Ulcerative colitis is a chronic, recurring disease of the large bowel or colon. The colon 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 it is voluntarily evacuated.
When ulcerative colitis affects the colon, inflammation and ulcers, or sores, form in the lining of the colon. The disease may involve the entire colon (pancolitis), only the rectum (ulcerative procitis), or more commonly, some area between the two.
What Causes Ulcerative Colitis?
The cause of ulcerative colitis is unknown. Some experts believe there may be 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 also possible that a combination of factors may be involved in the cause.
Who is at risk?
The disorder can occur in both genders, all races, and all age groups. However, it is a disease that usually begins in young people.
The disorder typically begins gradually, with campy abdominal pain and diarrhea that is sometimes bloody. In more severe cases, diarrhea is very severe and frequent. Loss of appetite and weight loss occurs, and the patient becomes weak and very sick. When the disease is localized to the rectum, the symptoms are rectal urgency, bleeding and passage of small amounts of bloody stool. Usually the symptoms tend to come and go, and there may be long periods without any at all. Inevitably, they recur.
Diagnosis of ulcerative colitis can be suspected from the symptoms. Initially, certain blood and stool tests are performed to rule out an infection that mimics the disorder. A visual examination of the lining of the rectum and lower colon (sigmoidoscopy) or the entire colon (colonoscopy) is required. This exam typically reveals a characteristic pattern. Small, painless biopsies are taken which show certain features of ulcerative colitis. Barium enema x-rays of the colon are 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. However, some attacks maybe 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 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 who will develop colon cancer. 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 bring the disorder under control. Then the drug is tapered to low, maintenance doses, even to an alternating daily schedule. 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 adverse side effects.
- Other anti-inflammatory drugs - there are increasing numbers of these drugs available. They can be given by pill or enema. The generic and (trade) names of these drugs are sulfasalazine (Azulfidine), olsalazine (Dipentum), and mesalamine (Asacol, Pentasa, and Rowasa).
- Immune system suppressors - An overactive immune system is probably important in causing ulcerative colitis. Certain drugs such as azathioprine (imuran), 6-MP (Purinethol), and cyclosporine (Sandimmune) 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 multiple vitamin and iron supplement is often recommended.
Stress and anxiety may aggravate symptoms of the disorder but are not believed to cause it of make it worse. Any chronic disease can produce a serious emotional reaction in the patient. This can usually be handled through discussion with the physician.
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 after surgery. Newer operations may avoid the need for an ileostomy. In this operation, a reservoir is created by the small intestine just above the rectum.
Most people with ulcerative colitis lead normal, active lives with few restrictions. Although there is no cure (except by surgery), the disorder can be managed with present treatments. For a few patients, the course of the disease may be more difficult and complicated, requiring more testing and intensive therapy. Surgery sometimes is required. In all cases, follow-up care with the physician is essential to monitor the disease and prevent and treat any complications that arise.