Ulcerative Colitis

Ulcerative colitis is a chronic inflammatory disease that affects the lining of the large intestine (colon) and rectum. People with this condition have tiny ulcers and small abscesses in their colon and rectum that flare up periodically and cause bloody stools and diarrhea.

Ulcerative colitis is characterized by alternating periods of flare-ups and remission in which the disease appears to have disappeared. The periods of remission can last from weeks to years.

The inflammation usually begins in the rectum and then spreads to other segments of the colon. How much of the colon is affected varies from person to person. If the inflammation is limited to the rectum, the disease may be called ulcerative proctitis. Ulcerative colitis, unlike Crohn's disease, does not affect the esophagus, stomach or small intestine.

When grouped together, ulcerative colitis and Crohn's disease are referred to as inflammatory bowel disease because they cause inflammation of the bowel.

What are the symptoms of ulcerative colitis?

The main symptom of ulcerative colitis is diarrhea that often becomes bloody. Occasionally, the symptoms of ulcerative colitis include severe bloody diarrhea, dehydration, abdominal pain, and fever. Other symptoms may include painful, urgent bowel movements or pus or blood in the stool. Ulcerative colitis may be associated with weight loss, joint pain, anemia (a deficiency in red blood cells), or skin lesions (sores).

What causes ulcerative colitis?

The cause of ulcerative colitis remains unknown, but it is likely caused by an abnormal response of the immune system in the gastrointestinal tract to something in the gut -- food or bacteria in the intestines, or even the lining of the bowel -- that causes uncontrolled inflammation.

Who gets ulcerative colitis?

Ulcerative colitis can be inherited. Up to 25% of people with inflammatory bowel disease have a first-degree relative (mother, father, brother, sister) with the disease.

How is ulcerative colitis diagnosed?

A variety of diagnostic procedures and laboratory tests are used to distinguish ulcerative colitis from other conditions. First, your doctor will review your medical history and perform a complete physical examination. One or more of the following tests may be ordered:

• Endoscopy, such as colonoscopy or proctosigmoidoscopy.
• Blood tests.
• Stool samples.
• Barium X-ray.
• Other X-ray procedures, such as magnetic resonance imaging (MRI), or computed tomography (CT scan).

How is ulcerative colitis treated?

Treatment can include drug therapy, dietary modifications and/or surgery. Though treatments cannot cure ulcerative colitis, they can help most people lead normal lives.

It is important for you to seek treatment as soon as you start having symptoms. If you have severe diarrhea and bleeding, hospitalization may be necessary to prevent or treat dehydration, reduce your symptoms and ensure that you receive proper nutrition.

Medications

Several medications, including 5-aminosalicylic drugs, corticosteroids, immunosuppressive agents and antibiotics, are used to reduce inflammation of the bowel tissue, allowing it to heal and relieve symptoms.

• 5-aminosalicylic acid (5-ASA). Sulfasalazine is one of the treatments for ulcerative colitis. Let your doctor know if you are allergic to sulfa before taking this medication since it contains sulfa. He or she can prescribe a sulfa-free 5-ASA.
• Corticosteroids. Anti-inflammatory medications can be used when 5-ASA is ineffective. Corticosteroids are also used to treat people who have more severe disease. The use of corticosteroids is limited by side effects and the potential of long-term complications. In general, corticosteroids are used for short periods of time to cause remission. Remission is maintained with a 5-ASA medication.
• Immunosuppressants. If corticosteroids or 5-ASA are not effective, immunosuppressants, such as 6-mercaptopurine (6- MP), or azathioprine may be prescribed.
• Biologic agents. Infliximab (Remicade®) is a monoclonal antibody directed against tumor necrosis factor. It is used in ulcerative colitis patients to treat those with severely active disease. Other biologic agents available for ulcerative colitis patients are Humira®, Simponi®, and Entyvio®.

Nutrition

For mild to moderate ulcerative colitis, your doctor or dietitian may recommend a diet high in protein and calories and low in fiber.

Surgery

Surgery, in which the entire colon is removed, may be necessary when medications are not effective or if you have severe complications of the disease.

Surgery to remove the entire large intestine (colectomy), or both the colon and rectum (proctocolectomy) removes the threat of colon cancer.

If the entire colon is removed, the operation may create an opening, or stoma, in the abdominal wall, to which a bag is attached (ileostomy). The tip of the lower small intestine is brought through the stoma. Stools pass through this opening and collect in an external pouch, which is attached to the stoma and must be worn at all times.

The pelvic pouch, or ileal pouch-anal anastomosis (IPAA), is a procedure that does not require a permanent stoma. In this procedure, the colon and rectum are removed, and the small intestine is used to form an internal pouch or reservoir that will serve as a new rectum. This pouch is connected to the anus. The reservoir is called a J-pouch. This procedure is frequently done in two to three operations and requires a temporary ileostomy in between.

The continent ileostomy (Kock pouch) is an option for people who would like their old-style ileostomy converted to an internal pouch and for people who don't qualify for the IPAA procedures. In this procedure, there is a stoma but no bag. The colon and rectum are removed, and an internal reservoir is created from the small intestine. An opening is made in the abdominal wall, and the reservoir is then joined to the skin with a nipple valve. To drain the pouch, you insert a catheter through the valve into the internal reservoir.

If you have been told you need surgery to treat ulcerative colitis, you may want to seek a second opinion to ensure the treatment prescribed is the most appropriate. Make sure your diagnosis is confirmed by experts at an institution experienced in identifying and treating digestive disorders.

When should I call my doctor?

Call your doctor immediately if:

• You are having heavy, persistent diarrhea.
• You have rectal bleeding, with clots of blood in your stool.
• You have constant pain and a high fever.