Is Ulcerative Colitis an Autoimmune Disease?

Ulcerative colitis is a type of inflammatory bowel disease (IBD). It is a serious condition in which ulcers (sores), swelling, and inflammation develop in the digestive tract. Ulcerative colitis symptoms usually develop slowly over time and can be debilitating. The complications of this condition can be life-threatening. There is no cure for ulcerative colitis. However, treatments can help to manage ulcerative colitis effectively.

Please continue reading to learn more about ulcerative colitis, including why it occurs and how it is treated. We will also discuss whether people with ulcerative colitis are at a high risk of COVID-19 infection.

What is inflammatory bowel disease?

Inflammatory bowel disease (IBD) is a broad term used to describe health conditions in which there is chronic inflammation in the digestive tract. There are two types of IBD— ulcerative colitis (UC) and Crohn's disease. Both Crohn’s and ulcerative colitis are therefore inflammatory diseases.

Ulcerative colitis is characterized by inflammation and ulcers that are present superficially in the lining of the colon (large intestine) and rectum.

Crohn's disease involves inflammation in the deeper layers of the gut. It can occur anywhere in the digestive tract.

Crohn’s and UC symptoms include abdominal pain, bloody diarrhea, rectal bleeding, weight loss, and fatigue.

Are Crohn's and ulcerative colitis autoimmune diseases?

Crohn’s disease and ulcerative colitis are autoimmune disorders. Experts say they occur because of an overactive immune system. In other words, there is an inappropriate immune response in people with ulcerative colitis and Crohn’s disease, where the body’s immune system attacks healthy tissue in the gut, leading to inflammation. It is also common that there is a family history of this disease, which tells us that genetics is an important causal factor as well.

Is ulcerative colitis always autoimmune?

Ulcerative colitis is an autoimmune disease. However, according to the Crohn’s and Colitis Foundation, the exact cause of this condition remains unclear. Environmental factors like diet and stress were previously suspected as culprits, but experts now say that while these may be triggers for a flare-up, they are not causative factors.

The consensus is that ulcerative colitis is an autoimmune condition, but it results from an abnormal immune response, genetics, and environmental factors. Some evidence suggests that this autoimmune disease occurs due to an interaction between the body’s immune system and viral or bacterial infections.

Certain foods can aggravate IBD symptoms, while others can calm them. However, Crohn’s and ulcerative colitis are not caused by foods and cannot be cured by what you eat.

Risk factors for ulcerative colitis include age (it usually begins before age 30), race (the incidence is highest in Ashkenazi Jews of Eastern and Central European descent), and family history (genetically predisposed people are those with first-degree relatives who have ulcerative colitis).

Does ulcerative colitis affect your immune system?

Ulcerative colitis can affect your immune system if you don’t get appropriate IBD treatment. UC can lower the immune response in the body overall due to excessive immune activity in the digestive tract. Also, certain medications used to treat ulcerative colitis can compromise the immune system, such as:

Steroids (prednisone and budesonide)
Anti-TNF (adalimumab, golimumab, infliximab, certolizumab pegol)
Immunomodulators (methotrexate, azathioprine, 6-mercaptopurine)
Anti-integrin (natalizumab, vedolizumab)
Anti-IL12/23 (ustekinumab)
JAK inhibitor (tofacitinib)

Does ulcerative colitis put you at high risk for COVID-19?

Ulcerative colitis does not put a person at a high risk of COVID-19 infection. However, some medications that are a part of the treatment plan for ulcerative colitis can suppress the immune system. For example, steroids and immunomodulators, which are commonly used to treat IBD, can lower immunity. Outcomes are worse in patients with an ulcerative colitis diagnosis who are on steroids or 5-aminosalicylates and better in patients taking biological agents.

Nonetheless, studies have shown that patients with inflammatory bowel disease are at the same risk of COVID-19 as the general population.

If you have inflammatory bowel disease (ulcerative colitis or Crohn’s disease), experts recommend that you keep your IBD in remission and prevent flare-ups and further inflammation with antibiotics and other IBD medications prescribed by your doctor. This will help to protect you against COVID-19-related complications.

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