Ulcerative colitis is an acute and chronic disease of the colon or large bowel. It causes inflammation and destruction of the tissue lining the colon and is a risk for the later development of colon cancer.
What is going on in the body?
Ulcerative colitis occurs when the lining of the colon is attacked by the body's immune system. It appears to involve an inflammatory and immune response, which means that the person's body produces targeted immune cells, mediators of inflammation, and antibodies against its own tissues in the colon and sometimes elsewhere (joints, eyes, skin).
The disease can start in the rectum , but may involve any or all of the larger colon at different times. Unlike another inflammatory bowel disease, Crohn's Disease, Ulcerative colitis does not involve the small bowel.
The attacks may cause abscesses, or pus pockets, in the colon or may distend or stretch it enough that it may perforate and lead to a serious infection in the abdominal cavity.
What are the causes and risks of the disease?
The cause of ulcerative colitis is unknown. People with ulcerative colitis have an altered immunity to as of yet unidentified stimuli. Many scientists believe that the immune response is triggered by specific bacteria. There has been no specific gene identified that is associated with the disease.
Stress and dietary factors do not cause ulcerative colitis. However, they may worsen the symptoms when someone has the disease.
What can be done to prevent the disease?
There is no known way to prevent ulcerative colitis. People who have had an appendectomy early in life are either less susceptible to ulcerative colitis or have less severe disease. It is possible that individuals who have an intestinal worm infestation have some protection against ulcerative colitis.
How is the disease diagnosed?
Diagnosis of ulcerative colitis begins with a medical history and physical exam.
The healthcare provider may order tests, including:
A colonoscopy to look directly at the lining of the colon
blood tests to check for anemia or signs of inflammation
a biopsy of tissue from the colon lining during a colonoscopy.
a lab test to check for blood and white blood cells in the stool
specific blood tests that may be positive in ulcerative colitis like a "P-ANCA"
tests to eliminate other causes of colon-mediated diarrhea like a test for a bacteria called C. difficile or other bacteria like Shigella.
Long Term Effects
What are the long-term effects of the disease?
Ulcerative colitis can cause serious long-term effects, including:
- a higher risk of colorectal cancer
- life-threatening blood loss
or inflammation of the abdominal cavity lining
What are the risks to others?
Ulcerative colitis is not contagious and poses no risk to others.
What are the treatments for the disease?
Treatment of ulcerative colitis varies, depending on the intensity and location of the inflammation. The healthcare provider will work with the individual to control the inflammation.
Treatment may include:
ASA agents, such as sulfasalazine (i.e., Azulfidine) and mesalamine (i.e., Asacol, Pentasa), to control inflammation either locally (when they are given by enema) or orally and intravenously to treat larger areas of the colon.
corticosteroids, such as prednisone, which are used when ASA agents aren't able to control the disease. Corticosteroid enemas may be used for disease limited to the rectum and left-side of the colon.
dietary restrictions to allow the colon to rest
intravenous fluids to replace fluid and body salts, or transfusions if bleeding is significant.
aggressive intravenous feedings may be used. These are called "TPN" or Total Parenteral Nutrition
pain medicines as needed (they may be avoided because they can stop the bowel's necessary movement and functions.
medications that suppress the immune manifestations of the disease including azathioprine (i.e., Azasan, Imuran), 6-mercaptopurine (i.e., Purinethol), methotrexate (i.e., Trexall) and similar agents.
recently, medications that prevent rejection in transplant patients have been used successfully in ulcerative colitis. These have included ,cyclosporine (i.e., Restasis, which has been demonstrated to decrease the need for surgical removal of the colon) and tacrolimus (i.e., FK506, Prograf).
If these measures aren't successful in controlling the disease, surgery may be recommended. The entire colon and rectum may be removed. An ileostomy is done to empty the contents of the small bowel into a pouch. This pouch can become infected later (this is called "pouchitis" and require antibiotic treatment).
A newer procedure known as an ileoanal anastamosis leaves part of the rectum intact. Bowel waste is then passed out through the rectum. This has been called rectal sparing surgery.
What are the side effects of the treatments?
Medicines used to treat ulcerative colitis may cause vomiting, lethargy, and allergic reactions (the 5-ASA compounds).
Surgery may cause bleeding, infection, and reactions to anesthesia. Corticosteroids increase the risk of infections and soften bones (called osteoporosis).
Infections are more common in ulcerative colitis patients who take the other medications that suppress immunity.
What happens after treatment for the disease?
People with ulcerative colitis can have periods when the symptoms go away, even completely. It is important for patients to comply with their medications (especially 5-ASA compounds) which have been proven to prevent recurrences of ulcerative colitis) and regular professional care.. Symptoms and active disease can return.
How is the disease monitored?
People with ulcerative colitis will have regular visits with the healthcare provider. The provider will order regular colonoscopy exams to monitor the disease and provide surveillance against colon cancer.
Any new or worsening symptoms which may be a result of ulcerative colitis should be immediately reported to the healthcare provider.
Patients may receive bone density scans to monitor for osteoporosis. If a woman with ulcerative colitis considers pregnancy, she should consult with her provider. The medications can harm the baby and pregnancy may increase disease recurrence.
Professional Guide to Disease, Sixth Edition, Springhouse. Springhouse Publication, 1998.
Griffith, H. Winter.Philadelphi, W.B. Saunders Company, 1994.