Ulcerative Colitis

General Illness Information

Common Name:
Ulcerative Colitis

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.

Causes: Unknown.

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.

Risk Factors

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.

General Measures:

  • 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).

Medications:

  • 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.

Activity:

Normal activity if the disease is controlled. Bed rest and curtailment of activity may be advised for severe illness.

Diet:

A normal diet for mild cases. For all other forms of the illness, low roughage or elemental diets may be advised.

Possible Complications:

  • Hemorrhage.
  • 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:

  • Arthritis
  • Ankylosing spondylitis
  • Uveitis
  • Erythema nodosum
  • Pyoderma gangrenosum
  • Episcleritis

Prognosis

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.

Other

Nothing specified.

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