Ulcerative colitis is a disease that causes inflammation and sores, called ulcers, in the lining of the rectum and colon. Ulcers form where inflammation has killed the cells that usually line the colon, then bleed and produce pus. Inflammation in the colon also causes the colon to empty frequently, causing diarrhea.
When the inflammation occurs in the rectum and lower part of the colon it is called ulcerative proctitis. If the entire colon is affected it is called pancolitis. If only the left side of the colon is affected it is called limited or distal colitis.
Ulcerative colitis is an inflammatory bowel disease (IBD), the general name for diseases that cause inflammation in the small intestine and colon. It can be difficult to diagnose because its symptoms are similar to other intestinal disorders and to another type of IBD called Crohn's disease. Crohn's disease differs because it causes inflammation deeper within the intestinal wall and can occur in other parts of the digestive system including the small intestine, mouth, esophagus, and stomach.
Ulcerative colitis can occur in people of any age, but it usually starts between the ages of 15 and 30, and less frequently between 50 and 70 years of age. It affects men and women equally and appears to run in families, with reports of up to 20 percent of people with ulcerative colitis having a family member or relative with ulcerative colitis or Crohn's disease. A higher incidence of ulcerative colitis is seen in Whites and people of Jewish descent.
Cause of ulcerative colitis
Although many theories about what causes ulcerative colitis exist, none has been proven. The cause of ulcerative colitis is unknown, and currently there is no cure, except through surgical removal of the colon. A theory suggests that some agent, possibly a virus or an atypical bacterium, interacts with the body's immune system to trigger an inflammatory reaction in the intestinal wall.
Although much scientific evidence shows that people with ulcerative colitis have abnormalities of the immune system, physicians do not know whether these abnormalities are a cause or result of the disease.
- Diarrhea, from only a few episodes to very frequently throughout the day (blood and mucus may be present)
- Abdominal pain and cramping that usually subsides after a bowel movement
- Abdominal sounds (borborygmus, a gurgling or splashing sound heard over the intestine)
- Weight Loss
- Constant feeling of need to pty the bowel, accompanied by pain, cramping, and involuntary straining efforts
Additional symptoms that may be associated with ulcerative colitis include the following:
- Nausea and vomiting
- Joint pain
- Gastrointestinal bleeding
- Skin lesions/ rash
- Liver diorders
- Kidney stones
How is ulcerative colitis diagnosed?
A thorough physical examination, including blood tests to determine whether an anemic condition exists, or if the white blood cell count is elevated (a sign of inflammation), is part of the diagnostic process. Symptoms that suggest ulcerative colitis may also be evaluated with the following procedures:
- stool sample - to check for bleeding or infection.
- colonoscopy - a test that uses a long, flexible tube with a light and camera lens at the end (colonoscope) to examine inside the large intestine.
- biopsy - removal of a sample of tissue (from the lining of the colon) to examine under the microscope.
- barium enema - a procedure performed to examine the large intestine for abnormalities. A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is given into the rectum as an enema. An x-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems.
Treatment for ulcerative colitis
The goals of treatment are to control the acute attacks, prevent repeated attacks, and help the healing of the colon. Hospitalization is often required for severe attacks. Corticosteroids may be prescribed to reduce inflammation.
Medications that may be used to decrease the frequency of attacks include 5-aminosalicylates such as mesalamine and immunomodulators such as azathioprine and 6-mercaptopurine. An intravenous medicine called infliximab has also been shows to improve symptoms of ulcerative colitis.
Surgery to remove the colon will cure ulcerative colitis and removes the threat of colon cancer. Patients may need an ostomy (a surgical opening in the abdominal wall), or a procedure that connects the small intestine to the anus to help the patient gain more normal bowel function.