Ulcerative Colitis or
Inflammatory Bowel Disease
- 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
- 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 go to the bathroom
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 stomach or in the lower left section,
may get better after they have a bowel movement.
- Some people with the disease may be
anemic (low blood 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
- Arthritis and joint problems
(effusion and pain)
- Spondylitis: inflammation of the
- Eye complications such as Cataracts, uveitis,
corneal ulcerations, and other problems could occur
- Aphthous Ulcers (shallow irritating
mouth ulcers) may be seen, or changes in the liver (e.g.,
Cirrhosis), skin (e.g., erythema nodosum), 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
- Moderate disease -- more frequent
bowel movements, usually with blood in the stools. There
may be some abdominal pain and tenderness.
- Severe disease -- more than 6 to
12 bloody stool per day, along with abdominal pain and
tenderness. Patients with severe disease may be dehydrated
- The cause of Ulcerative Colitis is still not
- 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 abdominal 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 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
- 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
how the colon looks when examined. However, a biopsy (a
small piece of the colon is removed and examined under a
microscope) may be needed to confirm the
- Positive family history
- People of Jewish ancestry
- There is a lower incidence in
smokers (this is not a reason to
- Treatment depends on the area of
inflammation and the severity of the inflammation
- Some general things that can be
done to decrease symptoms:
- Avoid caffeine
- Avoid gas-producing vegetables,
such as beans and legumes.
- Either increase the amount of
fiber in the diet or take fiber supplements.
- Anti-Diarrhea medicines should
only be used under a doctor's supervision. During times
when the disease flares up, anti-Diarrhea medicines should
not be taken because they may make things worse. However,
when the disease is under control, anti-Diarrhea medicines
can help reduce the number of bowel movements per
- For mild disease that only affect
the last part of the colon (rectum or rectosigmoid
- The treatment of choice is
Mesalamine suppositories (500mg twice a day) or a
Mesalamine enema (4 grams at bedtime). This medicine helps
reduce the inflammation.
- A steroid cream or enema can
also be used to reduce inflammation.
- If this does not work,
then people may have to take steroids or other Immune
system altering/suppressing drugs such as Cyclosporine
or Azathioprine orally.
- 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 and Mesalamine are the drugs most often used. These drugs are 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
- 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
- Patients who are not allowed to
eat, because of the severity of
their disease, 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
- Some people with a very severe
disease who do not improve quickly with the steroids need
surgery to remove the inflamed part of their 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
- 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
- With medications, the rate of
recurrent flare-ups can be considerably reduced.
- Medicines used to prevent recurrent
- Sulfasalazine - 1- 1.5 grams
twice a day.
- Olsalazine - 500 mg twice a day.
- Mesalamine - 800 mg three times a
- 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 either part or
the entire colon may be needed for uncontrollable bleeding,
if there is evidence of cancer, or if the disease is very
severe and does not respond to medicines. Surgery usually
cures the disease.
- 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.
- 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.
- 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.
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