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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:

bulletabdominal pain
bulletbloody diarrhea
bulletfatigue
bulletanemia
bulletweight loss
bulletloss of appetite
bulletrectal bleeding
bulletloss of body fluids and nutrients
bulletfever
bulletnausea
bulletarthritis

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

bullet Ulcerative Proctitis: inflammation of the rectum.  Most common symptoms are rectal bleeding, urgency (the frequent, urgent need to defecate) and tenesmus (painful, ineffective urge to empty the bowels)
bulletProctosigmoiditis: inflammation of the rectum and sigmoid colon (lower colon).  Most common symptoms are similar to ulcerative proctitis and also include bloody diarrhea and cramps.
bulletLeft-Sided Colitis: inflammation of the rectum, sigmoid colon and left-side of the colon (descending colon).  Most common symptoms include bloody diarrhea, cramps, weight loss and left-side pain.
bulletPancolitis (universal colitis): inflammation of the entire colon.  Most common symptoms include bloody diarrhea, cramps, abdominal pain, weight loss, fatigue, fever, night sweats.  This condition is a more severe version of ulcerative colitis and is more difficult to treat.
bulletFulminant colitis: severe pancolitis.  Most common symptoms include: dehydration, severe abdominal pain, bloody diarrhea and shock.  Severe complication are common in these cases which can lead to rupture of the colon.  In some cases, surgical removal of the colon is necessary.

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:

bulleterythema hodosum: painful, red, raised spots on skin
bulletpyoderma gangerosum: ulcerating skin condition on ankles
bulletarthritis: stiffness of joints
bulletepiscleritis: an eye condition that causes pain and impaired vision.
bulletlower back inflammation (sacroiliac joint arthritis) and spine inflammation (anklyosing spondylitis), resulting in pain and stiffness in these areas.
bulletliver disease: hepatitis, cirrhosis
bulletkidney stones
bullet primary schlerosing cholangitis
bulletosteoporosis
bulletskin rash

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:

bulletinduce remissions
bulletmaintain remission
bulletminimize side-effects
bulletimprove quality of life

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:

bulletAnti-Inflammatory Agents such as mesalamine, which act via direct contact with the affected area.
bulletCorticosteroids: systemic medication, which means it affects the entire body, has no direct contact with the affected area and has several side-effects.  There are topical corticosteroids available, which involve direct contact with the affected area and have less side-effects.
bulletTopical antibiotics such as metronidazole.
bulletImmuno-modulators: reduce inflammation by reducing the number of immune cells in the body.  By minimizing the ability of the immune system with this type of medication, the individual would be more susceptible to infection and disease; however, the benefits of this medication are thought to greatly outweigh the disadvantages of a lowered immunity.

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:

bulletacne
bulletincrease in body hair
bulletweight gain
bullethigh blood pressure
bulletcataracts
bulletglaucoma
bulletweakness
bulletdepression
bulletinsomnia
bulletmood swings
bulletpersonality changes
bulletirritability
bulletosteoporosis (especially with corticosteroids)
bulletasceptic necrosis-degeneration of hip bone

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:

bulletpatient suffers from fulminant colitis and toxic megacolon and is not responding to medication.
bulletpatients suffers from longstanding pancolitis or left-side colitis and is at risk of developing colon cancer.
bulletpatient has suffered from years of colitis, which has not responded to medications.

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:

bulletileostomy: removal of the colon and rectum.  The end of the small intestine (ileum) is then attached to an opening or stoma in the side of the patient.  Stool can be excreted t and collected in a bag, which is attached to the stoma.
bulletcontinent ileostomy: like an ileostomy, the colon and rectum are removed.  In this case, a pouch is created inside the abdominal cavity from the small intestine.  In contrast to an ileostomy, there is no attached bag.  The pouch is emptied, as necessary, through a leak-proof opening in the side of the patient.
bulletileo-anal anastomosis: the small intestine is attached to the anus.  This is a relatively new procedure, and is available to patients whose anus is still intact after the removal of the colon and rectum.  With this procedure, the normal flow of stool is maintained.

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BrooklynGI.com with offices in New York City Brooklyn Queens and Manhattan. Treating patients from New York, New Jersey and Connecticut. is dedicated to helping patients and physicians receive accurate and up-to-date information on the Gastrointestinal tract (GI Tract) The organs that compose the GI tract include, Esophagus, Stomach, Small Intestine, Large Intestine (Colon), Pancreas and the Liver and Gall Bladder (Hepato-Biliary Tree) Dr. Scott Tenner
Physicians include Dr. Scott Tenner Dr. Robin Baradarian Dr. Susan Ramdhaney Dr. Nison Badalov
Private Practice at 2211 Emmons Ave. Other locations include Maimonides Medical Center 1025 48th Street, Beth Israel Medical Center at KD3201 Kings Highway, Kingsbrook Jewish Medical Ctr at 585 Schenectady Ave, Brookdale Hospital at One Brookdale Plaza, and Kings Highway Hospital at 2525 Kings Highway
We treat a variety of gastrointestinal GI diseases and conditions including Achalasia
Barrett's Esophagus Chronic Hepatitis Cirrhosis of the liver Celiac disease Collagenous Colitis Colorectal cancer Colorectal polyps Constipation Crohn's disease Diverticulosis And Diverticulitis Fatty liver (Steatohepatitis) Gallstones Gas Gastritis Gastric Cancer GERD Helicobacter pylori infection Hemochromatosis Hemorrhoids Hepatitis (Viral Hepatitis A, B, C etc) Hiatus Hernia Irritable Bowel Syndrome Lactose Intolerance Liver failure and transplantation Lymphocytic Colitis Microscopic Colitis Esophageal Cancer Pancreatitis Peptic Ulcer Primary biliary cirrhosis Reflux esophagitis Ulcerative colitis
A premier site for the diagnosis, treatment and management Gastrointestinal diseases, Drs. Tenner and Baradarian provide a variety of Patient Services.
Drs. Tenner and Baradarian are Board Certified Gastroenterologists performing a variety of tests and procedures at their private offices and at Maimonides Medical Center.
We perform many tests & procedure, including: Barium Enema Barium Esophagram Capsule Endoscopy Colonoscopy Colon Cancer Screening EGD (Esophagogastroduodenoscopy) Endoscopic Ultrasound ERCP (Endoscopic Retrograde Cholangiopancreatography) Esophageal Dilation Esophageal pH Fundoplication Hemorrhoid Banding Hemorrhoidectomy Lactose Tolerance Test Liver Biopsy PEG (Percutaneous Endoscopic Gastrostomy) Sigmoidoscopy Stool Acidity Test Upper GI Series
BrooklynGI.com with offices in New York City Brooklyn Queens and Manhattan. Treating patients from New York, New Jersey and Connecticut. is dedicated to helping patients and physicians receive accurate and up-to-date information on the Gastrointestinal tract (GI Tract) The organs that compose the GI tract include, Esophagus, Stomach, Small Intestine, Large Intestine (Colon), Pancreas and the Liver and Gall Bladder (Hepato-Biliary Tree) Dr. Scott Tenner. Physicians include Dr. Scott Tenner Dr. Robin Baradarian Dr. Susan Ramdhaney Dr. Nison Badalov.
Gastrointestinal GI diseases and conditions including Achalasia Private Practice at 2211 Emmons Ave. Other locations include Maimonides Medical Center 1025 48th Street, Beth Israel Medical Center at KD3201 Kings Highway, Kingsbrook Jewish Medical Ctr at 585 Schenectady Ave, Brookdale Hospital at One Brookdale Plaza, and Kings Highway Hospital at 2525 Kings Highway
Barrett's Esophagus Chronic Hepatitis Cirrhosis of the liver Celiac disease Collagenous Colitis Colorectal cancer Colorectal polyps Constipation Crohn's disease Diverticulosis And Diverticulitis Fatty liver (Steatohepatitis) Gallstones Gas Gastritis Gastric Cancer GERD Helicobacter pylori infection Hemochromatosis Hemorrhoids Hepatitis (Viral Hepatitis A, B, C etc) Hiatus Hernia Irritable Bowel Syndrome Lactose Intolerance Liver failure and transplantation Lymphocytic Colitis Microscopic Colitis Esophageal Cancer Pancreatitis Peptic Ulcer Primary biliary cirrhosis Reflux esophagitis Ulcerative colitis
A premier site for the diagnosis, treatment and management Gastrointestinal diseases, Drs. Tenner and Baradarian provide a variety of Patient Services.
Drs. Tenner and Baradarian are Board Certified Gastroenterologists performing a variety of tests and procedures at their private offices and at Maimonides Medical Center.
We perform many tests & procedure, including: Barium Enema Barium Esophagram Capsule Endoscopy Colonoscopy Colon Cancer Screening EGD (Esophagogastroduodenoscopy) Endoscopic Ultrasound ERCP (Endoscopic Retrograde Cholangiopancreatography) Esophageal Dilation Esophageal pH Fundoplication Hemorrhoid Banding Hemorrhoidectomy Lactose Tolerance Test Liver Biopsy PEG (Percutaneous Endoscopic Gastrostomy) Sigmoidoscopy Stool Acidity Test Upper GI Series

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