Ulcerative Colitis

It's estimated by the Crohn's and Colitis Foundation (CCF) that half a million people in the United States suffer from ulcerative colitis. It's one of the inflammatory bowel diseases (IBD). The other is Crohn's disease. (Read about "Crohn's Disease") Both cause inflammation to the large intestine. Crohn's also impacts other parts of the digestive tract. Ulcerative colitis however is limited to the lining of the large intestine. Ulcerative colitis is mainly a disease of the young, with most cases starting in people between the ages of 15 and 40 according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). It would appear to have a genetic connection. (Read about "Genetics") CCF says 20 percent of ulcerative colitis patients have a close relative with ulcerative colitis or Crohn's.

The causes and symptoms

There is no proven theory as to what exactly causes ulcerative colitis. One strong theory is a virus or bacteria invade the lining of the colon. (Read about "Microorganisms") This results in inflammation and ulceration of that lining. It can be in a small, limited area or affect the entire colon. Ulcerative colitis patients also have abnormalities of their immune systems (Read about "The Immune System"), according to NIDDK. It isn't known however if those abnormalities are the cause or the result of the disease.

The first sign of ulcerative colitis is cramps in the abdomen and bloody diarrhea. (Read about "Diarrhea") NIDDK also lists the following as symptoms:

• fatigue
• weight loss
• loss of appetite
• rectal bleeding (Read about "Gastrointestinal Bleeding")

Some of the symptoms mimic irritable bowel syndrome (Read about "Irritable Bowel Syndrome") or another condition called ischemic colitis which is caused by reduced blood flow (Read about "Ischemic Colitis") but ulcerative colitis is much more serious. Only your doctor will be able to diagnose the disease correctly.

Diagnosis

Once other potential causes of the symptoms are ruled out, things such as infections or food poisoning, the doctor will proceed with other tests. A blood test could look for anemia (Read about "Laboratory Testing" "Complete Blood Count" "Anemia") which would indicate bleeding in the colon or the rectum. (Read about "Gastrointestinal Bleeding") Ultimately, the doctor will probably examine the colon with a small camera to look at the lining. Those procedures are called sigmoidoscopy or colonoscopy. (Read about "Colonoscopy" "Flexible Sigmoidoscopy") The doctor will also probably take samples of the colon lining to be tested.

Treatment

Most patients are treated with drugs and diet changes. There are no specific foods that cause the disease but some can cause more discomfort than others. Also because of the diarrhea and bleeding, proper nutrition is important to the medical management of the disease says CCF. Drugs are used by some 60 percent of ulcerative colitis patients according to NIDDK. All of them are aimed at reducing the inflammation and allowing the colon to heal. Types of medications include:

• anti-inflammatory drugs, such as corticosteroids, mesalamine and others
• immune system suppressors such as azathioprine, mercaptopurine, cyclosporine and infliximab
• antidiarrheals
• laxatives
• iron supplements, which can help to prevent anemia due to internal bleeding (Read about "Anemia")

Different drugs can work better with different patients, so you my need to try several different medications before finding one that brings relief.

Surgery may be required eventually by up to 40 percent of patients says NIDDK. There are three types of surgery according to NIDDK. All of them involve the removal of the large intestine or colon. They differ in what is done with material coming from the small intestine and how it is removed. They are:

• A Brooke ileostomy where a small hole, called a stoma, is cut in the abdomen. The small intestine is attached to the stoma and waste exits into a pouch. The pouch is emptied as needed.
• A continent ileostomy uses the lowest part of the small intestine, called the ileum to create a pouch inside the abdomen. The waste empties into this pouch. The patient removes the waste by inserting a tube into a small leak proof opening in their side. An external pouch is only needed for a few months.
• An ileoanal anastomosis allows normal excretion of waste. The ileum is attached to the non-diseased part of the rectum and the anus. The ileum once again acts as a pouch but the waste is expelled in the normal manner.

Surgery choices depend on the severity of the disease and the individual's medical condition. Discuss the issues with your doctor. One good bit of news about the surgery is that once the colon is removed the ulcerative colitis is cured.

Complications

Ulcerative colitis does not stand alone as a disease. It can also cause problems in other parts of the body, according to NIDDK, including:

• arthritis (Read about "Arthritis and Rheumatic Diseases")
• liver disease (Read about "The Liver")
• cirrhosis (Read about "Cirrhosis")
• osteoporosis (Read about "Osteoporosis")
• skin rashes (Read about "Skin Rash")
• anemia (Read about "Anemia")
• kidney stones (Read about "Kidney Stones")

No one knows for sure why problems such as these would occur outside the colon. NIDDK says scientists think these complications may occur when the immune system triggers inflammation in other parts of the body, adding that such complications are usually mild and tend to go away when the ulcerative colitis is treated.

One other complication is the chance of colon cancer. (Read about "Colorectal Cancer") NIDDK says about 5 percent of people with ulcerative colitis develop colon cancer. The risk increases with the duration and the extent of the disease. If only the lower colon and the rectum are involved, the risk is no greater than normal, but if the entire colon is involved, the risk soars to 32 times the normal rate.

Related Information:

    Digestive System

    Primary Immunodeficiency

    Immune System Glossary