Ulcerative Colitis

Ulcerative Colitis

What is it?

Like Crohn’s diseases, ulcerative colitis is a type of inflammatory bowel disease. Ulcerative colitis usually only affects continuous stretches of the innermost lining of the large intestine. Crohn’s disease, on the other hand, can occur anywhere in the digestive tract and can affect all layers of the bowel wall.

What causes it?

Doctors do not know what causes ulcerative colitis. Current research focuses on two possibilities:

Immune System – Some scientists hypothesize that ulcerative colitis may be triggered by an inappropriate reaction from the immune system. It’s possible that the immune system may try to fight off an invading virus or bacterium, which then causes inflammation of the digestive tract. Alternatively, the inflammation may come from an autoimmune reaction that occurs despite the absence of a pathogen.

Heredity – Heredity likely plays a factor, as ulcerative colitis does run in families. Studies show that up to 20% of people who suffer from ulcerative colitis have a close relative of the disease. More research is needed to determine the cause of ulcerative colitis.

Who is at risk?

According to the New England Journal of Medicine, the incidence of ulcerative colitis is about 0.02% per year. It generally develops in people between the ages of 15 and 30, and affects both men and women equally. Caucasians and Ashkenazi Jews are at a higher risk for developing ulcerative colitis. People who have a close family member with Crohn’s disease or ulcerative colitis are also at greater risk.

Signs and Symptoms

Crohn’s disease, ulcerative colitis, and other inflammatory bowel diseases have similar symptoms, including diarrhea, cramping, abdominal pain, blood in the stool, and mouth sores. Low energy and fatigue is also common, as is a loss of appetite and subsequent weight loss. About 50% of patients with ulcerative colitis experience mild symptoms, including bloody stool, looser and more urgent bowel movements, fever, and anemia.

Ulcerative colitis can be categorized by locations, and each category has different symptoms.

Ulcerative proctitis – Inflammation is confined to the rectum, which is the area closest to the anus. This tends to be the mildest form of ulcerative colitis, and rectal bleeding may be the only symptom. Sufferers may also have rectal pain and a sense of urgency.

Proctosigmoiditis – Inflammation occurs in the rectum and lower part of the large intestine, also called the sigmoid colon. Symptoms include rectal bleeding, a sense of urgency, and an inability to make a bowel movement, despite the urge to do so (tenesmus). Cramps and abdominal pain may also occur.

Left-sided colitis – The inflammation extends through the rectum, sigmoid colon, and descending colon, which is the part of the large intestine that passes downwards on the left side of the abdomen. Consequently, pain and cramping may be focused on the left side. Bloody diarrhea and weight loss are also symptoms.

Pancolitis – This severe form of ulcerative colitis involves most of the large intestine. Symptoms include recurrent, serious bouts of chronic bloody diarrhea, persistent fatigue, abdominal pain and cramping, and significant weight loss.

Fulminant colitis – This is a rare and life-threatening form of ulcerative colitis that affects the entire large intestine. These patients have more than 10 loose, bloody stools per day, continuous bleeding, abdominal pain and swelling, and acute toxic symptoms. Dehydration and shock are common, as well. People with fulminant colitis are at risk of developing serious complications, including bowel or colon rupture and toxic megacolon.

Diagnosis

The first step in diagnosing ulcerative colitis is to rule out other diseases with common symptoms, like Crohn’s disease, irritable bowel syndrome, diverticulitis, and colon cancer. The doctor will perform a blood test to look for anemia, infection, and certain antibodies that could indicate a different diagnosis. A stool sample is usually taken, and analyzed for the presence of white blood cells, bacteria, viruses, and infections.

The next step is an endoscopy, in which the doctor inserts a tube through the anus to examine the interior of the large intestine. A sigmoidoscopy focuses on the rectum and lower colon, while a total colonoscopy looks at the entire small intestine. The doctor may take a biopsy during the procedure, which will be analyzed for indications of ulcerative colitis. These are the most accurate methods for diagnosing ulcerative colitis.

Treatment

There is no cure for ulcerative colitis, and it is a chronic, lifelong illness with symptoms that may disappear and recur. Dietary changes can reduce symptoms. These changes are often person-specific and depend on the symptoms and reactions of the patient, but may include eating small, frequent meals; avoiding carbonated beverages; eating bland foods; and avoiding foods that are high in fiber.

Certain medications can induce and maintain remission. The doctor may prescribe anti-inflammatory drugs, including corticosteroids, to reduce inflammation in the large intestine. The type of anti-inflammatory drug prescribed depends on the area of the large intestine which is affected by ulcerative colitis. Immunosuppressants suppress the immune response, and also decrease inflammation. They can be used in conjunction with corticosteroids and to treat more severe cases of ulcerative colitis. Antibiotics, anti-diarrheal medications, acetaminophen, and iron supplements may also be recommended.

If drug therapy is ineffective, surgery may be required. Unlike Crohn’s disease, which can return afterwards, surgery eliminates ulcerative colitis entirely. About 10 to 40% of people who suffer from ulcerative colitis eventually require surgery to remove the rectum and part or all of the large intestine. This surgery is called a proctocolectomy. After a proctocolectomy, the doctor may perform ileoanal anastomosis, or “pouch surgery,” so the patient can still have normal bowel movements.  A less common operation, called an ileostomy, creates an opening in the abdomen. An ostomy pouch is attached to the opening and collects stool. It must be emptied several times a day.