CMScript 3 of 2025: Focus on Ulcerative colitis

Ulcerative colitis (UC) is a chronic condition that causes inflammation in the large intestine. It is one of the two main types of inflammatory bowel disease (IBD), the other being Crohn’s disease. UC can affect anyone, but most people are diagnosed between the ages of 15 to 30 and 50 to 70.

In 2023, there were an estimated 5 million cases of UC worldwide, and in recent years, South Africa has also seen a rise in cases across all ethnic groups.

This edition of the CMScript makes it easier to understand UC by covering everything from causes and symptoms to the treatment and support your medical scheme provides under the Prescribed Minimum Benefits (PMBs).

Risk factors and causes

There is no single cause of UC, but risk factors include:

• Genetics: A family history of UC.
• Race or ethnicity: The risk is higher in Caucasians, but it can occur in any race.
• Immune system issues: Sometimes, the immune system overreacts and attacks healthy cells in the digestive tract while trying to fight off infections.
• Environmental factors: A highly refined diet, spicy or high-fibre dishes, pollution, stress, and exposure to certain infections may contribute to the risk.

Signs and symptoms

Symptoms of UC can develop gradually over time and may include:

• Frequent diarrhoea, often with blood or pus.
• Abdominal pain or cramping, especially on the lower left side.
• Sudden and urgent need to use the bathroom.
• Weight loss, poor appetite, or feeling very tired.
• Joint pain, skin lumps and rashes, or eye problems.
• Children with UC may not grow or develop properly.

How is UC diagnosed and treated?

Diagnosing UC may involve:

• Blood tests to check for signs of bleeding or inflammation.
• Stool tests to look for infection or blood.
• Scans like X-rays, CT or MRI to check the intestines.
• A colonoscopy (a thin, flexible tube with a tiny camera inserted through the rectum) to see inside the colon and take tissue samples for testing.

While UC cannot be prevented or cured, it can be managed effectively with:

• Anti-inflammatory medications to calm inflammation in the colon.
• Immune system suppressors to treat the acute stages of the disease by reducing fever and diarrhoea and improving appetite.
• Other medications such as pain relievers, iron supplements, vitamin B-12, calcium and vitamin D supplements.
• Dietary changes often with the help of a dietician to find foods that are easier on your digestive system.
• Lifestyle adjustments to reduce stress and getting enough rest to improve overall health.
• Surgery for severe cases.

What is covered under PMB level of care?

Ulcerative colitis is classified as a PMB condition. This means that when the condition worsens suddenly or leads to complications, your medical scheme must cover treatments and services, regardless of your benefit option, as long as you use a designated service provider.

UC is listed under two parts of the PMB framework:

• Under Diagnosis and Treatment Pair (DTP) code 292F, which applies to serious flare-ups and complications.
• Under the Chronic Disease List (CDL), which covers ongoing treatment for long-term management.

Based on the PMB treatment guidelines, your scheme should cover:

• Doctor visits and consultations.
• Blood tests, scans, and diagnostic procedures.
• Hospital stays for severe flare-ups.
• Medication approved on the scheme’s formulary.
• Dietician consultations and medical nutrition, if referred by your doctor.
• Surgery: If your doctor recommends it and it’s medically necessary.

If you or someone you know is living with UC, our detailed CMScript can help make navigating care and benefits much easier.

Download the full CMScript here.