Dr Deepak Varma Gastro Surgeon Cochin

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Ulcerative Colitis

Considered as one of the two major inflammatory bowel diseases, ulcerative colitis (UC) manifests itself in the large intestine. It is a multifactorial and polygenic disease, which can also include a genetic predisposition. UC is a lifelong illness and has a significant impact on an individual s emotional and social quotients. The inflammation starts at the rectum and spreads upwards with tiny ulcers forming in the lining of the colon. Contents of the bowel move and empty rapidly. There is a discharge of pus and mucus from the ulcers. The disease rarely affects the small intestine. UC can affect people of all ages but tend to develop between 15 years and 30 years of age.


  • Genetics: individuals with a family history of ulcerative colitis
  • Immune system reactions: the intestinal epithelial barrier is compromised leading to UC
  • Sulfate-reducing bacteria
  • Use of NSAIDs
  • Low levels of vitamin A and E

Signs and symptoms

  • Frequent stools
  • Rectal bleeding
  • Discharge of mucus from the rectum
  • Occasional tenesmus
  • Severe dehydration
  • Lower abdominal pain
  • Diarrhoea and cramps
  • Fever
  • Leukocytosis
  • Abdominal distention


Physical examination:

  • Tachycardia
  • Fever
  • Abdominal tenderness
  • Significant weight loss

Grading ulcerative colitis:

  • Severe: > 4 bowel motions per day; hypoalbuminemia < 30g/L, rectal bleeding
  • Moderate: > 4 bowel motions per day; rectal bleeding
  • Mild: < 4 bowel motions per day; rectal bleeding

Serologic markers: Antineutrophil cytoplasmic antibodies (ANCA); perinucelar ANCA (pANCA)

Laboratory studies:

  • CBC for anaemia and thrombocytosis
  • Comprehensive metabolic panel for hypoalbuminaemia; hypokalaemia; hypomagnesaemia; alkaline phosphate
  • Inflammatory markers: to check for erythrocyte sedimentation rates

Stool assays:

  • culture for bacterial pathogens
  • Endoscopy and biopsy
  • Plain abdominal radiographs
  • Cross-sectional imaging studies
  • Radionuclide studies


Most of the ulcerative colitis patients can be treated with medications. Surgery is a definitive therapy for ulcerative colitis. Predominant indications for surgery are non-responsiveness to medical treatment, uncontrolled colonic bleeding, dysplasia, adenocarcinoma , complications of ulcerative colitis like toxic megacolon or perforation. Such complications require emergency surgery as these are life-threatening situations.

We prescribe long-term monitoring for individuals diagnosed with ulcerative colitis. Our team drafts a careful treatment plan, which has to be followed by the patient throughout their lives.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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