Ulcerative Colitis

Ulcerative colitis is the inflammation and ulceration in the top layer of the colon lining.  Usually this inflammation and ulceration occurs in the rectum and lower colon; although, it can also affect the entire colon.  In rare cases, does the inflammation and ulceration spread to the small intestine.  Ulcerative colitis is also known as colitis, ileitis or proctitis.  It is part of a group of diseases classified as Irritable Bowel Disease (IBD) in addition to Crohn's Disease and Irritable Bowel Syndrome (IBS).

In ulcerative colitis, ulcers form in regions where inflammation has killed the cells lining the colon.  These ulcers will bleed and produce pus and mucous.  This condition is very similar to Crohn's Disease in terms of symptoms and treatment; although, Crohn's Disease more regularly affects the small intestine.  Ulcerative colitis usually occurs in individuals between the ages of 15 and 40, affecting men and women equally.

The cause of ulcerative colitis is not yet known.  Many scientists believe that it is caused by abnormalities in the immune system; whereby, the immune system reacts to an unknown bacteria or virus found in the colon, causing inflammation and eventually ulceration.  This immune system abnormality is genetic; therefore, the likelihood of developing ulcerative colitis is greater in individuals with primary relatives (mother, father, sibling) who also have the disease.

Symptoms

There are several non-specific symptoms associated with ulcerative colitis:

There are several types of ulcerative colitis, which are classified depending on their severity and location within the colon:

Complications

Patients with ulcerative proctitis and proctosigmoiditis usually respond well to treatment and rarely require surgery or suffer complication.  Symptoms in these cases are usually mild.  In more severe cases of ulcerative colitis such as pancolitis or fulminant colitis, anemia may be one possible complication.  Other complications include toxic megacolon; whereby, the colon dilates greatly.  This complication may lead to rupture of the colon if left untreated or if the condition does not respond to medication.  Patients with toxic megacolon are extremely ill and suffer from symptoms including fever, abdominal pain, distention, dehydration, and malnutrition.

Patients with a longstanding or severe case of ulcerative colitis are at greater risk of developing colon cancer.  This increased risk depends on the location of the disease.  Individuals with ulcerative proctitis and proctosigmoiditis are not at a greater risk of developing colon cancer, while patients suffering from pancolitis or fulminant colitis for more than 10 years are 10-20 times more likely to develop colon cancer than the general population.

There are also several extra-intestinal complications.  These complications most commonly affect the skin, joints, spin, eyes, liver and bile ducts:

Diagnosis

Diagnosis of ulcerative colitis is primarily based on symptoms.  Physicians will conduct further lab and blood tests to diagnose ulcerative colitis and rule out other forms of infection or disease in patients that are suffering from any of the above symptoms.  If the patient suffers from ulcerative colitis, the lab tests will show elevated white blood cells, a common sign of inflammation, and low red blood cells, protein and minerals, which may result from diarrhea.  Samples of the stool can also be analyzed to determine if there is bleeding from the rectum or colon.

The physician may also opt to perform a barium x-ray.  Barium is a white, chalky substance that shows up on a x-ray machine.  After the patient ingests barium or has it inserted as an enema, the physician can monitor its flow through the digestive system and determine if ulcers or a narrowing of the bowel has occurred. 

Another procedure which is used to diagnose ulcerative colitis and is more reliable than a barium x-ray is a colonoscopy.  During a colonoscopy, a thin viewing tube is inserted into the rectum and colon in order to determine if there are areas of inflammation or ulceration.  A colonoscopy may also be used to perform a biopsy: the removal of tissue samples from the colon to be further analyzed in the lab.

Treatment

There is no known cure for ulcerative colitis.  Physician can use medications or surgery to treat this condition.  Patients will experience periods of relapse (worsening of symptoms and inflammation) and remission.  During remission, the individual either does not suffer from symptoms or the symptoms are very mild.  Remission may occur with medication, surgery or no treatment at all.  If treatment is necessary, its primary purpose is to:

There are several medications available to help treat ulcerative colitis.  They fall into different categories, depending on the type of medication and the way in which it is applied:

There are many side-effects associated with these medications.  Each medication will have a different set of side-effects.  Here are some of the most common:

Another type of treatment is surgery.  Surgery is most often used in cases where the patient is not responding to medication or the condition has become so advanced that surgery is the only option.  Such situations include:

Each individual is different; therefore, there are a few types of surgery possible, which can be chosen depending on the particular case of the patient: