Ulcerative Colitis
· Symptoms
of Ulcerative Colitis
· Testing
· Incidence
· Treatment
· Drug
Therapy
· Surgery
· Research
· Resources
and More
Ulcerative colitis is an inflammatory bowel disease in which the inner lining
of the large intestine (colon or bowel) and rectum become inflamed. Inflammation
usually begins in the rectum and lower (sigmoid) intestine and spreads upward
to the entire colon. Ulcerative colitis rarely affects the small intestine except
for the lower section, the ileum.
The cause is unknown, and it may affect any age group although there are peaks
at ages 15 to 30 and then again at ages 50 to 70.
The disease usually begins in the rectal area and may eventually extend through
the entire large bowel. Repeated episodes of inflammation lead to thickening
of the wall of the intestine and rectum with scar tissue. Death of colon tissue
or sepsis may occur with severe disease. The symptoms vary in severity and their
onset may be gradual or sudden. Attacks may be provoked by many factors, including
respiratory infections or stress.
Symptoms
· Abdominal pain
· Bloody diarrhea
· Fatigue
· Weight loss
· Loss of appetite
· Rectal bleeding
· Loss of body fluids and nutrients
· Anemia caused by severe bleeding
Testing
· Stool sample: checks for
bleeding or infection
· Colonoscopy:insertion of
a flexible tube to look inside the colon
· Biopsy: examination of tissue
removed from the colon
· Barium enema: barium shows
up white on x-ray film, revealing growths and other abnormalities in the colon
Incidence
Although all ethnic groups may develop the disease, it is most prevalent among
people of Jewish descent. Risk factors include a family history of ulcerative
colitis or Jewish ancestry. The incidence is 5 out of 10,000 people.
Treatment
Treatment for ulcerative colitis depends on the seriousness of the disease.
Each person may experience ulcerative colitis differently, so treatment is adjusted
accordingly.
· Medication - Most people
are treated with medication.
· Surgery - In severe cases,
a patient may need surgery to remove the diseased colon. Surgery is the only
cure for ulcerative colitis.
·
· Elimination Diet - Some
people, whose symptoms are triggered by certain foods, are able to control the
symptoms by avoiding foods that upset their intestines, like highly seasoned
foods or dairy products (lactose).
Some people have remissions — periods when the symptoms go away — that last
for months or even years. However, most patients' symptoms eventually return.
This changing pattern of the disease makes it difficult to determine when a
treatment actually helps.
Drug
Therapy
Most patients with mild or moderate disease are first treated with 5-ASA agents,
a combination of the drugs sulfonamide, sulfapyridine, and salicylate that helps
control the inflammation. Possible side effects of 5-ASA preparations include
nausea, vomiting, heartburn, diarrhea, and headache.
People with severe disease and those who do not respond to mesalamine preparations
may be treated with corticosteroids. Prednisone and hydrocortisone are two corticosteroids
used to reduce inflammation. They can be given orally, intravenously, through
an enema, or in a suppository, depending on the location of the inflammation.
Corticosteroids can cause side effects such as weight gain, acne, facial hair,
hypertension, mood swings, and increased risk of infection. Doctors carefully
monitor patients taking these drugs.
Other drugs may be given to relax the patient or to relieve pain, diarrhea,
or infection.
Occasionally, symptoms are severe enough that the patient must be hospitalized.
For example, a person may have severe bleeding or severe diarrhea that causes
dehydration. In such cases the doctor will try to stop the diarrhea, loss of
blood, fluids, and mineral salts. The patient may need a special diet, feeding
through a vein, medications, or sometimes surgery.
Surgery
About 25 percent to 40 percent of Ulcerative Colitis patients must eventually
have their colons removed because of massive bleeding, severe illness, rupture
of the colon, or risk of cancer. Sometimes the doctor will recommend removing
the colon if the medical treatment fails, or if the side effects of corticosteroids
or other drugs threaten the patient's health.
One of several surgeries may be done. The most common surgery is a proctocolectomy
with ileostomy, which is done in two stages. In the proctocolectomy, the surgeon
removes the colon and rectum. In the ileostomy, the surgeon creates a small
opening in the abdomen, called a stoma, and attaches the end of the small intestine,
called the ileum. A pouch is worn over the opening to collect the waste, and
the patient empties the pouch as needed.
Not every operation is appropriate for every person. Which surgery to have depends
on the severity of the disease and the patient's needs, expectations, and lifestyle.
People faced with this decision should get as much information as possible by
talking to their doctors, to nurses who work with colon surgery patients (enterostomal
therapists), and to other colon surgery patients. Patient advocacy organizations
can direct people to support groups and other information resources. (See Resources
for the names of such organizations.)
Most people with ulcerative colitis will never need to have surgery. If surgery
ever does become necessary, however, some people find comfort in knowing that
after the surgery, the colitis is cured and most people go on to live normal,
active lives.
Research
Researchers are always looking for new treatments for ulcerative colitis. Several
drugs are being tested to see whether they might be useful in treating the disease:
Budesonide - A corticosteroid called budesonide may be nearly as effective
as prednisone in treating mild ulcerative colitis, and it has fewer side effects.
Cyclosporine - Cyclosporine, a drug that suppresses the immune system,
may be a promising treatment for people who do not respond to 5-ASA preparations
or corticosteroids.
Nicotine - In an early study, symptoms improved in some patients who
were given nicotine through a patch or an enema. Several studies have shown
that using the nicotine patch may help provide short-term relief from ulcerative
colitis flare-ups. How nicotine helps relieve symptoms of the disease isn't
clear, although doctors believe it may protect your colon by thickening and
increasing mucus in it. Nicotine may also play a role in reducing inflammation
in your colon.
Heparin - Researchers overseas are examining whether the anticoagulant
heparin can help control colitis by preventing blood clots
Resources
and More
Crohn's & Colitis Foundation of America, Inc.
National Headquarters
386 Park Avenue South, 17th Floor
New York, NY 10016-8804
Telephone: 212-685-3440
Toll Free: 800-932-2423
Fax: 212-779-4098
Email:info@ccfa.org
Pediatric Crohn's & Colitis Association, Inc.
P.O. Box 188
Newton, MA 02468
Telephone: (617) 489-5854
Website:
http://pcca.hypermart.net
Email: questions@pcca.hypermart.net
Reach Out for Youth with Ileitis and Colitis, Inc.
15 Chemung Place
Jericho, NY 11753
Telephone: 516-822-8010
United Ostomy Association, Inc.
19772 MacArthur Blvd., #200
Irvine, CA 92612-2405
Telephone: 949-660-8624
Toll Free: 800-826-0826
Fax: 949-660-9262
Website:
http://www.uoa.org
Email: uoa@deltanet.com
The Israel Foundation for Crohn's Disease and Ulcerative
Colitis
P.O. Box 5231
Herzlia
Israel
Fax: 09-9567628