Health Topics

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) swelling in the intestine.

It has been proven that people with ulcerative colitis have problems with their immune system. It is not known if these problems 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.

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

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 swelling somewhere in the body.
• Stool cultures tell if there is an infection by a parasite, virus or bacteria. Stool can also be tested for 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 that is put into the rectum and lower colon (sigmoid colon). It lets the doctor see swelling 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. 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.
• CT (Computed Tomography) Scan is a CAT scan which uses X-ray to take pictures of the inside of the body. This scan allows the doctors to look at the entire bowel for thickening or inflammation.
• MRI (Magnetic Resonance Imaging) takes pictures of the entire body but does not use radiation. This scan also allows the doctors to look at the entire bowel for thickening or swelling. 

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 swelling in the lining of the colon.

• Aminosalicylates (5-ASA drugs) alter the body's ability to create and maintain swelling. 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 swelling. 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 swelling in the last part of the colon. 
• Immunomodulatory medicines are used in patients when aminosalicylates and corticosteroids 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.

Clinical Trials / Research Studies

• IBD and Stress Research Study for Teens and Their Families