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Ulcerative Colitis
by Yael Rosenberg, RN

     Description
     Symptoms
     Incidence and Carriers
     Treatment
     Testing
    Resources and More
    Support Group

Description
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

Incidence and Carriers
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.

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

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

     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

Support Groups
     Reach Out for Youth with Ileitis and Colitis, Inc.
     15 Chemung Place
     Jericho, NY 11753
     Telephone: 516-822-8010

 

SUGGESTED READING

Jewish Genetic Disorders: A Layman's Guide: Guide to genetic disorders affecting  the Jewish population more than the non-Jewish. Includes basic facts on genetics & genetic disorders.
     ------------
Books: Jewish Genetic Diseases

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