This can serve as a quick guide for conditions or symptoms to look out for if you or a loved one has Inflammatory Bowel Disease (IBD).

Ulcerative Colitis

Complications & Extra Procedures Needed

1. Osteoporosis – problems with nutrient absorption, dietary restrictions, and dietary changes (also a side effect of steroids).
2. Growth delays – including anemia.
3. Sclerosing cholangitis, hepatitis – late stage may require a liver transplant.
4. Toxic megacolon – a colectomy may be needed in severe cases.
5. Bowel cancer (6)
6. Leak from anastomosis
7. Pelvic abscess
8. Enterocutaneous fistulas
9. Incontinence
10. Sexual dysfunction (7)
11. Oral ulcers
12. Oligoarticular or polyarticular non-deforming peripheral arthritis, spondylitis, sacroiliitis
13. Episcleritis, uveitis
14. Erythema nodosum
15. Pyoderma gangrenosum
16. Thromboembolic events – may be related to hyperhomocysteinemia
17. Stricturing (20)

According to NIS data analyzed from January-December 2020, 2794 patients had UC within the 1,050,045 COVID-19 hospitalizations. Ulcerative Colitis patients were found to have a significantly higher risk of DVT and a longer average hospital stay when compared to non-IBD patients.(9)

Indications for UC surgery are as follows:
– failure of medical therapy
– intractable severe colitis
– toxic megacolon
– perforation of colon
– uncontrollable bleeding
– intolerable side effects of medications
– strictures of colon
– unresectable dysplasia
– cancer
– growth disturbances in children (7)

Surgery for UC carries the risk of:
– Pouchitis: inflammation or infection of the J-pouch that is created. Signs/symptoms include diarrhea, frequent bowel movements, stomach cramps and pain, fever, and joint pain.
– Pouch prolapse.
– Bowel obstruction: signs and symptoms include cramping and nausea/vomiting.
– Pouch failure: signs and symptoms include fever, swelling, pain.(10)

Side Effects of Medications

Amino Salicylate (i.e. 5-ASA, Azathioprine) is used for mild-moderate UC and has the following side effects: headache, N/V, abdominal pain, and diarrhea. It is also susceptible to drug resistance.(19)
– Mesalamine: nausea, rash, diarrhea, pancreatitis, and acute interstitial nephritis
– Sulfasalazine and balsalazide: nausea, oligospermia, leukopenia, agranulocytosis, impaired folate metabolism, and hypersensitivity (fever, rash, hemolytic anemia, pneumonitis). Side effects seen in ~15-30% of patients.(20)

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