Ulcerative Colitis

Ulcerative colitis is a chronic, recurring disease of the colon (large bowel). The large bowel is the 5 to 6 foot segment of intestine that begins in the right-lower abdomen, extends upward and then across to the left side, and downward to the rectum. It dehydrates the liquid stool that enters it and stores the formed stool until a bowel movement occurs.

When ulcerative colitis affects the colon, inflammation, ulcers, or sores, form in the lining of the colon. The disease may involve the entire colon (pan colitis), only the rectum (ulcerative proctitis) or, more commonly, some area between the two.

The cause of ulcerative colitis is unknown. Some experts believe there may a defect in the immune system in which the body’s antibodies actually injure the colon. Others speculate that an unidentified microorganism or germ is responsible for the disease. It is probable that a combination of factors, including heredity, may be involved in the cause. The disorder can occur in both sexes, all races and all age groups. It is a disease that usually begins in young people.

Ulcerative Colitis typically begins gradually, with crampy abdominal pain and diarrhea that is sometimes bloody. In more severe cases, diarrhea is very severe and frequent. Loss of appetite and weight loss may occur as a result, the patient may become weak and very sick. When the disease is localized to the rectum, the symptoms include rectal urgency and passage of small amounts of bloody stool. Usually the symptoms tend to come and go, and there may be long periods without any symptoms at all. Usually, however, they will recur.

Diagnosis of ulcerative colitis can be suspected from the symptoms. Certain blood and stool tests are performed to rule out an infection that can mimic the disorder. A visual examination of the lining of the rectum and lower colon (sigmoidoscopy) or the entire colon (colonoscopy) is always required for an official diagnosis. This exam typically reveals s characteristic pattern and small, painless biopsies are taken to show certain features of ulcerative colitis. A barium enema x-ray of the colon is also needed at some point during the course of the disease.

Most patients with this disease respond well to treatment and go about their lives with few interruptions. Some attacks, however, may be quite severe, requiring a period of bowel rest, hospitalization and intravenous treatment. In rare cases, emergency surgery is required. The disease can affect nutrition causing poor growth during childhood and adolescence. Liver, skin, eye, or joint (arthritis) problems occasionally occur, even before the bowel symptoms develop. Other problems can include narrowing and partial blocking of the bile ducts which carry bile from the liver to the intestine. Fortunately, there is much that can be done about all of these complications.

In long-standing ulcerative colitis, the major concern is colon cancer. The risk of developing colon cancer increases significantly when the disorder begins in childhood, has been present for 8 to 10 years, or when there is a family history of colon cancer. In these situations, it is particularly important to perform regular and thorough surveillance of the colon, even when there are no symptoms. Analysis of colon biopsies performed during colonoscopy can often predict if colon cancer will occur. In these cases, preventive surgery is recommended.

There are several types of medical treatments available:

  • Cortisone, Steroids, Prednisone – These powerful drugs usually provide highly effective results. A high dose is often used initially to get the disorder under control. Then, the drug is tapered to low, maintaining doses, even to a dose every other day. These medications are given by pill, enema or intravenously during an acute attack. In time, the physician will usually try to discontinue these drugs because of potential long-term, adverse side effects.
  • Other Anti-inflammatory Drugs – There is an increasing number of these drugs available. They can be given by pill or enema. The generic and trade names of some of these drugs are sulfasalazine (Azulfidine), olsalazine (Dipentum), and mesalamine (Asacol, Pentasa, and Rowasa).
  • Immune System Suppressors – An overactive immune system is probably an important factor in causing ulcerative colitis. Certain drugs such as azathioprine (Imuran), 6-MP (Purinethol), cyclosporine (Neoral, Sandimmune), and methotrexate (Rheumatrex) suppress the immune system and, at times, are effective.

There are no foods known to injure the bowel; however, during an acute phase of the disease, bulky foods, milk, and milk products can increase diarrhea and cramping. Generally, the patient is advised to eat a healthy, well-balanced diet with adequate protein and calories. A multi-vitamin is often recommended. Iron may be prescribed if anemia is present.

Stress and anxiety may aggravate symptoms of the disorder, but are not believed to cause it or make it worse. Any chronic disease can produce a serious emotional reaction in the patient. This can usually be worked through by discussion with the physician. There are excellent support groups available in most communities like the Ileitis and Colitis Foundation.

For patients with longstanding disease that is difficult or impossible to control with medicine, surgery is a welcomed option. In these rare cases, the patient’s lifestyle and general health have been significantly affected. Surgical removal of the colon cures the disease and returns good health and a normal lifestyle to the patient. In the past a bag, or ileostomy, was required for this surgery. Advances in surgery now can avoid this problem. The colon is removed and a pouch or reservoir is created from the small intestine. Three to six liquid bowel movements occur daily. Most patients are extremely pleased with this new surgery.

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