What is Ulcerative Colitis?
Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that results in chronic inflammation of the large intestine. Inflammation is the body’s response to injury or illness, and may include increased blood flow, warmth and redness in the affected area. Unlike Crohn’s disease, another form of IBD, UC affects only the inner lining of the large intestine (colon). The inflammation starts at the anus and extends upward in a continuous manner to involve the rectum, the left side of the colon, most of the colon, or the entire colon.
Who gets Ulcerative Colitis?
UC occurs worldwide, and affects 1-2 million people in the United States. It is more common than Crohn’s disease. Although it can occur at any age, most people who have it develop symptoms before age 30. It affects both genders, but is slightly more common in males. UC happens more often in people of Caucasian and Ashkenazi Jewish ancestry, and less often in people of Asian, African and South American descent. It usually occurs in nonsmokers and those who stop smoking. Patients may have other family members with inflammatory bowel disease (UC or Crohn’s Disease).
What causes Ulcerative Colitis?
The exact cause of UC is not known. It is thought to result from genetic and environmental factors that lead to an abnormal response from the body’s immune system. The immune system is the body’s natural defense system for fighting infections. With UC, the immune system attacks the person’s digestive tract and other organs, resulting in inflammation. Infections and other illnesses, nonsteroidal pain medications (ibuprofen and related medications), antibiotics and stress are some of the things that can lead to a flare or worsening of UC symptoms.
What are the symptoms of Ulcerative Colitis?
Patients with inactive UC are without symptoms and considered to be in remission. When there is active colon inflammation, the patient is said to be having a “flare.” Typical gastrointestinal symptoms include diarrhea, bloody bowel movements, mucus in the stool, abdominal pain, rectal pain and urgency (a feeling of needing to go to the bathroom immediately), fever and weight loss. Other symptoms are mouth ulcers, low back pain, joint pain and swelling, painful red eye, and skin sores.
For some UC patients, a related liver condition called primary sclerosing cholangitis (PSC) can occur. PSC can cause symptoms of itching and jaundice (yellowing of the skin and/or whites of eyes).
How is the diagnosis of Ulcerative Colitis made?
Blood and stool tests are a common part of the evaluation, but there is no single blood or stool test that can enable a definite diagnosis. UC generally is diagnosed by one of two tests: a colonoscopy or flexible sigmoidoscopy. These procedures use an endoscope, which is a small camera attached to a lighted, flexible tube inserted into the rectum and colon. A flexible sigmoidoscopy shows only the lower portions of the colon; a colonoscopy shows the entire colon Tiny pieces of colon tissue are removed to examine under a microscope. This is called “biopsy” and is not painful.
What is the treatment for Ulcerative Colitis?
There is no cure for UC. The goals of medical treatment are to resolve symptoms and heal the colon inflammation, as well as to prevent complications from this condition. Patients often need to continue medical treatment long term to maintain remission (control of symptoms and inflammation). The decision regarding which medication to use, and whether to use a combination of medications, will depend on the extent and severity of UC, allergies, prior history with medications, potential side effects and patient preference.
Steroids are a type of medication which may be used for a short time in patients with active disease, but are not a good option as maintenance treatment due to their side effects.
Aminosalicylates (oral, enemas or suppositories) are a group of medicines used to treat inflammation of the gut. They may be used as maintenance therapy in patients with mild inflammation.
Some patients benefit from medications called immunomodulators, which act to “turn down” the immune system response. These are similar to medicines used to prevent a person’s immune system from rejecting an organ transplant.
Patients may also be treated with specially developed medicines called biologic therapies that may be given as shots or as infusions through an intravenous (IV) line. Many IBD specialists have a treatment area where patients can go to have medicines infused for a few hours and then return home.
Some patients are treated with a combination of medications.
Patients are encouraged to have a healthy, balanced diet and to keep up with vaccinations for conditions like the flu and pneumonia.
Can Ulcerative Colitis be treated with surgery?
Sometimes patients choose not to be treated with medications, or the medication don’t work well enough for them. In some cases, UC patients may develop precancerous changes or cancer in the colon. For these patients, surgery may be an option.
Some of precancerous changes can be treated during a colonoscopy, but some require surgical removal of the colon. Patients with colon cancer often require surgical removal of the colon. For patients with UC that does not respond to medical treatments, surgical removal of the entire colon also is an option. It is typical for patients to return to normal activities and quality of life following this surgery.
Liver transplantation may be required for patients with advanced liver disease or bile duct cancer related to PSC.
Are there complications from Ulcerative Colitis?
UC can lead to lower gastrointestinal bleeding, iron deficiency anemia, colon dilation and perforation. Patients are at risk for developing blood clots in their legs, arms, lungs and, rarely, veins in the abdominal area.
There is an increased risk of precancerous changes and colorectal cancer in patients who have had UC for many years. This risk is much higher in patients who also have PSC. Patients with UC who are at high risk of colorectal cancer need to be watched and checked with a surveillance colonoscopy every one to two years. A special colonoscopy procedure (chromoendoscopy) may be performed, which involves spraying a blue dye on the inside lining of the colon to help detect suspicious changes in the colon.
Patients with PSC are at risk for developing bile duct cancer, and may require liver transplantation.