Ulcerative
Colitis
What
is it?
Ulcerative colitis is an
inflammatory bowel disease (IBD), which is a
general name for diseases that cause the intestine
to become inflamed. Ulcerative colitis is a form
of IBD in which the inner lining of the large
intestine becomes inflamed, swollen, and
ulcerated.
The inflammation usually begins in the lower end of the large
intestine, called the sigmoid colon, which empties
into the rectum. (Inflammation
of the rectum only is called proctitis.) When
the rectum and large intestine become inflamed,
water can’t be absorbed into the blood stream,
which causes diarrhea.
Eventually, the inflammation spreads
throughout the large intestine, with the exception
of the last section called the ileum.
The small intestine is not affected.
Causes
The cause of ulcerative colitis is unknown. It
may affect any age group, although there are
peaks at ages 15 - 30 and then again at ages 50
- 70.
The disease usually begins in the rectal area
and may eventually extend through the entire
large intestine. Repeated swelling
(inflammation) leads to thickening of the wall
of the intestine and rectum with scar tissue.
Death of colon tissue or sepsis may occur with
severe disease.
The symptoms vary in severity and may start
slowly or suddenly. Many factors can lead to
attacks, including respiratory infections or
physical stress.
Risk factors include a family history of
ulcerative colitis, or Jewish ancestry. The
incidence is 10 to 15 out of 100,000 people.
What
are the symptoms?
Often the symptoms of
ulcerative colitis attack suddenly.
The most common symptoms are severe
abdominal pain, intense diarrhea, and high fever.
There may be blood and pus in the bowel
movements. Continued
diarrhea can cause dehydration, increased heart
rate, dizziness, and weight loss.
If the inflammation is limited the sigmoid
colon and rectum, the stools may be normal or hard
and dry. However,
there is a discharge of mucus containing red and
white blood cells either during or between bowel
movements.
People with ulcerative colitis may also experience arthritis,
liver and gallbladder disorders, eye inflammation,
mouth and skin ulcers, and inflammation of the
vertebrae (spondylitis). Symptoms of ulcerative
colitis may flare up and then go away for a period
of time (remission).
Patients with ulcerative colitis mostly on the left side of
the large intestine are most likely to have longer
periods of remission. Some people never have
anything more than mild symptoms.
In severe cases, however, there is a risk of a number of
complications.
These include anemia from frequent
bleeding, an increased risk of colon cancer, and
holes (perforations) in the wall of the intestine.
These are extremely dangerous because the
contents of the intestine can spill into the
abdomen and cause serious infection. Another
complication is toxic colitis, in which the colon
becomes extremely swollen.
When the colon swells to extreme
proportions and infection sets in, it is called
toxic megacolon.
How
is it diagnosed?
Your doctor will question you
about your symptoms and examine a stool sample for
blood and pus.
Because the inflammation of the large
intestine can be caused by disorders other than
ulcerative colitis, stool and blood samples are
important methods to determine whether the
symptoms are caused by a bacterial or parasitic
infection. Blood
tests may also reveal anemia in cases of severe
blood loss.
The best way to confirm a diagnosis and locate the area of
infection is through a procedure called endoscopy.
A tiny, flexible viewing tube inserted through the rectum and
into the colon lets the doctor examine the lining
of the intestine.
He or she can also take a small sample
(biopsy) of the intestine to examine under a
microscope for inflammation. If you have been
diagnosed with ulcerative colitis, your doctor
will recommend regular endoscopic exams and
biopsies because of the increased risk of colon
cancer. X-rays
of the abdomen are also helpful to diagnose the
severity and amount of intestine affected by the
disease. Once
treatment has begun, your doctor may order a
barium x-ray, in which you drink a chalky solution
that reveals more detail in an x-ray.
He may also order a colonoscopy, in which
the entire large intestine is examined with a
flexible viewing tube.
Because these procedures add stress to the
intestinal wall, your doctor will not perform
these tests if there is any risk of intestinal
perforation from ulcerative colitis.
What
is the treatment?
The goal of treatment for
ulcerative colitis is to control the inflammation,
reduce symptoms, and replace lost fluids and
nutrients caused by diarrhea and blood loss. Doctors
only recommend medications that can slow diarrhea,
such as loperamide or diphenoxylate, in cases of
mild diarrhea.
Antidiarrheal drugs can actually cause toxic megacolon if not
monitored carefully. Inflammation
is treated with drugs such as sulfasalazine or
mesalamine, which reduce inflammation and help
stop flare-ups.
Patients who don’t respond to these drugs
may be given steroid medications, such as
prednisone. If
prednisone is used, the goal is to slowly reduce
and then stop the steroid and continue the
sulfasalazine or mesalamine.
When symptoms of ulcerative colitis are
severe, the patient is hospitalized.
Treatment may include antibiotics, blood
transfusions, intravenous fluid replacement,
intravenous steroid medications, and nasogastric
suction to remove stomach juices through a tube
passed through
the nose.
If there is a risk of perforation with
toxic megacolon, surgery to remove the colon is
recommended.
This is called a colectomy.
Patients who show signs of colon cancer may
also need to have a colectomy. In this procedure,
a small opening is made in the front of the
abdominal wall, and the tip of the ileum is
brought to the skin's surface. The opening is
called a stoma. A
pouch is worn over the opening to collect waste,
and the patient empties the pouch as needed.
An alternative treatment is called the ileal pouch anal
anastomosis (IPAA).
With this procedure, the colon and rectum
are removed, but the anal sphincters are
preserved. A
small pouch-like reservoir is created from the
small intestine and connected to the remaining
rectum, just above the anus.
The patient has a stoma with a bag for a
short period of time while the intestine heals.
The pouch can store waste materials, which
are expelled through the anus after the temporary
stoma is closed. Surgery
to remove the large intestine and colon provides a
complete cure for severe ulcerative colitis.
About 20 to 25% of all ulcerative colitis
patients will require some type of surgery.
Your doctor will also make dietary
recommendations to help reduce and control
symptoms.
Self-care
tips
If you have been diagnosed
with ulcerative colitis, follow the treatment plan
your doctor has recommended.
Avoid any foods or beverages that cause indigestion.
If you have diarrhea, drink only clear
liquids. Get plenty of rest and continue to have
regular checkups.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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