Ulcerative Colitis
What is ulcerative colitis?
Ulcerative colitis and Crohn's disease are the illnesses called inflammatory bowel disease (IBD). These two diseases are very much alike.
In ulcerative colitis, the inner lining of the large intestine or bowel (colon) and the rectum become inflamed (irritated or raw and swollen). Ulcerative colitis can affect the entire colon, but it is usually in the rectum and the lower part of the colon. Inflammation from ulcerative colitis can make the colon empty often, which causes diarrhea. Ulcers form, causing bleeding.
Crohn's disease is usually in the lower part of the small intestine or bowel (ileum). However, it can affect any part of the digestive tract, from where food is taken in (the mouth) to where food comes out (the anus).
About one million Americans have IBD, inflammatory bowel disease. People of all age groups can get ulcerative colitis, but it usually begins between the ages of 15 and 30. Ulcerative colitis affects males and females equally. IBD is more common in Caucasians.
What causes ulcerative colitis?
There is no known cause for ulcerative colitis, but there are many theories about its cause. One theory is that the body's immune system (that fights off infection) reacts to a virus or bacteria. This reaction cannot stop and causes chronic (ongoing) inflammation in the intestine.
It has been proven that people with ulcerative colitis have abnormalities (problems) in the immune system. It is not known if these abnormalities are a cause of the disease or a result of the disease. There is little evidence that ulcerative colitis is caused by emotional distress or allergy to certain foods.
What are the symptoms of ulcerative colitis?
The most common symptoms of ulcerative colitis are stomach pain and bloody diarrhea (loose bowel movements). Other symptoms that can occur include:
- Rectal bleeding (blood in bowel movements)
- Fatigue (tiredness)
- Loss of appetite
- Weight loss
- Skin problems
- Joint pain
- Stunted growth
How is ulcerative colitis diagnosed?
Ulcerative colitis is diagnosed by a complete medical history and physical examination along with medical tests. The main goal of the tests is to make sure that the disease is ulcerative colitis and not some other kind of disease that causes diarrhea.
Testing for ulcerative colitis includes the following:
- Blood tests check for anemia (low red blood cell count), which can mean bleeding in the colon or rectum. They can also show if there is an increased number of white blood cells, which might mean that there is inflammation somewhere in the body.
- Stool cultures tell if there is an infection by a parasite, virus or bacteria. Stool can also be tested for occult (hidden) blood that is not seen on the stool.
- Sigmoidoscopy is a test using a flexible tube with a light and camera lens at the end (sigmoidoscope) that is put into the rectum and lower colon (sigmoid colon). It lets the doctor see inflammation in the lining of the rectum and lower colon.
- Colonoscopy is a test that uses a long, flexible tube with a light and camera lens at the end (colonoscope). This allows the doctor to examine the lining of the entire colon.
- Biopsy is a tissue sample that is taken for examination and testing in a laboratory. In ulcerative colitis, a biopsy (a small piece of tissue from the lining of the large bowel) is usually done during a sigmoidoscopy or colonoscopy.
- Barium enema / X-ray is a procedure that examines the large intestine for abnormalities. A chalky fluid called barium is put into the rectum as an enema. The barium coats the inside of the colon so that it will show up on an X-ray film (picture). An X-ray of the colon shows ulcers (sores) and other problems.
What is the treatment for ulcerative colitis?
Treatment for ulcerative colitis is different from one child to another. What helps one patient may not help another. Treatment for ulcerative colitis depends upon many things:
- Health of the child
- How much of the colon is inflamed
- Ability of the child to take certain medicines or undergo certain procedures
The goal of treatment is to:
- Put the disease into remission (making the disease inactive)
- Help keep the disease in remission
- Improve the quality of life
Some patients go into remission (the symptoms of ulcerative colitis go away). However, it is not uncommon for the symptoms to come back (a "flare").
Medication:
Three different types of medicines may be used to help control the symptoms of ulcerative colitis. Each helps decrease the inflammation in the lining of the colon.
- Aminosalicylates (5-ASA drugs) alter the body's ability to create and maintain inflammation. These drugs are used to treat mild cases. They may be taken by mouth or given as an enema or suppository. Examples include Asacol", Pentasa", Colazal", Dipentum" and azulfidine.
- Corticosteroids (such as prednisone) also affect the body's ability to create and maintain inflammation. These medicines are given by mouth or by vein (intravenous) to quiet down medium to severe disease symptoms, but they are not recommended for long-term use because of their side effects. Steroids may also be given as an enema or suppository for inflammation in the last part of the colon.
- Immunomodulatory medicines are used in patients when aminosalicylates and cortiosteroids do not work or when patients cannot get off the steroids without their symptoms coming back. These drugs quiet down the immune system but they can take as long as three months to work. Some examples are Imuran", (azathioprine) and purinethol (6-MP).
Surgery:
Most patients with ulcerative colitis do not need surgery. When medicine does not work, about 20 to 30 percent of patients must have surgery. Ulcerative colitis is cured when the colon is removed.
Two types of surgery are common:
- Ileoanal anastomosis. This operation removes the diseased part of the colon. The outer muscles of the rectum are not removed. The ileum is attached inside the rectum, forming a pouch to hold waste. This allows the patient to pass stool through the anus in a normal manner. Bowel movements may be more frequent and watery than usual.
- Proctocolectomy. This surgery removes the entire colon and rectum. A small opening is then made in the front of the abdominal wall and the tip of the ileum (end of the lower intestine) is brought to the skin's surface (this procedure is called an ileostomy). The opening of the ileostomy (called a stoma allows drainage of waste into a bag (outside of the body).
Patients can live normal and active lives after surgery.
Revised 8/03, 6/05
