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
- 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
- Growth failure
- 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.
- 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
- 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:
- Avoid caffeine
- Avoid gas-producing vegetables, such as beans and
- Either increase the amount of fiber in the diet or take
- 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
- 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 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
- 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
- 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
- With medications (sulfa and other
treatments), the rate of recurrent flare-ups can be
- 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.
- 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
- 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
- Infection of the colon by bacteria, viruses, or parasites
- Ischemic colitis
- Crohn's disease
- Arteriovenous malformations
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