ULCERATIVE COLITIS

What Is Ulcerative Colitis? Ulcerative colitis (UC), along with Crohn's disease (see the separate article on this condition), is considered a chronic inflammatory bowel disease (IBD). Ulcerative colitis is more common than Crohn's disease. The occurrence of both diseases peaks between the ages of 15 and 35, with a second peak between 50 and 75 years. However, people can develop IBD at any decade of life. Unlike Crohn's disease, UC is mostly limited to the colon, where there is diffuse, continuous inflammation of the mucosa (the inner surface lining of the colon). Usually, ulcerative colitis is a chronic disease with repeated flare-ups and remissions. In patients with chronic ulcerative colitis, the colon becomes rigid and shortened with irreversible structural changes. The disease can involve any section of the colon; however, the rectum is involved 95% of the time.

What Causes Ulcerative Colitis? There is no identified cause of UC. Evidence suggests that a genetic predisposition leads to an abnormal immune response to infection, diet or the environment. However, nothing has been proven conclusively. Ulcerative colitis is not caused by emotional distress or sensitivity to certain foods or food products, but these factors may trigger symptoms in some people. Unlike Crohn's disease, current cigarette smoking appears to reduce the risk of ulcerative colitis.

What Are Its Signs And Symptoms? There are two main types of signs and symptoms; those directly related to the intestinal tract, and those that are extraintestinal (outside the intestinal tract). Intestinal signs and symptoms include bloody diarrhea and abdominal pain. You may also experience the urge to have a bowel movement which cannot be relieved, even with straining. In more severe ulcerative colitis, there may be signs of dehydration, anemia, fever, and weight loss. Extraintestinal (outside the intestines) manifestations include arthritis, skin rashes, osteoporosis, kidney stones, thrombophlebitis, inflammation involving the eye, and evidence of liver disease, such as cirrhosis. In younger patients delayed growth and sexual maturation can occur. If any of these signs are experienced, see a doctor as soon as possible.

What Are The Complications of Ulcerative Colitis? One of the complications is an increased risk of colon cancer, especially if the first attack of UC is severe, if the disease involves the entire colon, if there is an early onset of the disease and if the disease lasts for more than 10 years. Obstruction is another complication that occurs in UC, but is rare. A condition known as toxic megacolon, a life-threatening complication of ulcerative colitis characterized by symptoms of toxicity and a dilated colon, affects 3% of patients.

With What Can Ulcerative Colitis Be Confused? Acute attacks of colitis caused by infections of salmonella, shigella, campylobacter, ameobiasis and sexually transmitted infectious agents such as gonorrhea, herpes virus and chlamydia can be confused with a first attack of ulcerative colitis. Special tests can be done to rule out these causes. In women using birth control, contraceptive-induced colitis is possible. Elderly patients may also have ischemic colitis (ischemic meaning due to poor blood supply). This should be ruled out especially if there is a history of atherosclerotic heart disease. Colon cancer rarely produces fever or mucus in the stool, but must be excluded as a cause of bloody diarrhea. Crohn's disease can also be confused with ulcerative colitis. However, it is usually differentiated from ulcerative colitis because it often involves severe perianal disease that spares the rectum, thus leading to less bleeding. Also, there is often asymmetric or patchy involvement of the colon.

How Is Ulcerative Colitis Diagnosed? A history typical of the illness, an examination of the stool and sigmoidoscopy (a procedure which allows physicians to inspect the inner lining of the sigmoid colon) is usually enough to diagnose ulcerative colitis. Barium enemas, and complete colonoscopy (an inspection of the entire colon) are not necessary before treatment and may be put the patient at risk for perforation of the colon if the disease is currently active.

How Is Ulcerative Colitis Treated? Treatment for ulcerative colitis depends on the severity of the disease. Most patients are treated with medication. In more severe cases, surgery may be recommended. However, the only cure for ulcerative colitis is surgery. The two main drug treatments are sulfasalazine and corticosteroids (e.g. prednisone). Both are anti-inflammatory drugs which can be taken orally. In the case of sulfasalazine, it can be given as a suppository or through an enema. Another medical treatment, although less proven in effectiveness, is an immunosuppressant such as Imuran (azathioprine). Elective surgery, which in most cases can cure ulcerative colitis, is only recommended when intensive medical treatment fails. Emergency surgery is indicated when complications such as excessive bleeding, toxic megacolon and precancerous changes are detected.