Is Ulcerative Colitis an Autoimmune Disease?

Amber J. Tresca
·7 min read

Medically reviewed by Jay N. Yepuri, MD

Ulcerative colitis is a type of inflammatory bowel disease (IBD). A problem with the immune system leads to inflammation, primarily in the large intestine (colon). Ulcers, which may bleed, form in the lining of the colon. Other parts of the body, including the eyes, joints, skin, and liver may also be affected by ulcerative colitis.

What causes this disorder is not completely understood. It is thought that some people may have genes that predispose them to developing the condition and that one or more environmental triggers begin the disease process.

This article discusses how the immune system's involvement in developing ulcerative colitis differs from the strict definition of an autoimmune disease, the effects of the condition and its impact on immune function, and how to manage symptoms of ulcerative colitis.

<p>Maksym Belchenko / Getty Images</p>

Maksym Belchenko / Getty Images

Is Ulcerative Colitis an Autoimmune Disease?

Ulcerative colitis, and IBD in general, are thought to involve a problem with the immune system. The immune system defends the body from invaders, such as viruses and bacteria. Sometimes, the immune response can’t tell the difference between an actual foreign invader and healthy tissue.

A disease or condition is called autoimmune when there is a presence of antibodies (specific immune proteins). These antibodies target normal, healthy tissue and cause inflammation.

Autoimmune diseases can result from the creation of a variety of different types of antibodies. Some conditions are diagnosed with the use of a laboratory test (such as a blood test) that finds these antibodies.

Some types of antibodies are found in people with ulcerative colitis and its companion condition, Crohn’s disease. However, not every person who has a form of IBD has these antibodies. There isn’t one specific type of antibody that’s been found in all people who live with ulcerative colitis.

For that reason, there may be other terms that fit ulcerative colitis better than “autoimmune.” There may be an autoimmune component, but there is also more to the story of the development of IBD.

Some experts are now calling IBD an “immune-mediated” or “autoinflammatory” disease. Ulcerative colitis might be called an immune-mediated inflammatory disease with an autoimmune component.

Does Ulcerative Colitis Compromise the Immune System?

Ulcerative colitis is connected to overactive activity by part of the immune system. However, in general, when the condition is controlled, it does not suppress the immune system. It will not make people more likely to get infected with viruses or bacteria. That could change when the condition is active and causing inflammation.

Ulcerative colitis can affect body systems outside of the digestive tract. People with active and especially severe ulcerative colitis may become really unwell and even malnourished. Being in poor physical condition overall could leave people open to infections.

Because ulcerative colitis is linked to an overactive immune response, it may be treated with medications that affect the immune system. IBD medications may target specific parts of the immune system, causing it to slow down its activity.

The immune system is not like a switch that is turned on or off; it is far more complicated than that. Medications used to treat IBD, such as biologics, steroids, or immunomodulators, turn down parts of the immune system in specific ways. In some cases, this can lead to a person’s immune system being less able to fight off infection with viruses or bacteria.

Related: The Risks of Untreated Ulcerative Colitis

Is There a Higher Risk of Getting COVID-19 With Ulcerative Colitis?

People who live with ulcerative colitis do not have a greater risk of becoming infected with the virus that causes COVID-19 than the general population. Even for those taking a medication that affects the immune system, there does not appear to be a greater risk.

People with ulcerative colitis can also live with other conditions. The following comorbid (co-occurring) conditions may increase the risk of a poor outcome from COVID-19:

  • Being older than age 65

  • Having chronic lung disease

  • Having human immunodeficiency virus ( HIV)

  • Having diabetes

  • Having heart disease

  • Having liver disease

  • Having chronic kidney disease

  • Having certain neurological disorders

  • Having obesity

How to Manage Symptoms of Ulcerative Colitis

It’s important to treat ulcerative colitis in order to avoid complications. Ulcerative colitis needs to be managed throughout a person’s lifetime. This often means combining medications and lifestyle changes. In a minority of cases, managing the condition is done through surgery.

Medications and Therapies

Broadly speaking, medications used to treat ulcerative colitis address the inflammation. This could be either by treating it or by trying to prevent it. Delivery methods include oral, infusion, injection, enema, and suppository.

The types of medications that may be used to treat ulcerative colitis include:

Lifestyle Changes and Self-Care

Along with medications, changes in lifestyle are usually used to manage symptoms of ulcerative colitis. These habits may not help directly with inflammation, but they can improve quality of life and reduce symptoms. 

Ulcerative colitis affects everyone differently, but lifestyle habits that can help everyone include:

  • Getting enough sleep and rest, especially during times of increased symptoms

  • Keeping active by getting regular exercise, such as yoga

  • Keeping a food and symptom journal to track triggers

  • Seeing healthcare providers regularly and as needed

  • Seeking mental health care as needed from a provider who has experience with chronic illness or pain

  • Staying hydrated by drinking enough fluids every day

  • Managing stress

  • Trying mindfulness techniques and meditation

Diet and Nutrition Tips

Diet can be an important part of managing ulcerative colitis. However, no single diet alone is prescribed for all people with this condition.

Instead many people instead find the best diet that works for them. This could be a combination of understanding what has worked for others, what a healthcare provider recommends, and what the research has shown.

Some of the diets that may be tried or recommended by a healthcare provider include:

Surgical Options

Surgery is another treatment option for severe or complicated ulcerative colitis. For some people, surgery may be needed because the symptoms are not controlled and are causing serious complications. Others may choose surgery because their quality of life is poor.

People with ulcerative colitis have some options when it comes to surgery to manage the condition.

Colectomy with ileal pouch-anal anastomosis (IPAA): This is the most commonly used surgery to treat ulcerative colitis. It is also known as J-pouch surgery.

The colon and most or all of the rectum are removed. The last section of the small intestine is folded on itself to make the shape of a “J.” This serves as a rectum, and stool is eliminated from the bottom through the anus. This surgery may be done in two or three stages.

Colectomy with ileostomy: In this surgery, the colon is removed. An opening is created in the abdomen, and a little part of the small intestine is brought through it and outside the body. Stool leaves the body through this opening, which is called a stoma.

An appliance is worn over the stoma to collect the stool. It is emptied several times a day. The rectum and anus are often left in place. However, if ulcerative colitis continues to cause disease there, they might also be removed in a surgery called a proctectomy.

Continent ostomy: This surgery is specialized and is used less often than others. An internal reservoir is created from the small intestine, but it is not connected to the anus. Instead, it is accessed through what's called a nipple valve made from part of the ileum in the abdomen.

Stool is eliminated from the body when a catheter is placed into the nipple. There’s usually no need for an external appliance on the abdomen, but people may place a bandage over the nipple.

Related: How Ulcerative Colitis Is Treated

Summary

Ulcerative colitis is a condition that’s thought to be caused by a genetic predisposition along with a dysregulation in the immune system and/or changes in the microbiome (dysbiosis). There are autoimmune components to ulcerative colitis, but the condition has other characteristics and may also be described as an inflammatory immune-mediated disease.

Ulcerative colitis might be treated with medications that slow down the immune response, lifestyle and diet changes, and surgery. There’s currently no known cure for ulcerative colitis.

Read the original article on Verywell Health.