Ulcerative colitis

Definition

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

See also: Crohn's disease

Alternative Names

Inflammatory bowel disease - ulcerative colitis; IBD - ulcerative colitis

Causes, incidence, and risk factors

The cause of ulcerative colitis is unknown. It may affect any age group, although there are peaks at ages 15 - 30 and then again at ages 50 - 70.

The disease usually begins in the rectal area and may eventually extend through the entire large intestine. Repeated swelling (inflammation) leads to thickening of the wall of the intestine and rectum with scar tissue. Death of colon tissue or sepsis (severe infection) may occur with severe disease.

The symptoms vary in severity and may start slowly or suddenly. Many factors can lead to attacks, including respiratory infections or physical stress.

Risk factors include a family history of ulcerative colitis, or Jewish ancestry.

Symptoms

• Abdominal pain and cramping that usually disappears after a bowel movement
• Abdominal sounds (a gurgling or splashing sound heard over the intestine)
• Diarrhea, from only a few episodes to very often throughout the day (blood and mucus may be present)
• Fever
• Tenesmus (rectal pain)
• Weight loss

Other symptoms that may occur with ulcerative colitis include the following:

• Gastrointestinal bleeding
• Joint pain
• Nausea and vomiting

Signs and tests

Colonoscopy with biopsy is generally used to diagnose ulcerative colitis.

Colonoscopy is also used to screen people with ulcerative colitis for colon cancer. Ulcerative colitis increases the risk of colon cancer. If you have this condition, you should be screened with colonoscopy about 8-12 years after being diagnosed. You should have a follow-up colonoscopy every 1-2 years.

Othe tests that may be done to help diagnose this condition include:

• Barium enema
• Complete blood count (CBC)
• C-reactive protein (CRP)
• Sedimentation rate (ESR)

Treatment

The goals of treatment are to:

• Control the acute attacks
• Prevent repeated attacks
• Help the colon heal

Hospitalization is often required for severe attacks. Your doctor may prescribe corticosteroids to reduce inflammation. You may be given nutrients through an intravenous (IV) line (through a vein).

DIET AND NUTRITION

Certain types of foods may worsen diarrhea and gas symptoms, especially during times of active disease. Diet suggestions:

• Eat small amounts of food throughout the day.
• Drink lots of water (frequent consumption of small amounts throughout the day).
• Avoid high-fiber foods (bran, beans, nuts, seeds, and popcorn).
• Avoid fatty greasy or fried foods and sauces (butter, margarine, and heavy cream).
• Limit milk products if you are lactose intolerant,. Dairy products are a good source of protein and calcium.
• Avoid or limit alcohol and caffeine.

MEDICATIONS

Medications that may be used to decrease the number of attacks include:

• 5-aminosalicylates such as mesalamine or sulfazine
• Immunomodulators such as azathioprine and 6-mercaptopurine
• Corticosteroids (prednisone and methylprednisolone) taken by mouth during a flareup or as a rectal suppository, foam, or enema
• Infliximab (Remicade) to treat patients who do not respond to other medications

SURGERY

Surgery to remove the colon will cure ulcerative colitis and removes the threat of colon cancer. Surgery is usually for patients who have:

• Colitis that does not respond to complete medical therapy
• Changes in the lining of their colon that are felt to be precancerous.
• Serious complications such as rupture (perforation) of the colon, severe bleeding (hemorrhage), or toxic megacolon

Most of the time, the entire colon, including the rectum, is removed. Afterwards, patients may need an ileoostomy (a surgical opening in the abdominal wall), or a procedure that connects the small intestine to the anus to help the patient gain more normal bowel function.

See also:

• Total prolectomy with ileostomy
• Total proctolectomy and ileal-anal pouch

Support Groups

Social support can often help with the stress of dealing with illness, and support group members may also have useful tips for finding the best treatment and coping with the condition.

For more information visit the Crohn's and Colitis Foundation of America (CCFA) web site at www.ccfa.org.

Expectations (prognosis)

About half of patients with ulcerative colitis have mild symptoms. Patients with more severe ulcerative colitis tend to respond less well to medications.

Permanent and complete control of symptoms with medications is unusual. Cure is only possible through complete removal of the large intestine.

The risk of colon cancer increases in each decade after ulcerative colitis is diagnosed.

Complications

• Ankylosing spondylitis
• Blood clots
• Colorectal cancer
• Colon narrowing
• Complications of corticosteroid therapy
• Impaired growth and sexual development in children
• Inflammation of the joints (arthritis)
• Lesions in the eye
• Liver disease
• Massive bleeding in the colon
• Mouth ulcers
• Pyoderma gangrenosum (skin ulcer)
• Tears or holes (perforation) in the colon

Calling your health care provider

Call your health care provider if you develop persistent abdominal pain, new or increased bleeding, persistent fever, or other symptoms of ulcerative colitis.

Call your health care provider if you have ulcerative colitis and your symptoms worsen or do not improve with treatment, or if new symptoms develop.

Prevention

Because the cause is unknown, prevention is also unknown.

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.

The American Cancer Society recommends having your first screening:

• 8 years after you are diagnosed with severe disease, or when most of, or the entire, large intestine is involved
• 12 - 15 years after diagnosis when only the left side of the large intestine is involved

Have follow-up examinations every 1 - 2 years.

References

Graham L. AGA reviews the use of corticosteroids, immunomodulators, and infliximab in IBD. Am Fam Physician. 2007;75:410-412.

Moyer MS. Chronic ulcerative colitis in childhood. J Pediatr. 2006;148:325.

Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 50.

Rutgeerts P, Vermeire S, Van Assche G. Biological therapies for inflammatory bowel diseases. Gastroenterology. 2009 Apr;136(4):1182-97. Epub 2009 Feb 26.