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Ulcerative colitis is a chronic inflammatory disease affecting the colon (large intestine) and the rectum. This inflammation causes a series of small open wounds, abscesses, or ulcers. The symptoms of UC are cyclic in that they present themselves in phases of remission and relapse or flare-ups. During a UC flare-up, individuals are likely to experience diarrhea mixed with blood from ulcers. A flare-up commonly begins in the rectum and spreads to the colon upon the worsening of symptoms.
UC is grouped with Crohn’s disease in the category of inflammatory bowel disease due to the inflammatory response the respective diseases cause. UC is distinctly different from Crohn’s disease and is differentiated by its singular placement within the colon. Inflammation caused by Crohn’s disease may be present anywhere along the gastrointestinal tract (the mouth to the anus). Additionally, the wounds associated with UC do not penetrate the walls of the intestines, therefore preventing the spread of infection to other locations in the body.
Why it is problematic
Ulcerative colitis produces unpleasant and painful symptoms during a flare up. Uncommonly, a flare-up can become so intense that it causes very severe symptoms including internal bleeding. An increased risk of malnutrition and anemia is associated with UC. Individuals with UC report emotional and psychological distress associated with the disease and its symptoms. Additionally, individuals with UC are at an increased risk of developing colon cancer. Recurring measures are taken to monitor changes within the colon that could indicate colon cancer.
Causes and Risk Factors
The cause of UC is currently unknown, but is believed to have a link to the immune system. The immune system of an individual with UC seems to not recognize the difference between “good” bacteria and “bad” bacteria. The presence of so-called “good” bacteria is essential in maintaining a healthy gastrointestinal tract (GI tract). A properly functioning immune system can differentiate between these types of bacteria and work to remove any potentially harmful foreign organisms. When the immune system does not function properly, it is prone to indiscriminately destroying both harmful and beneficial bacteria. Bacteria are necessary for digestive health and its absence provokes inflammation. It is unclear why this autoimmune response occurs, but it is often believed to have a joint genetic and environmental cause. According to this theory, bacteria or a virus may trigger UC in individuals genetically vulnerable to developing UC.
Ulcerative Colitis symptoms are cyclic in that they follow periods of remission and relapse. Symptoms will vary greatly from patient to patient in terms of frequency and intensity. The most common symptom of UC is the presence of diarrhea. UC caused diarrhea may be mixed with pus, mucus or blood. This is the result of a flare-up of ulcers in the colon. The full list of possible UC symptoms is:
• Diarrhea (persistent, possibly mixed with pus, mucus or blood)
• Abdominal Pain or discomfort
• Painful bowel movements
• Fecal urgency (urgency to evacuate bowels)
• Proctitis (rectum inflammation)
• Unintentional weight loss
• Recurring canker sores
• Joint Pain (Arthritis)
• Eye pain or sensitivity
• Skin Problems or sores
Please be advised that adults experiencing diarrhea (three or more loose or watery stools per day) for longer than 48 hours, and children experiencing diarrhea for longer than 24 hours, should contact a physician immediately.
Symptoms of ulcerative colitis are similar to those of other GI conditions. Doctors will use a series of diagnostic tests to diagnose UC and rule out other conditions. These tests may include:
Blood tests such as a complete blood count (CBC) test might be used to assess the overall state of health. Other bloods tests that identify the presence of nutrient deficiencies or anemia are often performed as well.
Stool samples are helpful in the diagnosis of UC because blood, pus, or mucus is often found in the stool of individuals with the disease. Stool samples are also used to detect the presence of certain bacteria commonly associated with UC.
Colonoscopy is often used to observe the colon to detect the presence of inflammation, polyps and/or ulcers. In this procedure a long, flexible, lighted tube (endoscope) with a camera is inserted into the rectum. The camera photographs the inside of the body as it makes its way to the colon. The photos collected are transferred on to a screen so that physicians can make clearer observations of the lower part of the GI tract. Biopsy is also possible using the endoscope. In the event of this, surgical tools are connected to the end of the tube to collect small samples.
Diagnostic Imaging Tests such as an X-ray, Ultrasound, and/or CT scan are tools that will analyze the GI tract in a noninvasive way. These tools are often used in combination with barium (contrast dye) to highlight specific regions, in this case, the large intestine. Once the large intestine is illuminated, a more refined picture is created thus providing a more efficient environment for diagnostic analysis. These tests typically are used to assess disease progression.
Treatment for ulcerative colitis will depend on the severity of an individual’s symptoms. Because there is no cure for UC, physicians focus their attention on alleviating painful symptoms caused by the disease and by attempting to extend the period of UC remission time. Treatment options may include any combination of the following:
Diet plays a role in the treatment of UC. Many individuals notice that certain foods, namely foods that are spicy, high in fiber or include dairy aggravate UC symptoms. The most common symptom of UC is diarrhea, which can cause dehydration and nutrient malabsorption. It is extremely important for UC patients to eat regularly and maintain a balanced diet.
Anti-inflammatory medications, such as Aminosalicylates (ASAs), are commonly administered to assist in the regulation of the inflammation associated with UC. ASAs come in pill-form, suppository and enema forms. Your doctor will decide which form is best for you based on the location of your inflammation caused by UC. Individuals with liver or kidney problems and pregnant or nursing women should not take ASAs. ASAs are not suitable for those with allergies to salicylates, (i.e. Aspirin or anything containing aspirin) or allergies to sulfonamide.
Corticosteroids are another type of anti-inflammatory medication that may be used to treat UC inflammation. This treatment comes in pill form, or via weekly injections. Common side effects of corticosteroids include: infection vulnerability, swelling in the face, and weight gain.
Biological therapies are a specialized type of anti-inflammatory medications made from genetically engineered living organisms that directly target the enzymes and proteins causing inflammation in the GI tract. Biological therapies or Biologics suppress the immune system. Evidence suggests that biologics treat UC very effectively.
Surgery is necessary in about 25-35% of UC patients due to serious complications. There are currently two types of surgical options available. Both include removing the colon (colectomy). One of the procedures also includes removing the rectum and creating a hole in the abdomen so that digestive waste can be collected in an appliance (ostomy) located outside of the body. The more modern procedure allows waste to collect internally in place of the colon. Certain factors determine a patient’s eligibility for each procedure including the condition of the body. A doctor will help determine which method is best for the patient. Fortunately, once this procedure has been performed, UC is cured. It will not return.
Ulcerative Colitis affects individuals of all ages but diagnosis most frequently occurs in males between the ages of 15 and 30. Ulcerative colitis affects individuals of European and Ashkenazic Jewish descent more frequently than those of other origins. Individuals with a family history of IBD have an increased risk of developing ulcerative colitis. In the U.S., It is estimated that UC affects 1-20 per 100,000 individuals.