Can Ulcerative Colitis Cause Worsening GERD?
No, ulcerative colitis does not directly cause or worsen GERD, as UC is a disease limited to the colon and does not involve the upper gastrointestinal tract including the esophagus.
Disease Localization and Pathophysiology
Ulcerative colitis is characterized by diffuse mucosal inflammation that is strictly limited to the colon, starting in the rectum and extending proximally in a continuous fashion 1, 2.
The inflammatory process in UC is confined to the mucosa and occasionally submucosa of the colon, and does not affect the esophagus, stomach, or small intestine 3, 2.
By definition, UC causes continuous colonic inflammation extending from the rectum to more proximal colon with variable extents, but never involves the upper GI tract 2, 4.
Important Clinical Considerations
If a patient with UC develops new or worsening GERD symptoms, consider alternative explanations:
Medication-related effects: Corticosteroids used to treat UC flares can worsen GERD by decreasing lower esophageal sphincter pressure and delaying gastric emptying (general medical knowledge).
Concurrent conditions: GERD and UC can coexist as separate conditions, as both are common in the general population, but one does not cause the other 5.
Functional symptoms: Up to 27% of UC patients with endoscopic and histologic healing may still experience gastrointestinal symptoms that could be misattributed to their UC 6.
Key Diagnostic Pitfall
If upper GI symptoms are present in a patient with presumed UC, reconsider the diagnosis—Crohn's disease can affect any part of the GI tract including the esophagus and stomach, unlike UC which is limited to the colon 1, 3.
The presence of upper GI involvement would suggest Crohn's disease rather than ulcerative colitis, as Crohn's shows patchy, discontinuous distribution throughout the gastrointestinal tract 3.