Diseases

Ulcerative Colitis

Ulcerative colitis is a chronic, recurring inflammatory condition of the large bowel or colon. In ulcerative colitis inflammation and ulcers, or sores, form in the lining of the colon. The disease may involve the entire colon (pancolitis), or part of it or only the rectum (proctitis). The cause of ulcerative colitis is unknown. It is probable that a combination of factors, including heredity, defect in immune system or unidentified microorganism, may be involved in the cause.

Symptoms

The disorder can occur in both sexes, all races and all age groups. It is a disease that usually begins in young people but can start in elderly people also. The disorder 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 occur. The patient may become weak and very sick. When the disease is localized to the rectum, the symptoms are 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 recur.

Diagnosis

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 colon by colonoscopy is usually required. This exam typically reveals a characteristic pattern. Small, painless biopsies are taken which show certain features of ulcerative colitis.

Complications

Most patients with this disease respond well to treatment and go about their lives with few interruptions. However, some attacks 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.

Treatments include medication and less commonly surgery:

1. Anti-inflammatory Drugs such as sulfasalazine (Azulfidine), mesalamine (Asacol, Pentasa and Rowasa) and balsalazide (Colazal) I pill form are usually started to begin with.

2. Steroids are also anti-inflammatory drugs but are powerful medications and very effective. Unfortunately these drugs, if given for long term, have serious side effects, and hence are tapered every time they are started.

3. Immune System Suppressors are actually disease modifying medications but have to be used very cautiously because of side effects. Commonly used ones are: azathioprine (Imuran), 6-MP (Purinethol), cyclosporine (Neoral, Sandimmune), and methotrexate (Rheumatrex).

4. Infliximab (Remicade) is the first of a group of medications that blocks the body's inflammation response. It is given by intravenous infusion every 8 weeks and is recently approved for ulcerative colitis.

5. For patients with longstanding disease that is difficult to control with medicine, surgery is an option. Surgical removal of the colon cures the disease and returns good health and a normal lifestyle to the patient. A permanent bag, or ileostomy, is required for this surgery but other alternative is a pouch or reservoir is created from the small intestine which acts as rectum and the patient does no have to wear an ileostomy bag. Three to six liquid bowel movements occur daily.