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 Ulcerative colitis is a chronic,
recurring disease of the
large bowel. The large bowel (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 a bowel movement occurs.
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 proctitis) or, more commonly, some area between the
two.
Causes
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 probable that a combination of factors, including
heredity, may be involved in the cause.
Who Develops Ulcerative Colitis?
The disorder can occur in both sexes, all races and all age
groups. It is a disease that usually begins in young people.
Symptoms
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 rectum and lower colon (sigmoidoscopy) or the
entire colon (colonoscopy) is always required. This exam
typically reveals a characteristic pattern. Small, painless
biopsies are taken which 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.
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 longstanding 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 IO 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.
Treatment
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 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 are increasing
numbers 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 important 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.
Diet and Emotions
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 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 handled through discussion with the
physician. There are excellent support groups available in most
communities. The Ileitis and Colitis Foundation is one of
them.
Surgery
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.
Summary
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.
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