General Illness Information
Medical Term: Ulcerative Colitis
Description: It is an inflammatory disease of the colon characterized by episodes of abdominal pain and bloody diarrhea. Secondary to ulceration in the mucosal lining of the large bowel. Usually this is a disease of flare ups and remissions. Occurs most commonly between ages of 15 and 40 and more common in women.
Genetic, infectious, immunologic and psychologic factors have all been suggested. None have been proven.
Prevention: There are no specific preventive measures.
Signs & Symptoms
- Episodes of bloody diarrhea with mucus, alternating with symptom free intervals.
- Left-sided abdominal pain, usually relieved after bowel movement.
- In severe cases, diarrhea and bleeding is extensive, and there may be abdominal pain and tenderness, fever, weight loss, dehydration and general malaise.
- Incidence of attacks varies considerably from person to person.
- Most commonly, attacks occur at intervals of a few months.
- In some patients, attacks occur almost continuously, while in others, they are infrequent.
- If there is predominantly rectal involvement, constipation, rectal bleeding, pain on defecation may be the presenting symptoms.
Familial predisposition to inflammatory bowel disease.
Diagnosis & Treatment
The diagnosis is made by history, examination, and definitively by sigmoidoscopy (examination of the lower part of the bowel with a special viewing instrument), when a biopsy may be taken. Also barium X-Rays may be performed. In many cases, the entire colon is viewed using a fiber-optic colonoscope.
- The aims of treatment are to control the inflammatory process and to replace nutritional losses. The treatment plan varies with the severity of the illness.
- In most cases, general medical treatment effectively controls the disease.
- Mild ulcerative colitis may be treated on an ambulatory basis.
- Severe cases require hospitalization and intravenous therapy.
- Blood transfusions may be required.
- In the severely ill patient, intravenous alimentation (feeding) may be required.
- Agents to control diarrhea should be used with extreme caution for fear of inducing toxic megacolon, a medical emergency.
- Trust and mutual understanding combined with the compassion and expertise of the physician are essential in the treatment of this disease.
- About 20 to 25 % of patients require surgery at some point in their illness.
- Surgery is indicated if medical therapy fails.
- Though there are various refinements, the usual surgery is a colectomy (removal of the large bowel), with an ileostomy ( an opening on the surface of the abdomen where feces is passed).
- Medical treatment usually consists of corticosteroid drugs ( to reduce inflammation), and sulfasalazine (to maintain long-term freedom from symptoms). Newer derivatives of sulfasalazine are being used effectively.
- Topical preparations of 5-aminosalicylate (mesalamine) given as an enema are effective in the treatment of distal sigmoido-proctitis.
- Other more potent drugs may be used if the above measures are not effective. These include azathioprine and cyclosporine.
Normal activity if the disease is controlled. Bed rest and curtailment of activity may be advised for severe illness.
A normal diet for mild cases. For all other forms of the illness, low roughage or elemental diets may be advised.
- Toxic colitis, toxic megacolon
- Risk of colon cancer.
- Liver: changes occur in about 3 % of patients, and range from mild elevation of liver enzymes to chronic hepatitis, primary sclerosing cholangitis to cirrhosis of the liver. A late complication may be cancer of the biliary tract.
Other complications may include:
- Ankylosing spondylitis
- Erythema nodosum
- Pyoderma gangrenosum
Depends upon severity of the disease and the complications. Nearly one-third of patients with ulcerative colitis ultimately require colectomy, which is usually curative. Patients with localised ulcerative proctitis have the best prognosis.