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Ulcerative Colitis



Inflammatory bowel disease, or idiopathic proctocolitis



  • Ulcerative colitis, a type of Inflammatory Bowel Disease that affects the colon (also known as the large intestine).  People with this disease develop inflammation and ulcers in the colon.
  • Ulcerative colitis may affect all ages, but usually has two peaks between the ages of 15-30, then again between the ages of 50-70.  Once detected, it can be treated with medicines.
  • Many with this disease have periods when the disease flares up, while at other times, they do have no symptoms at all.  Sometimes, surgical removal of the colon may be necessary.
  • Patients who have had ulcerative colitis for more than 10 years have an increased risk of developing colon cancer and may need part of their colon removed to prevent the development of cancer.

  • The most common symptoms of ulcerative colitis are stomach cramping and bloody diarrhea.
  • The stools may be either firm or loose, and can be either blood-tinged (slightly bloody) or have a large amount of blood and mucus present.
  • Many people also have fecal urgency, which means that they have to make a bowel movement immediately.  Some have pain around the rectum when they have bowel movements.  Both of these symptoms are because of an inflammation in the last part of the colon.
  • In some patients, abdominal pain, either throughout the abdomen or in the lower left section, may get better after they have a bowel movement.
  • Some people with the disease may be anemic (low red blood cell count), dehydrated, malnourished, and may even have a fever.
  • The amount and type of symptoms can be used to divide the disease into mild, moderate, and severe forms.
  • Growth failure
  • Arthritis and joint problems (effusion and pain)
  • Spondylitis (inflammation of the spine)
  • Eye complications such as Cataracts, uveitis, corneal ulcerations, and other problems could occur.
  • Aphthous ulcers (shallow irritating mouth ulcers) may be seen.
  • Changes in the liver (e.g., cirrhosis), skin (e.g., erythema nodosum), and heart (e.g., pericarditis), thromboembolic events and gallbladder involvement (e.g., primary sclerosing cholangitis) are rare complications of ulcerative colitis.
  • Mild disease -- people have fewer than 5 stools per day, with only occasional bleeding.  Usually, there is not much pain or tenderness in the stomach.
  • Moderate disease -- more frequent bowel movements, usually with blood in their stools.  There may be some abdominal pain and tenderness.
  • Severe disease -- more than 6 to 12 bloody stool per day, along with stomach pain and tenderness.  Patients with severe disease may be dehydrated anemic.

  • The cause of ulcerative colitis is still not known.
  • The disease causes inflammation and ulcers in the colon.  This inflammation is the cause of most of the symptoms associated with the disease.  The inflamed colon has a tendency to bleed easily, causing stomach pain, and not allowing the body to absorb nutrients normally.
  • Ulcerative colitis usually affects the last part of the colon.  The rectum is involved in majority of the cases, but sometimes it can cause inflammation throughout the entire colon.

  • A physical examination is the first step in diagnosis.  It may reveal abdominal tenderness, fever, and dehydration.  The rectal examination may show the presence of blood in the stool.
  • Lab tests may show that the person is anemic or that person is anemic or malnourished.
  • The best way to make the diagnosis is by flexible sigmoidoscopy, in which a camera is used to look into the last part of the colon.
  • Initially, only the last part of the colon is examined because it is too risky to look at the entire colon when there is a lot of inflammation.
  • After the person has recovered, then the rest of the colon is examined in order to see how much of the large intestine is affected by the disease.
  • Usually the diagnosis is made by the appearance of the colon when examined by sigmoidoscopy.  However, a biopsy (a small piece of the colon is removed and examined under a microscope) may be needed to confirm the diagnosis.

  • Positive family history
  • People of Jewish ancestry
  • There is a lower incidence in smokers (this is not a reason to smoke).

  • Treatment depends on the area of inflammation and the severity of the inflammation
  • Some general things that can be done to decrease symptoms:
    1. Avoid caffeine
    2. Avoid gas-producing vegetables, such as beans and legumes.
    3. Either increase the amount of fiber in the diet or take fiber supplements.
    4. Anti-diarrheal medicines should only be used under a doctor's supervision.  During times when the disease flares up, anti-diarrheal medicines should not be taken because they may make things worse.  However, when the disease is under control, anti-diarrheal medicines can help reduce the number of bowel movements per day.
  • For mild disease that only affects the last part of the colon (rectum or rectosigmoid areas): 2 drugs that have been used are 5-ASA, and sulfasalazine.  The manufacturer recommends not using sulfasalazine under the age of 2 years.  Rarely, these drugs worsen ulcerative colitis.
  • After the acute symptoms have been treated, people are given medicines to prevent recurrences.  If they do not take these medicines, then there is a very high rate of recurrent flare-ups.
  • For people in whom the disease affects a higher part of the colon, they usually are treated with oral medicines.
  • Oral sulfasalazine is the drugs most often used; often started at a low dose, and the dosage is gradually increased.  Most people improve within 2 to 3 weeks.  All patients on sulfasalazine should take folic acid supplements.
  • If they do not improve after 3 weeks, then steroids are added, usually in the form of foams or enemas.
  • If they still have not improved after another 2 weeks, then oral steroids are added.  The dose of the steroid is then slowly decreased over many weeks.  Oral steroids have a lot of side effects, and are used only when steroid enemas or suppositories do not work.
  • Patients are not allowed to eat in the hospital while they are severely ill with ulcerative colitis, so they are given intravenous fluids, and blood if needed.
  • Patients are treated with very high doses of intravenous steroids.  They are also given steroid enemas.  Most improve within 7-10 days.
  • If they do not improve within 7 to 10 days and refuse surgery, they are treated with cyclosporine.
  • Some people with a very severe disease who do not improve quickly with the steroids need surgery to remove the inflamed part of the colon.
  • There is a very small percentage of patients who become very ill.  They have a severe disease that can progress quickly.  They can develop "toxic megacolon," in which the colon enlarges, causing infection to set in.  These patients may need blood transfusions, antibiotics, or emergent surgery.

  • The first step in treating ulcerative colitis is to get rid of the inflammation.  However, more than 75 percent of people will develop another flare within one year if they do not take medicines to help prevent the disease.  Therefore, a very important part of the treatment of ulcerative colitis is to prevent repeat flare-ups.
  • With medications (sulfa and other treatments), the rate of recurrent flare-ups can be considerably reduced.
  • Sometimes chronic steroid therapy is needed.  However, it is best to avoid this if possible because of the side effects of long-term steroid use.
  • If the above medicines do not work or the person needs to be on chronic steroids, then azathioprine or mercaptopurine (drugs that suppress the immune system) may be used.  However, these drugs also have a lot of side effects.
  • The best drug for you should be discussed with your doctor.
  • Surgery to remove part of the entire colon, may be needed for any of these reasons: uncontrollable bleeding, or if there is evidence of cancer, or if the disease is very severe and does not respond to medicines.  Surgery usually cures the disease.

  • Special Information:
    1. People with ulcerative colitis for more than 10 years have a much higher risk of developing colon cancer.  Therefore, colonoscopy (in which a camera is used, to look at the large intestine) needs to be done every 1 to 2 years in people who have had the disease for more than 8 to 10 years.  Also, random biopsies are taken, and if there are any abnormal cells that even suggest the possibility of cancer, then surgery to remove the colon should be done.
    2. Ulcerative colitis is occasionally associated with other problems that occur outside the colon.  These problems include erythema nodosum, pyoderma gangrenosum, episcleritis, formation of blood clots, arthritis, anterior uveitis, ankylosing spondylitis, and sclerosing cholangitis.
    3. Ulcerative colitis is a life-long disease.  There are often many social consequences for people with this disease.  Therefore, the Crohn's and Colitis Foundation of America has been set up to help people with this disease.  Their phone number is 212-685-3440, or they can be found on the Internet at www.ccfa.org.

  • Infection of the colon by bacteria, viruses, or parasites
  • Ischemic colitis
  • Crohn's disease
  • Diverticulosis
  • Arteriovenous malformations




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