Ulcerative Colitis
Overview of ulcerative colitis
Symptoms of ulcerative colitis
Causes of ulcerative colitis
Diagnosis of ulcerative colitis
Cancer of the colon
Treatment
Overview of ulcerative colitis
Ulcerative colitis is categorized as an inflammatory bowel disease (IBD), the general name for diseases that cause inflammation in the small intestine and colon. Ulcerative colitis is a disease that causes inflammation and sores, called ulcers, in the lining of the rectum and colon. Ulcers form in the areas where inflammation has killed the cells that generally line the colon. The ulcers then bleed and produce pus. In addition, this inflammation causes the colon to empty frequently, causing diarrhea.
When the inflammation occurs in the rectum and lower part of the colon, the disease is referred to as ulcerative proctitis. If the entire colon is affected by the inflammation, it is called pancolitis. If only the left side of the colon is affected by the inflammation, it is referred to as limited or distal colitis.
It can be difficult to diagnose ulcerative colitis because the disease's symptoms are similar to other intestinal disorders and to another type of IBD called Crohn's disease. Crohn's disease differs from ulcerative colitis in that it causes inflammation deeper within the intestinal wall than ulcerative colitis and can occur in other parts of the digestive system, including the esophagus, mouth, stomach, and small intestine.
While ulcerative colitis can occur in individuals of any age, it typically starts between the ages of 15 and 30, and less frequently between the ages of 50 and 70. Ulcerative colitis affects men and women equally and appears to run in families – there are reports that up to 20 percent of individuals with ulcerative colitis have a family member or relative with ulcerative colitis or Crohn's disease. A higher incidence of ulcerative colitis is seen in Whites and individuals of Jewish descent.
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Symptoms of ulcerative colitis
The most common symptoms of ulcerative colitis are bloody diarrhea and abdominal pain. Patients also may experience one or more of the following:
- Rectal bleeding
- Fatigue
- Loss of body fluids and nutrients
- Anemia
- Weight loss
- Joint pain
- Loss of appetite
- Skin lesions
- Growth failure (specifically in children)
Approximately half of the individuals diagnosed with ulcerative colitis experience mild symptoms, but others experience bloody diarrhea, severe abdominal cramps, nausea, and frequent fevers. Ulcerative colitis may also cause other problems including inflammation of the eye, osteoporosis, arthritis, and liver disease. Why these problems occur outside the colon is unknown; however, scientists believe these complications may be due to inflammation triggered by the immune system. Some of these complications go away when the colitis is treated.
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Causes of ulcerative colitis
Many theories exist regarding why ulcerative colitis develops. Individuals with ulcerative colitis have abnormalities of the immune system, but doctors do not know whether these abnormalities are caused by or are a result of the disease. In individuals with ulcerative colitis, the immune system is believed to react abnormally to the bacteria in the body's digestive tract.
Although ulcerative colitis is not caused by emotional distress or sensitivity to particular foods or food products, these factors may trigger symptoms in some individuals. For people with ulcerative colitis, the stress of living with the disease may also contribute to a worsening of symptoms.
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Diagnosis of ulcerative colitis
Many tests are used to diagnose ulcerative colitis in individuals. The first step typically involves a physical exam and medical history.
Blood tests may be performed to check for anemia, which could indicate bleeding in the colon or rectum. Blood tests may also uncover a high white blood cell count, which is a sign of inflammation somewhere in the body.
A stool sample can also reveal white blood cells, the presence of which indicates ulcerative colitis or inflammatory disease. In addition, a stool sample can allow the doctor to detect infection or bleeding in the rectum or colon caused by a virus, parasites, or bacteria.
A colonoscopy or sigmoidoscopy are the most accurate methods for diagnosing ulcerative colitis and ruling out other possible conditions, including Crohn's disease, cancer, or diverticular disease. For both tests, the doctor inserts an endoscope – a long, flexible, lighted tube connected to a TV monitor and computer – into the anus to examine the inside of the rectum and colon. Through this exam, the doctor will be able to identify any inflammation, bleeding, or ulcers on the colon wall. During the exam, the doctor may perform a biopsy, which involves microscopic examination of a tissue sample from the lining of the patient's colon.
In addition, X-rays such as a barium enema or CT scans are occasionally also used to diagnose ulcerative colitis or its complications.
Schedule an appointment
To schedule an appointment with a Temple Digestive Disease Center Physician, click here or call 1-800-TEMPLE-MED [1-800-836-7536].
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Cancer of the colon
About five percent of individuals with ulcerative colitis develop colon cancer. The risk of cancer increases relative to the duration of the disease and the extent of damage to the colon. For instance, if only the individual's rectum and lower colon are involved, the risk of cancer is no higher than normal. However, if the individual's entire colon is involved, the risk of cancer can be as high as 32 times the normal rate.
Precancerous changes occasionally occur in the cells that line the colon. These precancerous changes are known as "dysplasia." Individuals with dysplasia are more likely to develop cancer than those without dysplasia. Doctors search for signs of dysplasia when performing a sigmoidoscopy or colonoscopy. Doctors also look for signs of dysplasia during examinations of tissue removed during those tests.
According to the 2002 updated guidelines for colon cancer screening, individuals who have had inflammatory bowel disease (IBD) throughout their colon for at least eight years and individuals who have had IBD in only the left colon for 12 to 15 years should have a colonoscopy with biopsies every one to two years to check for dysplasia. This type of screening has not been proven to reduce the risk of colon cancer, but the screening may help identify cancer early. These guidelines were developed by an independent expert panel and endorsed by a number of organizations, including the American College of Gastroenterology, the American Cancer Society, the Crohn's & Colitis Foundation of America, and the American Society of Colon and Rectal Surgeons.
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Treatment
Learn more about ulcerative colitis surgery and treatment information.
To schedule an appointment with a Temple Digestive Disease Center Physician, click here or call 1-800-TEMPLE-MED [1-800-836-7536].
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Sources:
National Digestive Diseases Information Clearinghouse (NDDIC), National Institutes of Health (NIH) - NIH Publication No. 06–1597, February 2006
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