronic intestinal inflammation also has an impact on people’s mental health, with those affected often suffering from anxiety or depression. In addition to effective therapy for ulcerative colitis, psychotherapy and dialogue with those affected (e.g. via Crohn Colitis Schweiz, the Swiss association for people with Crohn’s disease and ulcerative colitis) may therefore be useful for improving quality of life.

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  • Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheit (DGVS): Colitis ulcerosa (Stand: April 2021)
  • Universitätsspital Zürich: Colitis ulcerosa, unter: (Abrufdatum: 02.11.2022)
  • Bundesinstitut für Arzneimittel und Medizinprodukte: Januskinase-Inhibitoren: Behandlung von Entzündungskrankheiten, unter: (Abrufdatum: 03.11.2022)
  • Crohn Colitis Schweiz: Leben mit CED, unter: (Abrufdatum: 03.11.2022)
  • Internisten im Netz: Colitis ulcerosa: Symptome, unter: (Abrufdatum: 15.11.2022)
  • CED-Kompass: Beschwerden ausserhalb des Darms, unter: (Abrufdatum: 15.11.2022)
  • Pharmazeutische Zeitung: Jetzt auch bei Colitis ulcerosa zugelassen, unter: (Abrufdatum: 15.11.2022)
  • Deutsches Bundesministerium für Bildung und Forschung: Neuer Behandlungsansatz bei chronischen Darmerkrankungen, unter (Abrufdatum: 15.11.2022)
  • Leben mit CED: Ist meine Lebenserwartung durch die CED beeinträchtigt? unter: (Abrufdatum: 15.11.2022)
  • Geissner N. Fallbuch Pflege. Kommunikation verstehen. Georg Thieme Verlag, Stuttgart 2006
  • Willen C.: Neue Therapieansätze mit TYK2-Inhibition und S1P-Rezeptormodulation. Gastro-News 2022; 9, 62
  • Rapport F, Clement C, Seagrove AC, Alrubaiy L, Hutchings HA, Williams JG: Patient views about the impact of ulcerative colitis and its management with drug treatment and surgery: a nested qualitative study within the CONSTRUCT trial. BMC Gastroenterol. 2019, 15;19(1):166. doi: 10.1186/s12876-019-1085-y
  • Barberio B, Zamani M, Black CJ, Savarino EV, Ford AC: Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. The Lancet 2021, Vol. 6 Issue 5, 359-370