Ulcerative Colitis
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, somewhere between the two.
The cause of ulcerative colitis is unknown.
The disorder can occur in both sexes, all races and all age groups.
It is a disease that usually begins in young people.
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 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 may be needed at some point during the course of the
disease.
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 long-standing 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 10 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.
There are several types of medical treatments available:
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.
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),
mesalamine (Asacol, Pentasa and Rowasa) and balsalazide (Colazal).
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.
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
Crohn's and Colitis Foundation is one of them.
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 permanent 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.
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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