Ulcerative colitis is a disease of the colon that is closely related to Crohn's disease. The two are grouped in a category called inflammatory bowel disease (IBD), because they both involve inflammation of the digestive tract.

The major symptoms of ulcerative colitis include abdominal pain and bloody diarrhea. When the disease becomes severe, individuals may develop fever, weight loss, dehydration, and anemia. Sometimes, constipation develops instead of diarrhea. Arthritis, skin sores, and liver inflammation may occur as well.

One of the most feared consequences of ulcerative colitis is dramatic dilation of the colon, which can lead to fatal perforation of the colon. Ulcerative colitis also leads to a greatly increased risk of colon cancer.

Ulcerative colitis tends to wax and wane, with periods of remission punctuated by severe flare-ups. Medical treatment aims at reducing symptoms and inducing and maintaining remission.

Sulfasalazine is one of the most common medications for ulcerative colitis. Given either orally or as an enema, it can both decrease symptoms and prevent recurrences. Corticosteroids, such as prednisone, are used similarly in more severe cases, sometimes combined with other immunosuppressive drugs, such as azathioprine and cyclosporine. Partial removal of the colon may be necessary in severe cases.

People with ulcerative colitis can easily develop deficiencies in numerous nutrients. Chronic bleeding leads to iron deficiency. Malabsorption, decreased appetite, drug side effects, and increased nutrient loss through the stool may lead to mild or profound deficiencies of protein, vitamins A, B12, C, D, E, and K, folate, calcium, copper, magnesium, selenium, and zinc.1-10 If you have ulcerative colitis, supplementation to restore adequate body stores of these nutrients is highly advisable and may improve specific symptoms as well as overall health. We recommend working closely with your physician to identify any nutrient deficiencies and evaluate the success of supplementation in correcting them.

Essential Fatty Acids

Fish oil and evening primrose oil contain healthy fats called essential fatty acids. According to some, though not all, of the small, double-blind, placebo-controlled trials reported, fish oil might be helpful for reducing symptomsof active ulcerative colitis.11-15Evening primrose oil has also shown promise.18 However, larger studies will be necessary to discover for certain whether fish oil or evening primrose oil really help.

Regular use of fish oil alone, or in combination with gamma-linolenic acid (found in evening primrose oil), has not been found effective for preventingdisease flare-ups in people whose ulcerative colitis has gone into remission.16,17,35

For more information, including dosage and safety issues, see the Fish Oil and Evening Primrose Oil articles.

Probiotics

Friendly bacteria, or probiotics, might be helpful in ulcerative colitis.

A double-blind trial of 116 people with ulcerative colitis compared probiotic treatment against a relatively low dose of the standard drug mesalazine.19The results suggest that probiotic treatment might be equally effective as low-dose mesalazine for controlling symptoms and maintaining remission. Evidence of benefit was seen in other trials, as well.20,40,45,47For example, a 2011 review of 4 randomized trials with a total of 587 patients seemed to support the use of probiotics to reduce the relapse rates in people with ulcerative colitis.49 The authors, though, pointed out the need for better designed trials.

Probiotics may be less useful for inducingremission; when they were added to standard medications used for induction of remission, no additional benefits were seen in a study of people with mild-to-moderate ulcerative colitis.45

Probiotics might be useful for people with ulcerative colitis who have had part or all of the colon removed. Such individuals frequently develop a complication called "pouchitis," inflammation of part of the remaining intestine. Two double-blind, placebo-controlled studies found that probiotics can help prevent pouchitis and also reduce relapses in people who already have it.21,38 The probiotic mixture used in these trials contained four strains of Lactobacillus, three strains ofBifidobacterium, and one strain ofStreptococcus salivarius.

In addition, some evidence hints that probiotics might reduce the joint pain that commonly occurs in people with inflammatory bowel disease.41

For more information, including dosage and safety issues, see the Probiotics article.

Aloe

In a double-blind, placebo-controlled trial, 44 people hospitalized with severe active ulcerative colitis were given oral aloe gel or placebo twice daily for 4 weeks.39 The results showed that aloe was more effective than placebo in inducing full or partial remission of symptoms.

For more information, including dosage and safety issues, see the full Aloe article.