Doctor Discussion

If you’ve been diagnosed with ulcerative colitis it’s essential to devise an effective treatment strategy. The condition, a type of inflammatory bowel disease (IBD), can wreak havoc with life and worsen over time, and also increases your likelihood of developing colon cancer. As a result, it’s essential to spend some time with your doctor and understand the pros and cons of different approaches, particularly medication and surgery.

Here are some key questions to ask if you think you might have ulcerative colitis:

Have we conducted comprehensive diagnostic testing and ruled out other potential problems?

The symptoms of ulcerative colitis—inflammation, pain, anemia, diarrhea, fatigue and weight loss—can be associated with other conditions, including ova and parasites, cancer, malabsorption problems, endocrine disorders, irritable bowel disease, functional bowel disease, and Crohn’s Disease. Your physician will order a comprehensive workup of your symptoms to determine the root cause of your complaint. Potential tests for these symptoms may include a battery of blood tests, stool sample, barium enema, colonoscopy, biopsy and CT scan. An experienced pathologist should review any biopsy in order to make a definitive diagnosis.

What is my risk of colon cancer?

Ulcerative colitis patients are at an increased risk of cancer. According to the National Institutes of Health, about 5 percent of people with ulcerative colitis develop colon cancer. Moreover, the risk of cancer increases as the disease persists and progresses—and the colon is further damaged. Those who display signs of dysplasia—marked changes in the cells lining the colon—are at particular risk. The American Cancer Society recommends an initial colonoscopy screening to confirm the diagnosis and follow up exam every one to two years.

What lifestyle changes might help control inflammation and delay the need for medication or surgery?

A number of things, including stress and diet, can affect ulcerative colitis. It’s important to explore stress reduction methods such as biofeedback, exercise, massages, meditation and support groups or therapy. It’s also vital to develop a diet plan and engage in healthy lifestyle habits. An ideal diet is high in protein, complex carbohydrates and healthful fats. Conversely, some high fiber foods, including raw vegetables and seeds, may worsen symptoms. Alcohol, caffeine and carbonated beverages also pose problems for many sufferers, though there is no strong evidence for these links and these effects can variy substantially from individual to individual.

What type of medication should I consider and what side effects exist?

If you’re unable to control inflammation along with possible bleeding, pus and diarrhea, you may benefit from medication. The first line of therapy often incorporates mesalamine (also known as 5-aminosalicylic acid or 5-ASA). Administered through tablets or suppositories, it suppresses inflammation. Patients that fail to improve or cannot tolerate 5-ASA medications may require oral steroid therapy or injections. These corticosteroids typically take 10 to 14 days to work effectively. However, they produce numerous undesirable side effects including weight gain, high blood sugar, bone thinning, and suppression of natural hormone production in the body.

A third class of drugs, called immunomodulators, reduce inflammation of the immune system—though they can take as long as 6 months to work effectively. All medications have potential side effects, so it’s important to discuss this issue in detail with your physician to determine the ideal course of treatment. Patients who do not respond well to these medications may benefit from medications known as TNF-alpha inhibitors. This medication is administered through an IV line and must be given in a controlled setting like a doctor’s office. Because of the complexity, risks, and cost, it is important to discuss this option in great detail before committing to therapy with this medication.

What are the pros and cons of surgery and would I benefit?

Surgery is usually considered a treatment of last resort because it involves removal of some or all of the colon. However, if you experience severe bleeding and ongoing illness, medications have failed or you’ve developed dysplasia or cancer (or you’re at high risk), your doctor could suggest either a total proctocolectomy with Ileostomy or a total proctocolectomy and Ileal pouch-anal anastomosis. The former procedure leaves a patient with an external pouch that collects waste at the beltline area. The surgeon creates an opening, called a stoma, from the abdomen and waste flows into the bag. The latter surgery creates an internal pouch from the ileum portion of the small intestine. This allows a person to pass waste through the anus. Both types of surgery are effective in curing the disease.

What is my overall outlook and what can I do to minimize the impact of the disease?

About 90 percent of patients that suffer from ulcerative colitis experience remission after the first bout with the disease. Those with colitis limited to the left side have a better prognosis. Approximately 20-to-25 percent of patients with colitis require a colectomy. About 10 percent die within 10 years of diagnosis. Severe attacks might require hospitalization—along with transfusions and intravenous feeding, as well as consideration of sugery to remove the problem colon altogether. It’s important to work with your doctor to understand symptoms, develop a treatment plan and track results. The right approach could improve your prognosis…and quality of life.