Ulcerative colitis is different from Crohn’s disease, another type of IBD. Crohn’s disease causes inflammation deeper within the intestinal wall. In addition, Crohn’s disease can occur in other parts of the digestive tract including the mouth, esophagus, stomach, and small intestine.
In ulcerative colitis, inflammation of the inner lining of the rectum and colon can cause ulcerations. As a result, bleeding and pus formation may occur. In addition, inflammation in the colon also causes the colon to empty frequently, causing diarrhea.
The disease may involve the entire colon—a term called pancolitis or only the rectum (ulcerative proctitis). If only the left side of the colon is affected it is called limited or distal colitis.
Who can get ulcerative colitis?
Ulcerative colitis can occur in people of any age, gender, or race. The condition appears to run in families. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about 20 percent of people with ulcerative colitis have a family member or relative with ulcerative colitis or Crohn’s disease.
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Causes
The cause of ulcerative colitis is not fully understood. Some experts believe that there may be is an abnormality in the immune system, which causes it to attack normal cells in the colon. However, more studies are being conducted to better understand the condition.
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Symptoms
Symptoms of ulcerative colitis may differ from person to person. But most people with the condition experience abdominal pain and bloody diarrhea. Other signs and symptoms may include:
• anemiaAbout half of the people diagnosed with the condition experience mild symptoms. In others, frequent fevers, bloody diarrhea, nausea, and severe abdominal cramping occur. Ulcerative colitis may also cause problems such as arthritis, inflammation of the eye, liver disease, and osteoporosis. Experts are not sure why these problems occur outside the colon. Scientists believe that these complications may be the result of inflammation triggered by the immune system. Some of these problems go away when the colitis is treated.
• fatigue
• weight loss
• loss of appetite
• rectal bleeding
• loss of body fluids and nutrients
• skin lesions
• joint pain
• growth failure (specifically in children)
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Diagnosis
Diagnosis of ulcerative colitis involves many tests and procedures. A physical exam and medical history are usually the first step.
Blood tests — This test is done to check for anemia, which could indicate bleeding in the colon or rectum, or they may uncover a high white blood cell count, which is a sign of inflammation somewhere in the body.
Stool sample analysis — This procedure can also reveal white blood cells, whose presence indicates ulcerative colitis or inflammatory disease. In addition, a stool sample allows the doctor to detect bleeding or infection in the colon or rectum caused by bacteria, a virus, or parasites.
Visual examination — A colonoscopy or sigmoidoscopy are the most accurate methods for making a diagnosis of ulcerative colitis and ruling-out other possible conditions, such as Crohn’s disease, diverticular disease, or cancer. For both tests, the doctor inserts an endoscope—a long, flexible, lighted tube connected to a computer and TV monitor—into the anus to see the inside of the colon and rectum. The doctor will be able to see any inflammation, bleeding, or ulcers on the colon wall. During the exam, the doctor may do a biopsy, which involves taking a sample of tissue from the lining of the colon to view with a microscope.
Sometimes x rays such as a barium enema or CT scans are also used to diagnose ulcerative colitis or its complications.
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Treatment
Treatment for ulcerative colitis depends on the severity of the disease. Each person experiences ulcerative colitis differently, so treatment is adjusted for each individual.
Drug Therapy
The goal of drug therapy is to induce and maintain remission, and to improve the quality of life for people with ulcerative colitis. Several types of drugs are available.
- Aminosalicylates, drugs that contain 5-aminosalicyclic acid (5-ASA), help control inflammation. Sulfasalazine is a combination of sulfapyridine and 5-ASA. The sulfapyridine component carries the anti-inflammatory 5-ASA to the intestine. However, sulfapyridine may lead to side effects such as nausea, vomiting, heartburn, diarrhea, and headache. Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, have a different carrier, fewer side effects, and may be used by people who cannot take sulfasalazine. 5-ASAs are given orally, through an enema, or in a suppository, depending on the location of the inflammation in the colon. Most people with mild or moderate ulcerative colitis are treated with this group of drugs first. This class of drugs is also used in cases of relapse.
- Corticosteroids such as prednisone, methylprednisone, and hydrocortisone also reduce inflammation. They may be used by people who have moderate to severe ulcerative colitis or who do not respond to 5-ASA drugs. Corticosteroids, also known as steroids, can be given orally, intravenously, through an enema, or in a suppository, depending on the location of the inflammation. These drugs can cause side effects such as weight gain, acne, facial hair, hypertension, diabetes, mood swings, bone mass loss, and an increased risk of infection. For this reason, they are not recommended for long-term use, although they are considered very effective when prescribed for short-term use.
- Immunomodulators such as azathioprine and 6-mercapto-purine (6-MP) reduce inflammation by affecting the immune system. These drugs are used for patients who have not responded to 5-ASAs or corticosteroids or who are dependent on corticosteroids. Immunomodulators are administered orally, however, they are slow-acting and it may take up to 6 months before the full benefit. Patients taking these drugs are monitored for complications including pancreatitis, hepatitis, a reduced white blood cell count, and an increased risk of infection. Cyclosporine A may be used with 6-MP or azathioprine to treat active, severe ulcerative colitis in people who do not respond to intravenous corticosteroids.
Other drugs may be given to relax the patient or to relieve pain, diarrhea, or infection.
Some people have remissions—periods when the symptoms go away—that last for months or even years. However, most patients’ symptoms eventually return.
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Hospitalization
Occasionally, symptoms are severe enough that a person must be hospitalized. For example, a person may have severe bleeding or severe diarrhea that causes dehydration. In such cases the doctor will try to stop diarrhea and loss of blood, fluids, and mineral salts. The patient may need a special diet, feeding through a vein, medications, or sometimes surgery.
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Surgery
About 25 to 40 percent of ulcerative colitis patients must eventually have their colons removed because of massive bleeding, severe illness, rupture of the colon, or risk of cancer. Sometimes the doctor will recommend removing the colon if medical treatment fails or if the side effects of corticosteroids or other drugs threaten the patient’s health.
Surgery to remove the colon and rectum, known as proctocolectomy, is followed by one of the following:
Not every operation is appropriate for every person. Which surgery to have depends on the severity of the disease and the patient’s needs, expectations, and lifestyle. People faced with this decision should get as much information as possible by talking to their doctors, to nurses who work with colon surgery patients (enterostomal therapists), and to other colon surgery patients. Patient advocacy organizations can direct people to support groups and other information resources.
- Ileostomy, in which the surgeon creates a small opening in the abdomen, called a stoma, and attaches the end of the small intestine, called the ileum, to it. Waste will travel through the small intestine and exit the body through the stoma. The stoma is about the size of a quarter and is usually located in the lower right part of the abdomen near the beltline. A pouch is worn over the opening to collect waste, and the patient empties the pouch as needed.
- Ileoanal anastomosis, or pull-through operation, which allows the patient to have normal bowel movements because it preserves part of the anus. In this operation, the surgeon removes the colon and the inside of the rectum, leaving the outer muscles of the rectum. The surgeon then attaches the ileum to the inside of the rectum and the anus, creating a pouch. Waste is stored in the pouch and passes through the anus in the usual manner. Bowel movements may be more frequent and watery than before the procedure. Inflammation of the pouch (pouchitis) is a possible complication.
Source: Adapted from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (February 2006). NIH Publication No. 06–1597. Retrieved: March 29, 2009.
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