Health
| TZPSS science |
| Topics Front Page |
Knowledge has power.
| Ulcerative Colitis |
Ulcerative colitis is a disease that causes inflammation and
sores, called ulcers, in the lining of the rectum and colon.
Ulcers form where inflammation has killed the cells that usually
line the colon, then bleed and produce pus. Inflammation in
the colon also causes the colon to empty frequently, causing
diarrhea.
When the inflammation occurs in the rectum and lower part of
the colon it is called ulcerative proctitis. If the entire colon is
affected it is called pancolitis. If only the left side of the colon
is affected it is called limited or distal colitis.
Ulcerative colitis is an inflammatory bowel disease (IBD), the
general name for diseases that cause inflammation in the small
intestine and colon. It can be difficult to diagnose because its
symptoms are similar to other intestinal disorders and to
another type of IBD called Crohn�s disease. Crohn�s disease
differs because it causes inflammation deeper within the
intestinal wall and can occur in other parts of the digestive
system including the small intestine, mouth, esophagus, and
stomach.
Ulcerative colitis can occur in people of any age, but it usually
starts between the ages of 15 and 30, and less frequently
between 50 and 70 years of age. It affects men and women
equally and appears to run in families, with reports of up to 20
percent of people with ulcerative colitis having a family member
or relative with ulcerative colitis or Crohn�s disease. A higher
incidence of ulcerative colitis is seen in Whites and people of
Jewish descent.
What are the symptoms of ulcerative colitis?
The most common symptoms of ulcerative colitis are
abdominal pain and bloody diarrhea. Patients also may
experience
* anemia
* fatigue
* weight loss
* loss of appetite
* rectal bleeding
* loss of body fluids and nutrients
* skin lesions
* joint pain
* growth failure (specifically in children)
About half of the people diagnosed with ulcerative colitis have
mild symptoms. Others suffer frequent fevers, bloody
diarrhea, nausea, and severe abdominal cramps. Ulcerative
colitis may also cause problems such as arthritis, inflammation
of the eye, liver disease, and osteoporosis. It is not known
why these problems occur outside the colon. Scientists think
these complications may be the result of inflammation
triggered by the immune system. Some of these problems go
away when the colitis is treated.
What causes ulcerative colitis?
Many theories exist about what causes ulcerative colitis.
People with ulcerative colitis have abnormalities of the immune
system, but doctors do not know whether these abnormalities
are a cause or a result of the disease. The body�s immune
system is believed to react abnormally to the bacteria in the
digestive tract.
Ulcerative colitis is not caused by emotional distress or
sensitivity to certain foods or food products, but these
factors may trigger symptoms in some people. The stress of
living with ulcerative colitis may also contribute to a worsening
of symptoms.
How is ulcerative colitis diagnosed?
Many tests are used to diagnose ulcerative colitis. A physical
exam and medical history are usually the first step.
Blood tests may be done to check for anemia, which could
indicate bleeding in the colon or rectum, or they may uncover
a high white blood cell count, which is a sign of inflammation
somewhere in the body.
A stool sample can also reveal white blood cells, whose
presence indicates ulcerative colitis or inflammatory disease. In
addition, a stool sample allows the doctor to detect bleeding
or infection in the colon or rectum caused by bacteria, a virus,
or parasites.
A colonoscopy or sigmoidoscopy are the most accurate
methods for making a diagnosis of ulcerative colitis and ruling-
out other possible conditions, such as Crohn�s disease,
diverticular disease, or cancer. For both tests, the doctor
inserts an endoscope�a long, flexible, lighted tube connected
to a computer and TV monitor�into the anus to see the
inside of the colon and rectum. The doctor will be able to see
any inflammation, bleeding, or ulcers on the colon wall. During
the exam, the doctor may do a biopsy, which involves taking a
sample of tissue from the lining of the colon to view with a
microscope.
Sometimes x rays such as a barium enema or CT scans are
also used to diagnose ulcerative colitis or its complications.
What is the treatment for ulcerative colitis?
Treatment for ulcerative colitis depends on the severity of the
disease. Each person experiences ulcerative colitis differently,
so treatment is adjusted for each individual.
Drug Therapy
The goal of drug therapy is to induce and maintain remission,
and to improve the quality of life for people with ulcerative
colitis. Several types of drugs are available.
* Aminosalicylates, drugs that contain 5-aminosalicyclic acid (5-
ASA), help control inflammation. Sulfasalazine is a combination
of sulfapyridine and 5-ASA. The sulfapyridine component
carries the anti-inflammatory 5-ASA to the intestine. However,
sulfapyridine may lead to side effects such as nausea,
vomiting, heartburn, diarrhea, and headache. Other 5-ASA
agents, such as olsalazine, mesalamine, and balsalazide, have
a different carrier, fewer side effects, and may be used by
people who cannot take sulfasalazine. 5-ASAs are given orally,
through an enema, or in a suppository, depending on the
location of the inflammation in the colon. Most people with
mild or moderate ulcerative colitis are treated with this group
of drugs first. This class of drugs is also used in cases of
relapse.
* Corticosteroids such as prednisone, methylprednisone, and
hydrocortisone also reduce inflammation. They may be used
by people who have moderate to severe ulcerative colitis or
who do not respond to 5-ASA drugs. Corticosteroids, also
known as steroids, can be given orally, intravenously, through
an enema, or in a suppository, depending on the location of
the inflammation. These drugs can cause side effects such as
weight gain, acne, facial hair, hypertension, diabetes, mood
swings, bone mass loss, and an increased risk of infection. For
this reason, they are not recommended for long-term use,
although they are considered very effective when prescribed
for short-term use.
* Immunomodulators such as azathioprine and 6-mercapto-
purine (6-MP) reduce inflammation by affecting the immune
system. These drugs are used for patients who have not
responded to 5-ASAs or corticosteroids or who are
dependent on corticosteroids. Immunomodulators are
administered orally, however, they are slow-acting and it may
take up to 6 months before the full benefit. Patients taking
these drugs are monitored for complications including
pancreatitis, hepatitis, a reduced white blood cell count, and
an increased risk of infection. Cyclosporine A may be used
with 6-MP or azathioprine to treat active, severe ulcerative
colitis in people who do not respond to intravenous
corticosteroids.
Other drugs may be given to relax the patient or to relieve
pain, diarrhea, or infection.
Some people have remissions—periods when the symptoms
go away—that last for months or even years. However, most
patients' symptoms eventually return.
Hospitalization
Occasionally, symptoms are severe enough that a person
must be hospitalized. For example, a person may have severe
bleeding or severe diarrhea that causes dehydration. In such
cases the doctor will try to stop diarrhea and loss of blood,
fluids, and mineral salts. The patient may need a special diet,
feeding through a vein, medications, or sometimes surgery.
Surgery
About 25 to 40 percent of ulcerative colitis patients must
eventually have their colons removed because of massive
bleeding, severe illness, rupture of the colon, or risk of cancer.
Sometimes the doctor will recommend removing the colon if
medical treatment fails or if the side effects of corticosteroids
or other drugs threaten the patient�s health.
Surgery to remove the colon and rectum, known as
proctocolectomy, is followed by one of the following:
* Ileostomy, in which the surgeon creates a small opening in
the abdomen, called a stoma, and attaches the end of the
small intestine, called the ileum, to it. Waste will travel through
the small intestine and exit the body through the stoma. The
stoma is about the size of a quarter and is usually located in
the lower right part of the abdomen near the beltline. A pouch
is worn over the opening to collect waste, and the patient
empties the pouch as needed.
* Ileoanal anastomosis, or pull-through operation, which
allows the patient to have normal bowel movements because it
preserves part of the anus. In this operation, the surgeon
removes the colon and the inside of the rectum, leaving the
outer muscles of the rectum. The surgeon then attaches the
ileum to the inside of the rectum and the anus, creating a
pouch. Waste is stored in the pouch and passes through the
anus in the usual manner. Bowel movements may be more
frequent and watery than before the procedure. Inflammation
of the pouch (pouchitis) is a possible complication.
Not every operation is appropriate for every person. Which
surgery to have depends on the severity of the disease and
the patient�s needs, expectations, and lifestyle. People faced
with this decision should get as much information as possible
by talking to their doctors, to nurses who work with colon
surgery patients (enterostomal therapists), and to other colon
surgery patients. Patient advocacy organizations can direct
people to support groups and other information resources.
Is colon cancer a concern?
About 5 percent of people with ulcerative colitis develop colon
cancer. The risk of cancer increases with the duration of the
disease and how much the colon has been damaged. For
example, if only the lower colon and rectum are involved, the
risk of cancer is no higher than normal. However, if the entire
colon is involved, the risk of cancer may be as much as 32
times the normal rate.
Sometimes precancerous changes occur in the cells lining the
colon. These changes are called "dysplasia." People who have
dysplasia are more likely to develop cancer than those who do
not. Doctors look for signs of dysplasia when doing a
colonoscopy or sigmoidoscopy and when examining tissue
removed during these tests.
According to the 2002 updated guidelines for colon cancer
screening, people who have had IBD throughout their colon
for at least 8 years and those who have had IBD in only the
left colon for 12 to 15 years should have a colonoscopy with
biopsies every 1 to 2 years to check for dysplasia. Such
screening has not been proven to reduce the risk of colon
cancer, but it may help identify cancer early. These guidelines
were produced by an independent expert panel and endorsed
by numerous organizations, including the American Cancer
Society, the American College of Gastroenterology, the
American Society of Colon and Rectal Surgeons, and the
Crohn�s & Colitis Foundation of America.
Content Credit NDDIC
sores, called ulcers, in the lining of the rectum and colon.
Ulcers form where inflammation has killed the cells that usually
line the colon, then bleed and produce pus. Inflammation in
the colon also causes the colon to empty frequently, causing
diarrhea.
When the inflammation occurs in the rectum and lower part of
the colon it is called ulcerative proctitis. If the entire colon is
affected it is called pancolitis. If only the left side of the colon
is affected it is called limited or distal colitis.
Ulcerative colitis is an inflammatory bowel disease (IBD), the
general name for diseases that cause inflammation in the small
intestine and colon. It can be difficult to diagnose because its
symptoms are similar to other intestinal disorders and to
another type of IBD called Crohn�s disease. Crohn�s disease
differs because it causes inflammation deeper within the
intestinal wall and can occur in other parts of the digestive
system including the small intestine, mouth, esophagus, and
stomach.
Ulcerative colitis can occur in people of any age, but it usually
starts between the ages of 15 and 30, and less frequently
between 50 and 70 years of age. It affects men and women
equally and appears to run in families, with reports of up to 20
percent of people with ulcerative colitis having a family member
or relative with ulcerative colitis or Crohn�s disease. A higher
incidence of ulcerative colitis is seen in Whites and people of
Jewish descent.
What are the symptoms of ulcerative colitis?
The most common symptoms of ulcerative colitis are
abdominal pain and bloody diarrhea. Patients also may
experience
* anemia
* fatigue
* weight loss
* loss of appetite
* rectal bleeding
* loss of body fluids and nutrients
* skin lesions
* joint pain
* growth failure (specifically in children)
About half of the people diagnosed with ulcerative colitis have
mild symptoms. Others suffer frequent fevers, bloody
diarrhea, nausea, and severe abdominal cramps. Ulcerative
colitis may also cause problems such as arthritis, inflammation
of the eye, liver disease, and osteoporosis. It is not known
why these problems occur outside the colon. Scientists think
these complications may be the result of inflammation
triggered by the immune system. Some of these problems go
away when the colitis is treated.
What causes ulcerative colitis?
Many theories exist about what causes ulcerative colitis.
People with ulcerative colitis have abnormalities of the immune
system, but doctors do not know whether these abnormalities
are a cause or a result of the disease. The body�s immune
system is believed to react abnormally to the bacteria in the
digestive tract.
Ulcerative colitis is not caused by emotional distress or
sensitivity to certain foods or food products, but these
factors may trigger symptoms in some people. The stress of
living with ulcerative colitis may also contribute to a worsening
of symptoms.
How is ulcerative colitis diagnosed?
Many tests are used to diagnose ulcerative colitis. A physical
exam and medical history are usually the first step.
Blood tests may be done to check for anemia, which could
indicate bleeding in the colon or rectum, or they may uncover
a high white blood cell count, which is a sign of inflammation
somewhere in the body.
A stool sample can also reveal white blood cells, whose
presence indicates ulcerative colitis or inflammatory disease. In
addition, a stool sample allows the doctor to detect bleeding
or infection in the colon or rectum caused by bacteria, a virus,
or parasites.
A colonoscopy or sigmoidoscopy are the most accurate
methods for making a diagnosis of ulcerative colitis and ruling-
out other possible conditions, such as Crohn�s disease,
diverticular disease, or cancer. For both tests, the doctor
inserts an endoscope�a long, flexible, lighted tube connected
to a computer and TV monitor�into the anus to see the
inside of the colon and rectum. The doctor will be able to see
any inflammation, bleeding, or ulcers on the colon wall. During
the exam, the doctor may do a biopsy, which involves taking a
sample of tissue from the lining of the colon to view with a
microscope.
Sometimes x rays such as a barium enema or CT scans are
also used to diagnose ulcerative colitis or its complications.
What is the treatment for ulcerative colitis?
Treatment for ulcerative colitis depends on the severity of the
disease. Each person experiences ulcerative colitis differently,
so treatment is adjusted for each individual.
Drug Therapy
The goal of drug therapy is to induce and maintain remission,
and to improve the quality of life for people with ulcerative
colitis. Several types of drugs are available.
* Aminosalicylates, drugs that contain 5-aminosalicyclic acid (5-
ASA), help control inflammation. Sulfasalazine is a combination
of sulfapyridine and 5-ASA. The sulfapyridine component
carries the anti-inflammatory 5-ASA to the intestine. However,
sulfapyridine may lead to side effects such as nausea,
vomiting, heartburn, diarrhea, and headache. Other 5-ASA
agents, such as olsalazine, mesalamine, and balsalazide, have
a different carrier, fewer side effects, and may be used by
people who cannot take sulfasalazine. 5-ASAs are given orally,
through an enema, or in a suppository, depending on the
location of the inflammation in the colon. Most people with
mild or moderate ulcerative colitis are treated with this group
of drugs first. This class of drugs is also used in cases of
relapse.
* Corticosteroids such as prednisone, methylprednisone, and
hydrocortisone also reduce inflammation. They may be used
by people who have moderate to severe ulcerative colitis or
who do not respond to 5-ASA drugs. Corticosteroids, also
known as steroids, can be given orally, intravenously, through
an enema, or in a suppository, depending on the location of
the inflammation. These drugs can cause side effects such as
weight gain, acne, facial hair, hypertension, diabetes, mood
swings, bone mass loss, and an increased risk of infection. For
this reason, they are not recommended for long-term use,
although they are considered very effective when prescribed
for short-term use.
* Immunomodulators such as azathioprine and 6-mercapto-
purine (6-MP) reduce inflammation by affecting the immune
system. These drugs are used for patients who have not
responded to 5-ASAs or corticosteroids or who are
dependent on corticosteroids. Immunomodulators are
administered orally, however, they are slow-acting and it may
take up to 6 months before the full benefit. Patients taking
these drugs are monitored for complications including
pancreatitis, hepatitis, a reduced white blood cell count, and
an increased risk of infection. Cyclosporine A may be used
with 6-MP or azathioprine to treat active, severe ulcerative
colitis in people who do not respond to intravenous
corticosteroids.
Other drugs may be given to relax the patient or to relieve
pain, diarrhea, or infection.
Some people have remissions—periods when the symptoms
go away—that last for months or even years. However, most
patients' symptoms eventually return.
Hospitalization
Occasionally, symptoms are severe enough that a person
must be hospitalized. For example, a person may have severe
bleeding or severe diarrhea that causes dehydration. In such
cases the doctor will try to stop diarrhea and loss of blood,
fluids, and mineral salts. The patient may need a special diet,
feeding through a vein, medications, or sometimes surgery.
Surgery
About 25 to 40 percent of ulcerative colitis patients must
eventually have their colons removed because of massive
bleeding, severe illness, rupture of the colon, or risk of cancer.
Sometimes the doctor will recommend removing the colon if
medical treatment fails or if the side effects of corticosteroids
or other drugs threaten the patient�s health.
Surgery to remove the colon and rectum, known as
proctocolectomy, is followed by one of the following:
* Ileostomy, in which the surgeon creates a small opening in
the abdomen, called a stoma, and attaches the end of the
small intestine, called the ileum, to it. Waste will travel through
the small intestine and exit the body through the stoma. The
stoma is about the size of a quarter and is usually located in
the lower right part of the abdomen near the beltline. A pouch
is worn over the opening to collect waste, and the patient
empties the pouch as needed.
* Ileoanal anastomosis, or pull-through operation, which
allows the patient to have normal bowel movements because it
preserves part of the anus. In this operation, the surgeon
removes the colon and the inside of the rectum, leaving the
outer muscles of the rectum. The surgeon then attaches the
ileum to the inside of the rectum and the anus, creating a
pouch. Waste is stored in the pouch and passes through the
anus in the usual manner. Bowel movements may be more
frequent and watery than before the procedure. Inflammation
of the pouch (pouchitis) is a possible complication.
Not every operation is appropriate for every person. Which
surgery to have depends on the severity of the disease and
the patient�s needs, expectations, and lifestyle. People faced
with this decision should get as much information as possible
by talking to their doctors, to nurses who work with colon
surgery patients (enterostomal therapists), and to other colon
surgery patients. Patient advocacy organizations can direct
people to support groups and other information resources.
Is colon cancer a concern?
About 5 percent of people with ulcerative colitis develop colon
cancer. The risk of cancer increases with the duration of the
disease and how much the colon has been damaged. For
example, if only the lower colon and rectum are involved, the
risk of cancer is no higher than normal. However, if the entire
colon is involved, the risk of cancer may be as much as 32
times the normal rate.
Sometimes precancerous changes occur in the cells lining the
colon. These changes are called "dysplasia." People who have
dysplasia are more likely to develop cancer than those who do
not. Doctors look for signs of dysplasia when doing a
colonoscopy or sigmoidoscopy and when examining tissue
removed during these tests.
According to the 2002 updated guidelines for colon cancer
screening, people who have had IBD throughout their colon
for at least 8 years and those who have had IBD in only the
left colon for 12 to 15 years should have a colonoscopy with
biopsies every 1 to 2 years to check for dysplasia. Such
screening has not been proven to reduce the risk of colon
cancer, but it may help identify cancer early. These guidelines
were produced by an independent expert panel and endorsed
by numerous organizations, including the American Cancer
Society, the American College of Gastroenterology, the
American Society of Colon and Rectal Surgeons, and the
Crohn�s & Colitis Foundation of America.
Content Credit NDDIC
| MEDICAL NOTES |
DISEASES AND
CONDITIONS
Acidosis
Acne
Acromegaly
Addison's Disease
Adrenal Crisis
Age. macular degn
Alzheimer's disease
Autoimmune
Hepatitis
Barrett's Esophagus
Cancer
Constipation
Colon Polyps
Crohns Disease
Cushing's Syndrm.
Diabetes
Erectile Dysfunction
Fecal Incontinence
Gallstones
Gastritis
Gastroenteritis
Gastroesophageal
Reflux (GERD)
Growth Hormone
Def.
Heartburn
Hemochromatosis
Hemorrhoids
Hyperparathyroidism
Hypertension
Inflam. Bowel Dis.
Kidney Stone
Liver Cirrhosis
Migraines
Multiple Sclerosis
Obesity
Osteorithritis
Osteoporosis
Pancreatitis
Parkinson's Disease
Peyronies' Disease
Prolactinoma
Psoriasis
Sprain and Strain
Stroke
Ulcerative Colitis
Urin. Incontinence
Vitiligo
CONDITIONS
Acidosis
Acne
Acromegaly
Addison's Disease
Adrenal Crisis
Age. macular degn
Alzheimer's disease
Autoimmune
Hepatitis
Barrett's Esophagus
Cancer
Constipation
Colon Polyps
Crohns Disease
Cushing's Syndrm.
Diabetes
Erectile Dysfunction
Fecal Incontinence
Gallstones
Gastritis
Gastroenteritis
Gastroesophageal
Reflux (GERD)
Growth Hormone
Def.
Heartburn
Hemochromatosis
Hemorrhoids
Hyperparathyroidism
Hypertension
Inflam. Bowel Dis.
Kidney Stone
Liver Cirrhosis
Migraines
Multiple Sclerosis
Obesity
Osteorithritis
Osteoporosis
Pancreatitis
Parkinson's Disease
Peyronies' Disease
Prolactinoma
Psoriasis
Sprain and Strain
Stroke
Ulcerative Colitis
Urin. Incontinence
Vitiligo