What Is Pan Ulcerative Colitis?

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Pan ulcerative colitis is a form of ulcerative colitis that affects the entire colon. It is characterized by inflammation, which can lead to sores, ulcers, and gastrointestinal symptoms. It is commonly referred to as pancolitis, total colitis, or universal colitis. Ulcerative colitis is a form of inflammatory bowel disease (IBD), a chronic, lifelong condition.

Approximately 14%–35% of patients with ulcerative colitis will develop pancolitis.

Large intestine, artwork

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Causes

The cause of ulcerative colitis is not well understood by researchers, but it is thought to be the result of complex interactions between the intestinal lining and immune system. The immune system mistakenly attacks the cells of the intestine, causing inflammation, ulcers, and sores. Other factors that may influence the development of ulcerative colitis include genetics, age, gut microbiota, toxic pathogens, and the environment.

People who develop pancolitis start with some form of ulcerative colitis, which begins in the rectum. Over time, the inflammation extends to more of the surrounding tissue. When the entire colon is affected by the inflammation, the condition is called pancolitis.

Causes of Disease Progression

It is uncertain what causes the progression of ulcerative colitis into pancolitis. One study has suggested that several factors may be associated with the progression of the disease, including:

Approximately one-third of ulcerative colitis cases will progress into pancolitis within 10 years.

Symptoms

Patients with pancolitis have gastrointestinal symptoms that range from mild to severe. Symptoms may include:

  • Feeling tired or nauseated
  • Unexplained weight loss
  • Abdominal discomfort or pain
  • Diarrhea without blood to frequent diarrhea with blood, pus, or mucus
  • Urgency or immediate need to go to the bathroom
  • High fever and tenderness in the stomach area

Symptoms of Severe Inflammation

Some patients with severe inflammation may experience additional symptoms that go beyond the digestive system. Approximately 19% of patients with pancolitis will experience changes to their skin while a small number (5%) will develop eye conditions.

Symptoms may include:

  • Skin rash (tenderness, red bumps, dry, itchy, and flaky skin, scaly patches, welts, bruising, and painful sores)
  • Painful, swollen joints
  • Headache
  • Sensitivity to light
  • Blurred vision
  • Burning
  • Increased eye secretions

Diagnosis

A doctor will perform a variety of exams to determine a ulcerative colitis diagnosis. These can include a colonoscopy (a type of endoscopy that examines the large intestine and rectum), imaging tests, blood tests, and stool tests.

Once diagnosed, an endoscopy (a procedure in which a flexible tube with a light and camera is inserted into the body to observe the digestive tract) will be performed to determine the extent and severity of the ulcerative colitis.

When ulcerative colitis is diagnosed, the extent of the disease is determined by the Montreal classification system. The Montreal classification system has three subgroups that determine the extent (E) of the spread.

Montreal Classification of Extent of Ulcerative Colitis (UC)
Extent   Description
E1 Ulcerative proctitis Inflammation limited to the rectum
E2  Left-sided UC (distal UC)  Inflammation limited to a portion of the colon and rectum
E3  Extensive UC (pancolitis) Inflammation that extends throughout the entire colon

Treatment

The goal for treating pancolitis is remission, or to help patients feel well and reduce the signs of inflammation. Given that pancolitis involves extensive inflammation, people diagnosed with this condition tend to experience more severe symptoms and less relief with medical therapy compared to milder forms of ulcerative colitis.

Medical therapy for pancolitis involves medication and surgery.

Medications

There are a variety of options for managing symptoms of pancolitis. Medications can include one or a combination of the following:

  • Aminosalicylates: Help control inflammation, especially with mild-to-moderate symptoms
  • Corticosteroids: Help lessen inflammation, especially with moderate-to-severe symptoms but are short-term treatments
  • Immunomodulators: Block the immune system response that causes inflammation and can help decrease swelling in the gastrointestinal tract
  • Biological agents: Help lessen inflammation in severe cases that do not respond to other medications

Surgery

Sometimes, medicine is not enough to manage the symptoms of pancolitis, so surgery may be recommended. Approximately 40% of patients diagnosed with pancolitis will require surgery to treat the disease.

Surgeries that your doctor may discuss with you include:

  • Proctocolectomy (removes colon and rectum)
  • Restorative proctocolectomy (removes the colon and rectum but allows the patient to continue to pass stool through the anus)

It's important to speak with your healthcare team before making the decision to have surgery because surgery has serious implications and risks.

Prognosis

There's no cure for pancolitis, but medications can help manage and alleviate symptoms. How patients respond to treatment depends on the severity of the disease, past complications, and response to previous treatments.

While pancolitis is generally not considered to be fatal, it can cause serious health complications if it is not managed. Some of the health conditions associated with unmanaged pancolitis include:

  • Increased risk of colorectal cancer: The risk of developing cancer increases every year with a diagnosis of pancolitis.
  • Toxic megacolon: This condition is characterized by the inflammation of the deep tissue layers of the large intestine, causing it to swell and stop working.
  • Dehydration and malabsorption: These conditions are caused by diarrhea and inflammation.
  • Anemia: Anemia is a lack of healthy red blood cells that is caused by ulcers and bleeding.

A Word From Verywell

If you are experiencing persistent changes in bowel movements or any signs and symptoms of ulcerative colitis such as consistent abdominal pain, bloody stools, ongoing diarrhea, and urgency to use the bathroom, speak with your doctor.

It's important to remember that everyone experiences symptoms of pancolitis differently, and there are a variety of treatment options to consider. Continue to communicate with your healthcare team to find the best combination of treatments to keep your symptoms as manageable as possible.

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9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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