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Ulcerative Colitis

Ulcerative Colitis

Overview of Ulcerative Colitis
What is Ulcerative Colitis?
Who Gets Ulcerative Colitis?
What Causes Ulcerative Colitis?
What are the Symptoms of Ulcerative Colitis?
What are the Complications of Ulcerative Colitis?
How is Ulcerative Colitis Diagnosed?
What is the Role of Diet and Stress in Ulcerative Colitis?
Treatment of Ulcerative Colitis

Overview of Ulcerative Colitis

Ulcerative colitis is a chronic disease that causes inflammation (swelling, irritation) and ulcers in the large bowel (also called the large bowel or large intestine). This inflammation and ulceration leads to symptoms of diarrhea, abdominal cramps and pain, rectal bleeding, fever and weight loss. These symptoms are often intermittent, flaring up for days, weeks or months and then calming down again for periods of “remission” when you feel well. There is not yet a medical cure for ulcerative colitis, but special diets and medications can reduce inflammation, ease symptoms, and reduce the risk of complications. Surgery is an option when medications are not sufficient.

Ulcerative colitis is a challenging disease. Handling the ups and downs of symptoms and complications can be stressful. The symptom and disease process varies from person to person, and a treatment that is effective in one person might not work in another. That’s why patients need personalized advice, close monitoring, and highly individualized therapy.

What is Ulcerative Colitis?

Ulcerative colitis is a chronic condition that causes inflammation in the lining of the colon, also known as the large bowel or large intestine. Inflammation is swelling or irritation that can lead to ulcers, bleeding and scarring—and painful symptoms. Inflammation in the colon and rectum also upsets the normal absorption of water through the bowel—leading to diarrhea (loose bowel movements and urgency to go to the bathroom).

If inflammation only occurs in the rectum, the disorder is sometimes called ulcerative proctitis. Other types of ulcerative colitis based on the location of inflammation include: proctosigmoiditis (inflammation affecting the rectum and extending into the nearby sigmoid colon); left-sided colitis (inflammation that extends from the rectum all the way along the sigmoid colon and up the left-sided colon to the bend near the spleen); and pan-colitis (inflammation throughout the entire colon).

(Image: NIH Publication No. 12-3140, December, 2011)

Ulcerative colitis is one of the two main types of Inflammatory Bowel Disease (IBD). The other is Crohn’s disease. The two diseases are similar, but the inflammation in ulcerative colitis occurs only in the colon while Crohn’s inflammation is more widespread throughout the entire gastrointestinal (GI) tract (from mouth to anus). Also, in ulcerative colitis, the swelling affects mainly the surface (lining) of the colon and is spread continuously along part or all of the colon. By contrast, in Crohn’s disease, the inflammation often penetrates deeper into spotty patches along the GI tract with normal healthy areas seen in between the inflamed patches.

Inflammatory Bowel Disease = Crohn’s Disease OR Ulcerative Colitis
Irritable Bowel Syndrome ≠ Inflammatory Bowel Disease

It is important to distinguish between ulcerative colitis and other diseases that cause similar symptoms—like Crohn’s disease, irritable bowel syndrome, celiac disease (sprue, or gluten intolerance), or cancer—because these other diseases require different therapies. Early diagnosis of ulcerative colitis can lead to earlier therapy, which can help prevent serious complications or the need for hospitalization or surgery. Up to 1 in every 4 patients with ulcerative colitis eventually need surgery, but better medications are reducing that need.

Who Gets Ulcerative Colitis?

More than half a million Americans have ulcerative colitis. Most people are young (between 15 and 30 years of age) when their symptoms start. Both men and women get ulcerative colitis. It tends to run in families. As many as one in five people with ulcerative colitis have a relative with Inflammatory Bowel Disease. Increasing numbers of African American and Hispanic patients are now being diagnosed with ulcerative colitis.

What causes Ulcerative Colitis?

The exact cause of ulcerative colitis is not known. Multiple factors are likely involved. Many suspect that the immune system, which normally protects the body against infections, attacks the patient’s own healthy bacteria or tissues in the GI tract. This misguided immune reaction triggers chronic inflammation. A person’s genes and the environment—where you live and what you eat—also may play a role in ulcerative colitis, possibly by sparking the immune system. Diet and stress may aggravate the disease.

What are the Symptoms of Ulcerative Colitis?

The most common symptoms of ulcerative colitis are:

  • Pain or cramps in the abdominal area
  • Persistent diarrhea (watery stools, often with an urgent need to move the bowels)
  • Rectal bleeding and anemia

Other symptoms may include: loss of appetite, weight loss, fever/nausea, fatigue, joint pain, skin lesions and liver problems. The types of symptoms and their severity vary from person to person.

Many individuals with ulcerative colitis have only minor symptoms but some develop severe symptoms or have increasingly frequent relapses that require hospitalization or surgery.

What are the Potential Complications of Ulcerative Colitis?

Some people with ulcerative colitis develop serious problems such as:

  • Severe bleeding and anemia that causes fatigue (feeling tired all the time); this can be due to the loss of red blood cells or due to poor nutrition
  • Severe dehydration due to diarrhea
  • Rapid swelling of the colon (“toxic megacolon”) or a hole in the colon (“perforated colon”)—these can be life-threatening emergencies
  • Nutritional problems due to malabsorption of protein, vitamins, or calories; this can also be due to loss of appetite related to stomach pain or poor diet
  • Non-GI problems such as inflammation of the skin, eyes, or joints; bone loss (osteoporosis); kidney stones, blood clots, or liver disease
  • Strictures or narrowings, due to inflammatory swelling and scar tissue that narrows the intestine and prevents waste material from moving normally. If severe, strictures can cause intestinal blockages.
  • Fissures or tears in the lining of the anus
  • Increased risk of colorectal cancer; a regular program of monitoring with colonoscopies can reduce this risk of colorectal cancer

Other complications may arise due to medication side effects. Children with ulcerative colitis may have delayed development and stunted growth (due to loss of nutrients). Women with ulcerative colitis may have problems with infertility. Pregnant women with ulcerative colitis can have a healthy baby but careful planning and monitoring is recommended.

How is Ulcerative Colitis Diagnosed?

The most common tests to diagnose ulcerative colitis and rule out other possible causes of your symptoms include:

History and physical exam: First, your gastroenterologist will listen carefully to your description of symptoms and then ask questions about your symptoms and how they affect your life. A physical exam can check for any external signs of disease (such as skin changes, arthritis, inflamed eyes or mouth).

Blood tests and stool tests: Blood tests can detect low red blood cells (indicating anemia), high white blood cells (indicating an infection or inflammation), or specific antibodies (indicating an immune reaction). Analysis of a stool sample can help check for intestinal bleeding or infection.

X-rays: Standard x-rays of the upper (and possibly lower) GI tract can help to show intestinal inflammation, ulcers, narrowing, strictures, or fistulas. This is sometimes called radiography. The patient drinks a chalky barium solution before the upper GI x-ray so the outline of the intestine shows up better on the film.

Lower Endoscopy (colonoscopy or sigmoidoscopy): The GI specialist may also use a special instrument to look inside your colon. Before the procedure, you take a laxative to clear out your bowels. During the procedure you may be sedated and you lie on your side. A long thin flexible tube (an endoscope) with tiny camera tip is inserted through the opening of the anus. As the instrument is moved carefully along the length of the colon, the doctor looks closely at the surface of the colon on a video screen. Samples (or biopsies) of inflamed tissue can be taken for examination under a microscope. A sigmoidoscopy uses a short instrument to examine only the lower part of the colon. A colonoscopy uses a longer tube that allows visual inspection of the whole 3-foot length of the colon. To diagnose Crohn’s disease, a full colonoscopy is usually needed. At Temple, we sometimes also use a special technique called chromoendoscopy to stain the colon before endoscopy examination; this highlights areas of potential early cancer (dysplasia) and allows more precise sampling (biopsy), which can lead to earlier diagnosis and treatment of cancer.

Upper Endoscopy (esophagogastroduodenoscopy, or EGD): In some cases to rule out Crohn’s disease or other conditions, the gastroenterologist will examine the upper portion of the GI tract—including the esophagus, the stomach, and the beginning of the small intestine (called the duodenum). For this upper endoscopy procedure, a long thin flexible tube (an endoscope) with a tiny camera tip is inserted through the mouth and down through the esophagus and stomach to the first portion of the small intestine. The EGD is often used to check for sources of bleeding or causes of pain.

Imaging Tests (CT and MR enterography): In some cases, a computerized tomography (CT) scan will check for disease inflammation or complications (such as tumors, bowel obstruction, or bleeding). A CT takes many x-rays at once and creates a highly detailed 3-D image of the small intestines and other GI tract structures. Sometimes, a specialized CT called CT enterography is used to obtain a greater amount of detail of the small intestine. To evaluate certain areas or to avoid repeated exposures to the low-dose radiation of x-rays (especially in young patients who may need many imaging tests over the course of a long lifetime), a special magnetic resonance (MR) imaging test called MR enterography may be used instead of CT enterography. The MR test does not use x-rays; instead, it uses radiofrequency waves and a large magnet to create a picture of the GI tract.

The Temple Inflammatory Bowel Disease Program is experienced in the diagnosis of ulcerative colitis with all the tests mentioned above. Temple gastroenterologists are also pioneers in the use of double-balloon enteroscopy to examine and treat the small intestine—an area that cannot be reached by standard colonoscopy. For advanced CT or MR imaging, patients have access to the GI radiology experts at Temple University Hospital. This group is highly experienced in all CT and MR imaging techniques, including special narrow-band imaging to monitor for cancer.

Your gastroenterologist can explain the risks associated with the diagnostic procedures needed to evaluate your conditions.

What are the Roles of Diet and Stress in Ulcerative Colitis?

Many people with ulcerative colitis think that a particular food is causing their abdominal pain and diarrhea. Although diet is not a direct cause of the disease, diet can definitely affect how healthy you feel. For example, specific foods like milk products or bulky grains may increase diarrhea or cramping. Also, if your stomach always hurts, you may not eat properly or your GI inflammation may prevent you from absorbing nutrients.

Many patients also find that stress may trigger a flare-up of symptoms. Again, while there is no evidence that stress actually causes ulcerative colitis, living with a painful chronic disease like colitis can undoubtedly add to the stress of everyday life. This disease- and symptom-related stress, in a vicious cycle, can make the symptoms worse in some people.

These many connections between ulcerative colitis and diet and stress explain why any treatment program should include education and clear instructions on good food choices, proper nutrition, and stress reduction.

Patients coming to the Temple Inflammatory Bowel Disease Program have access to a full team of nutrition specialists, psychiatrists, counselors, nurse educators and support groups. We are prepared to help patients control their disease with better diet, exercise, and relaxation methods. In some cases, special supplements are recommended. Those having a severe bout of disease activity are assisted with temporary intravenous nutrition.

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Treatment of Ulcerative Colitis

Learn more about treatment for ulcerative colitis surgery and treatment information.

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