Ulcerative Colitis

Introduction     

     Ulcerative colitis is a type of inflammatory bowel disease that affects the large intestine and rectum.

Causes

• 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 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.

Risk Factors

• Positive family history

• People of Jewish ancestry

• There is a lower incidence in smokers (this is not a reason to smoke)

Symptoms

• 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 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 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 severe forms.

• Arthritis and joint problems (fluid in the joints; 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), 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 abdomen.

• 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 and anemic.

Screening and Diagnostics

• 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 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 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 diagnosis.

Treatment

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-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 day.

• There are 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.

Complications

• Tears or holes (perforation) in the colon

• Cancer

• Massive bleeding in the colon

• Colon narrowing

• Inflammation of the joints

• Ankylosing spondylitis

• Lesions in the eye

• Mouth ulcers

• Liver disease

• Impaired growth and sexual development in children

• Pyoderma gangrenosum (skin ulcer)

• Complications of corticosteroid therapy

Prevention

     Because the cause is unknown, prevention is also unknown.

    In patients with ulcerative colitis, nonsteroidal anti-inflammatory drugs (NSAIDs) may make symptoms worse.

     Due to the risk of colon cancer associated with ulcerative colitis, screening with colonoscopy is recommended after 8 years of disease.