What is ulcerative colitis?
Ulcerative colitis is a disease that causes inflammation and
sores, called ulcers, in the lining of the rectum and colon.
Ulcers form where inflammation has killed the cells that usually
line the colon, then bleed and produce pus. Inflammation in the
colon also causes the colon to empty frequently, causing diarrhea.
When the inflammation occurs in the rectum and lower part of the
colon it is called ulcerative proctitis. If the entire colon is
affected it is called pancolitis. If only the left side of the
colon is affected it is called limited or distal colitis.
Ulcerative colitis is an inflammatory bowel disease (IBD), the
general name for diseases that cause inflammation in the small
intestine and colon. It can be difficult to diagnose because its
symptoms are similar to other intestinal disorders and to another
type of IBD called Crohn’s disease. Crohn’s disease differs
because it causes inflammation deeper within the intestinal wall
and can occur in other parts of the digestive system including the
small intestine, mouth, esophagus, and stomach.
Ulcerative colitis can occur in people of any age, but it usually
starts between the ages of 15 and 30, and less frequently between
50 and 70 years of age. It affects men and women equally and
appears to run in families, with reports of up to 20 percent of
people with ulcerative colitis having a family member or relative
with ulcerative colitis or Crohn’s disease. A higher incidence of
ulcerative colitis is seen in Whites and people of Jewish descent.
What are the symptoms of ulcerative
colitis?
The most common symptoms of ulcerative colitis are abdominal pain
and bloody diarrhea. Patients also may experience
anemia
fatigue
weight loss
loss of appetite
rectal bleeding
loss of body fluids and nutrients
skin lesions
joint pain
growth failure (specifically in children)
About half of the people diagnosed with ulcerative colitis have
mild symptoms. Others suffer frequent fevers, bloody diarrhea,
nausea, and severe abdominal cramps. Ulcerative colitis may also
cause problems such as arthritis, inflammation of the eye, liver
disease, and osteoporosis. It is not known why these problems
occur outside the colon. Scientists think these complications may
be the result of inflammation triggered by the immune system. Some
of these problems go away when the colitis is treated.
What causes ulcerative colitis?
Many theories exist about what causes ulcerative colitis. People
with ulcerative colitis have abnormalities of the immune system,
but doctors do not know whether these abnormalities are a cause or
a result of the disease. The body’s immune system is believed to
react abnormally to the bacteria in the digestive tract.
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. The stress of living with
ulcerative colitis may also contribute to a worsening of symptoms.
How is ulcerative colitis diagnosed?
Many tests are used to diagnose ulcerative colitis. A physical
exam and medical history are usually the first step.
Blood tests may be 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.
A stool sample 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.
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.
What is the treatment for ulcerative
colitis?
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 sulfa pyridine and 5-ASA. The sulfa pyridine component carries
the anti-inflammatory 5-ASA to the intestine. However,
sulfa pyridine 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, methyl
prednisone, 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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