Alternative Names: Inflammatory bowel disease - ulcerative colitis.
Colitis is a disease that causes inflammation and sores, called ulcers, in the lining of the rectum and colon. Ulcers form where inflammation has killed the cells that usually line the colon, then bleed and produce pus. Inflammation in the colon also causes the colon to empty frequently, causing diarrhea.
When the inflammation occurs in the rectum and lower part of the colon it is called ulcerative proctitis. If the entire colon is affected it is called panacolitis. If only the left side of the colon is affected it is called limited or distal colitis.
Ulcerative colitis is an inflammatory bowel disease (IBD), the general name for diseases that cause inflammation in the small intestine and colon. It can be difficult to diagnose because its symptoms are similar to other intestinal disorders and to another type of IBD called Crohn's disease. Crohn's disease differs because it causes inflammation deeper within the intestinal wall and can occur in other parts of the digestive system including the small intestine, mouth, esophagus, and stomach.
Ulcerative colitis can occur in people of any age, but it usually starts between the ages of 15 and 30, and less frequently between 50 and 70 years of age. It affects men and women equally and appears to run in families, with reports of up to 20 percent of people with ulcerative colitis having a family member or relative with ulcerative colitis or Crohn's disease. A higher incidence of ulcerative colitis is seen in Whites and people of Jewish descent.
About 5 percent of people with ulcerative colitis develop colon cancer. The risk of cancer increases with the duration of the disease and how much the colon has been damaged. For example, if only the lower colon and rectum are involved, the risk of cancer is no higher than normal. However, if the entire colon is involved, the risk of cancer may be as much as 32 times the normal rate.
Sometimes precancerous changes occur in the cells lining the colon. These changes are called "dysplasia." People who have dysplasia are more likely to develop cancer than those who do not. Doctors look for signs of dysplasia when doing a colonoscopy or sigmoidoscopy and when examining tissue removed during these tests.
According to the 2002 updated guidelines for colon cancer screening, people who have had IBD throughout their colon for at least 8 years and those who have had IBD in only the left colon for 12 to 15 years should have a colonoscopy with biopsies every 1 to 2 years to check for dysplasia. Such screening has not been proven to reduce the risk of colon cancer, but it may help identify cancer early. These guidelines were produced by an independent expert panel and endorsed by numerous organizations, including the American Cancer Society, the American College of Gastroenterology, the American Society of Colon and Rectal Surgeons, and the Crohn's & Colitis Foundation of America.
Researchers are studying how and why the immune system is activated, how it damages the colon, and the processes involved in healing. Through this increased understanding, new and more specific therapies can be developed. Currently, there are numerous clinical trials being conducted that are investigating ulcerative colitis.
The most common symptoms of ulcerative colitis are abdominal pain and bloody diarrhea. Patients also may experience
Loss of appetite.
Loss of body fluids and nutrients.
Growth failure (specifically in children).
About half of the people diagnosed with ulcerative colitis have mild symptoms. Others suffer frequent fevers, bloody diarrhea, nausea, and severe abdominal cramps. Ulcerative colitis may also cause problems such as arthritis, inflammation of the eye, liver disease, and osteoporosis. It is not known why these problems occur outside the colon. Scientists think these complications may be the result of inflammation triggered by the immune system. Some of these problems go away when the colitis is treated.
Causes and Risk factors:
Researchers do not know the exact causes of inflammatory bowel disease. IBD appears to be due to an interaction of many complex factors including genetics, impaired immune system response, and environmental triggers. The result is an abnormal immune system reaction, which in turn causes an inflammatory response in the body's intestinal regions.
Although the exact causes of inflammatory bowel disease are not yet known, genetic factors certainly play some role. Between 10 - 20% of people with ulcerative colitis have family members with the disease. Several identified genes and chromosome locations play a role in the development of ulcerative colitis, Crohn's disease, or both. Genetic factors appear to be more important in Crohn's disease, although there is evidence that both conditions have some genetic defects in common.
In 2006, scientists identified variations in the interleukin-23 receptor (IL23R) as an important genetic link to both Crohn's disease and ulcerative colitis. Interleukin 23 is a cytokine that plays an important part in the inflammatory response and inflammatory diseases. Interestingly, scientists found that certain variations in the IL23 receptor gene can either increase or decrease the risk for inflammatory bowel disease.
Inflammatory bowel disease is much more prevalent in industrialized nations and in higher-income groups. However, there is no strong evidence that diet or particular types of food cause Crohn's disease or ulcerative colitis.
Risk Factors: About 1 million Americans suffer from inflammatory bowel disease (IBD), and about half of these patients have ulcerative colitis. There are several risk factors for ulcerative colitis.
Gender: Men and women are equally at risk for developing ulcerative colitis.
Family History: Ulcerative colitis tends to run in families, with up to 20% of patients having a close relative who also has the disease.
Race and Ethnicity: Ulcerative colitis is more common among whites than non-whites. Jewish people of Ashkenzi (Eastern European) descent have a heightened risk for ulcerative colitis.
Smoking: Smoking appears to increases the risk of developing Crohn's disease, and can worsen the course of the disease. Conversely, smoking appears to decrease the risk of developing ulcerative colitis. Because of the hazards of smoking, however, it should never be used to protect against ulcerative colitis.
Age: Ulcerative colitis can occur at any age, but it is most often diagnosed in people ages 15 - 35 and, less commonly, in people ages 50 - 75.
There is no definitive diagnostic test for ulcerative colitis, although findings on biopsy and barium x-rays, as well as appearance during endoscopy enable a clear diagnosis in most cases. A doctor will diagnose ulcerative colitis based on medical history and physical examination, and the results of laboratory and endoscopic tests.
Laboratory Tests: Blood tests are used for various purposes, including to determine the presence of anemia. An increased number of white blood cells or elevated levels of inflammatory markers such as C-reactive protein may indicate the presence of inflammation. A stool sample may be taken and examined for blood, infectious organisms, or both.
Flexible Sigmoidoscopy and Colonoscopy: Flexible sigmoidoscopy and colonoscopy are standard endoscopic procedures for diagnosing ulcerative colitis. They are important in the diagnosis of both ulcerative colitis and Crohn's disease. Both procedures involve snaking a fiberoptic tube called an endoscope through the rectum to view the lining of the colon. The doctor may also insert instruments through the endoscope to remove a tissue sample for a biopsy.
Sigmoidoscopy, which is used to examine the rectum and left (sigmoid) colon, lasts about 10 minutes and is done without sedation. It may be mildly uncomfortable, but it is not painful. Ulcerative colitis almost always involves the lower left colon and rectum. The doctor usually observes an evenly distributed inflamed surface lining the intestine, and the bowel wall bleeds easily when touched with a swab. If sigmoidoscopy indicates ulcerative colitis, the doctor may order a colonoscopy to confirm the diagnosis and to identify how much of the colon is involved.
Colonoscopy allows a view of the entire colon and requires a sedative, but it is still performed on an outpatient basis. It is helpful for distinguishing between Crohn's disease and ulcerative colitis and in screening for colon cancer.
Barium Enema X-Ray: Sigmoidoscopy and colonoscopy are standard tests for diagnosing ulcerative colitis, but in some cases the doctor may order a double-contrast barium enema swallowed barium passes into the small intestine and shows up on an x-ray image, which may reveal inflammation and other abnormalities.
Treatment can help suppress the inflammatory response and manage symptoms. A treatment plan for ulcerative colitis includes:
Surgery (when necessary).
Diet and nutrition.
Diet and Nutrition: Malnutrition may occur in ulcerative colitis, although it tends to be less severe than with Crohn's disease. Patients with ulcerative colitis may experience reduced appetite and weight loss.
Patients should strive to eat a well-balanced healthy diet and focus on getting enough calories, protein, and essential nutrients from a variety of food groups. These include protein sources such as meat, chicken, fish or soy; dairy products such as milk, yogurt, and cheese (if the patient is not lactose-intolerant); and fruits and vegetables.
Depending on your nutritional status, your doctor may recommend that you take a multivitamin or iron supplement. Other types of dietary supplements, such as probiotics (“healthy bacteria” like lactobacilli), are being investigated for ulcerative colitis. Studies suggest that probiotics do not help much for remission, but they may have modest effects for reducing disease activity and improving symptoms in people with mild-to-moderate ulcerative colitis.
Certain types of foods may worsen diarrhea and gas symptoms, especially during times of active disease. While people vary in their individual sensitivity to foods, general guidelines for dietary management during active disease include:
Eat small amounts of food throughout the day. Stay hydrated by drinking lots of water (frequent consumption of small amounts throughout the day). Eat soft, bland foods and avoid spicy foods. 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 (or consider taking a lactase supplement to improve tolerance). Otherwise, dairy products are a good source of protein and calcium. Avoid or limit alcohol and caffeine consumption.
Medications: Drug therapies for ulcerative colitis aim to resolve symptoms (induce remission) and prevent flare-ups (maintain remission). The main types of drugs used for treating ulcerative colitis include:
Aminosalicylates: Mild-to-moderate ulcerative colitis is usually treated with aspirin-like medications called aminosalicylates, or 5-ASAs. These drugs are also used to treat relapses. They may be administered rectally in patients who have mild-to-moderate disease that occurs only in the last portion of the intestine. They may also be taken by mouth.
Corticosteroids: Corticosteroids (steroids) may be added or used alone to reduce acute inflammation. (Because of their significant side effects, they are not recommended for long-term use and maintenance therapy). Steroids may be administered rectally as an alternative to an aminosalicylate if the disease is limited to the last portion of the intestine. Forms taken by mouth may treat moderate-to-severe cases. People who do not respond to less aggressive treatments may need intravenous steroids
Immunosuppressants: Drugs that suppress the immune system (immunosuppressants) are useful, either alone or in combinations, for disease that does not respond to other treatments or for maintenance of remissions.
Drug therapy is considered successful if it can push the disease into remission (and keep it there) without causing significant side effects. The patient's condition is generally considered in remission when the intestinal lining has healed and symptoms such as diarrhea, abdominal cramps, and tenesmus (straining painfully or ineffectively to defecate or urinate) are normal or close to normal.
Other types of drugs may also be used to treat specific conditions and symptoms associated with ulcerative colitis. Anti-diarrheal medications such as loperamide (Imodium) may be given to help control diarrhea.
Surgery: Drugs do not help about 25 - 40% of patients with ulcerative colitis. As a result, these people nee surgical treatment. Surgery may also be necessary because of hemorrhage, perforation of the colon, or toxic megacolon.
Total proctocolectomy with ileal pouch anal anastomosis (IPAA), also known as restorative proctolectomy, and total proctocolectomy with ileostomy are the two definitive surgical approaches for widespread ulcerative colitis that cannot be controlled with medications. Other patients may have a colectomy (resection of a portion of the colon) for more limited disease.
Crohn's disease can recur after any attempt at bowel resection, but ulcerative colitis does not recur after total proctocolectomy, which is considered a cure for ulcerative colitis.
Medicine and medications:
Aminosalicylates: The standard aminosalicylate drug is sulfazine (Azulfidine). This drug combines the 5-ASA drug mesalamine with sulfapyridine, a sulfa antibiotic. While sulfazine is cheap and effective, the sulfa component of the drug can cause unpleasant side effects, including headache, nausea, and rash.
Corticosteroids: Corticosteroids (commonly called steroids) are powerful anti-inflammatory drugs. They are used only for active ulcerative colitis. Prednisone (Deltasone), methylprednisolone (Medrol), and hydrocortisone (Cortef and Cortisol) are the most common oral corticosteroids. Oral steroids can have distressing and sometimes serious long-term side effects.
Immunosuppressive Drugs: Azathioprine (Imuran, Azasan) and 6-mercaptopurine (6-MP, Purinethol) are the standard oral immunosuppressant drugs. However, it can take 3 - 6 months for these drugs to have an effect. To speed up the response, they are sometimes prescribed along with a corticosteroid drug. Lower steroid doses are then needed, resulting in fewer side effects. Corticosteroids may also be withdrawn more quickly. For this reason, immunosuppressants are sometimes referred to as steroid-sparing drugs.
Other pill forms of immunosuppressants include cyclosporine A (Sandimmune, Neoral) and tracrolimus (Prograf). Cyclosporine A is also given intravenously to patients with severe ulcerative colitis. General side effects of immunosuppressants may include nausea, vomiting, and liver or pancreatic inflammation.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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