7 Ulcerative Colitis Complications

Ulcerative colitis (UC), a form of inflammatory bowel disease (IBD), is often associated with extraintestinal complications — those that occur in other parts of the body, such as the skin, eyes, and liver.

“UC is not just a disease of the intestines, but a systemic, or bodywide, disorder of the immune system," says Jessica Philpott, MD, PhD, a gastroenterologist at the Cleveland Clinic in Ohio.

Here are seven complications commonly linked with UC.

1. Arthritis

"While we can’t say there’s a direct cause, the joint pain usually flares up when the bowel disease flares up as well,” says Laura Raffals, MD, a gastroenterologist at the Mayo Clinic in Rochester, Minnesota.

2. Skin Problems

“Biologics have been shown to be highly effective treatments for a range of inflammatory diseases, and they’re much safer than steroids,” says Dr. Raffals.

3. Eye Issues

4. Bone Loss

5. Liver Disease

• Steatotic (Fatty) Liver Disease With this, extra fat is deposited into the liver and can replace liver cells; the disease is often attributed to steroid use. Weight loss and controlling cholesterol levels usually reverse steatotic liver disease.
• Hepatitis B People with UC may be more susceptible to hepatitis B infection, especially those on immunosuppressant medications used to treat UC. The hepatitis B vaccine is generally recommended for people with UC, but research suggests the response to the vaccine may be lower in some individuals with UC, such as those on certain medications.

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• Primary Sclerosing Cholangitis Nearly 3 percent of people with UC experience inflammation that causes scarring in the bile ducts, impeding the normal flow of bile. Backed-up bile ducts can cause jaundice and itching, and potentially liver damage. A stent may need to be placed to reopen the duct.

6. Colorectal Cancer

The connection between UC and colorectal cancer is unknown, but a strong correlation exists between the two, especially for people who have had UC for a long time.

“It seems mainly related to cellular changes caused by the autoimmune-mediated inflammation,” says Dr. Philpott. “Furthermore, if more of the colon is involved, then the risk is higher.”

Philpott says that people with UC should remain vigilant about screenings. “We recommend that patients with UC who have a higher risk of colon cancer not wait for symptoms but rather undergo routine surveillance colonoscopies that look for precancerous changes,” says Philpott. “That being said, certainly, bleeding, weight loss, and change in bowel symptoms should always prompt you to consult your physician.”

7. Toxic Megacolon

In rare cases, people with UC can develop toxic megacolon, a swelling and inflammation of the deeper layers of the colon that can cause the colon to stop working or rupture.

“Fortunately, this is a rare condition, but it's very serious when it occurs,” says Raffals. “If a patient is severely ill from their colitis and is experiencing severe bloody diarrhea, abdominal pain, and fever, they should be evaluated. These patients often present with fever, a fast heart rate, abnormal labs, and even sometimes low blood pressure and confusion.”

Ways to Reduce Complications

While a cure for UC has yet to be found that doesn’t involve surgery, some complications may disappear altogether when the disease is appropriately treated. Work with your doctor and other healthcare team members to get optimal control of the disease as soon as possible.

The Takeaway

• In addition to the digestive system symptoms it causes, ulcerative colitis (UC) can cause complications in other parts of the body, such as the eyes, skin, and liver.
• The risk of developing colorectal cancer is higher in people with UC. More frequent colonoscopies may be recommended for people with the condition than for the general population.
• Staying on top of any new symptoms and reporting them to your doctor ensures that any complications can be treated before they worsen.

Additional reporting by Zachary Smith.