Disease and Condition

Ulcerative Colitis
What is it?Ulcerative colitis is an inflammatory bowel disease (IBD), which is a general name for diseases that cause the intestine to become inflamed. Ulcerative colitis is a form of IBD in which the inner lining of the large intestine becomes inflamed, swollen, and ulcerated. The inflammation usually begins in the lower end of the large intestine, called the sigmoid colon, which empties into the rectum. (Inflammation of the rectum only is called proctitis.) When the rectum and large intestine become inflamed, water can’t be absorbed into the blood stream, which causes diarrhea. Eventually, the inflammation spreads throughout the large intestine, with the exception of the last section called the ileum. The small intestine is not affected.

Who gets it?
Ulcerative colitis can affect all age groups, but occurs most commonly in people between the ages of 15 and 40. It has been found that people of the Jewish faith are three to six times likelier to have a form of IBD. It is also more common in whites than other racial groups. If someone in your family suffers from an IBD, you have a 20% chance of also having the disease.

What causes it?
The cause of ulcerative colitis isn’t known. While stress can increase symptoms, stress is not a direct cause. Evidence supports the belief that heredity and overactive immune responses could be causes. Some researchers believe some type of viral, bacterial, or fungal organism sets off the cycle of the disease.

What are the symptoms?
Often the symptoms of ulcerative colitis attack suddenly. The most common symptoms are severe abdominal pain, intense diarrhea, and high fever. There may be blood and pus in the bowel movements. Continued diarrhea can cause dehydration, increased heart rate, dizziness, and weight loss. If the inflammation is limited the sigmoid colon and rectum, the stools may be normal or hard and dry. However, there is a discharge of mucus containing red and white blood cells either during or between bowel movements. People with ulcerative colitis may also experience arthritis, liver and gallbladder disorders, eye inflammation, mouth and skin ulcers, and inflammation of the vertebrae (spondylitis). Symptoms of ulcerative colitis may flare up and then go away for a period of time (remission). Patients with ulcerative colitis mostly on the left side of the large intestine are most likely to have longer periods of remission. Some people never have anything more than mild symptoms. In severe cases, however, there is a risk of a number of complications. These include anemia from frequent bleeding, an increased risk of colon cancer, and holes (perforations) in the wall of the intestine. These are extremely dangerous because the contents of the intestine can spill into the abdomen and cause serious infection. Another complication is toxic colitis, in which the colon becomes extremely swollen. When the colon swells to extreme proportions and infection sets in, it is called toxic megacolon.

How is it diagnosed?
Your doctor will question you about your symptoms and examine a stool sample for blood and pus. Because the inflammation of the large intestine can be caused by disorders other than ulcerative colitis, stool and blood samples are important methods to determine whether the symptoms are caused by a bacterial or parasitic infection. Blood tests may also reveal anemia in cases of severe blood loss. The best way to confirm a diagnosis and locate the area of infection is through a procedure called endoscopy. A tiny, flexible viewing tube inserted through the rectum and into the colon lets the doctor examine the lining of the intestine. He or she can also take a small sample (biopsy) of the intestine to examine under a microscope for inflammation. If you have been diagnosed with ulcerative colitis, your doctor will recommend regular endoscopic exams and biopsies because of the increased risk of colon cancer. X-rays of the abdomen are also helpful to diagnose the severity and amount of intestine affected by the disease. Once treatment has begun, your doctor may order a barium x-ray, in which you drink a chalky solution that reveals more detail in an x-ray. He may also order a colonoscopy, in which the entire large intestine is examined with a flexible viewing tube. Because these procedures add stress to the intestinal wall, your doctor will not perform these tests if there is any risk of intestinal perforation from ulcerative colitis.

What is the treatment?
The goal of treatment for ulcerative colitis is to control the inflammation, reduce symptoms, and replace lost fluids and nutrients caused by diarrhea and blood loss. Doctors only recommend medications that can slow diarrhea, such as loperamide or diphenoxylate, in cases of mild diarrhea. Antidiarrheal drugs can actually cause toxic megacolon if not monitored carefully. Inflammation is treated with drugs such as sulfasalazine or mesalamine, which reduce inflammation and help stop flare-ups. Patients who don’t respond to these drugs may be given steroid medications, such as prednisone. If prednisone is used, the goal is to slowly reduce and then stop the steroid and continue the sulfasalazine or mesalamine. When symptoms of ulcerative colitis are severe, the patient is hospitalized. Treatment may include antibiotics, blood transfusions, intravenous fluid replacement, intravenous steroid medications, and nasogastric suction to remove stomach juices through a tube passed through

the nose. If there is a risk of perforation with toxic megacolon, surgery to remove the colon is recommended. This is called a colectomy. Patients who show signs of colon cancer may also need to have a colectomy. In this procedure, a small opening is made in the front of the abdominal wall, and the tip of the ileum is brought to the skin's surface. The opening is called a stoma. A pouch is worn over the opening to collect waste, and the patient empties the pouch as needed. An alternative treatment is called the ileal pouch anal anastomosis (IPAA). With this procedure, the colon and rectum are removed, but the anal sphincters are preserved. A small pouch-like reservoir is created from the small intestine and connected to the remaining rectum, just above the anus. The patient has a stoma with a bag for a short period of time while the intestine heals. The pouch can store waste materials, which are expelled through the anus after the temporary stoma is closed. Surgery to remove the large intestine and colon provides a complete cure for severe ulcerative colitis. About 20 to 25% of all ulcerative colitis patients will require some type of surgery. Your doctor will also make dietary recommendations to help reduce and control symptoms.

Self-care tips
If you have been diagnosed with ulcerative colitis, follow the treatment plan your doctor has recommended. Avoid any foods or beverages that cause indigestion. If you have diarrhea, drink only clear liquids. Get plenty of rest and continue to have regular checkups.


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