ulcerative colitis

Ulcerative Colitis 

Definition

Ulcerative colitis is a form of inflammatory bowel disease (IBD). It causes swelling, ulcerations, and loss of function of the large intestine.

Description

The primary problem in IBD is inflammation, as the name suggests. Inflammation is a process that often occurs in order to fight off foreign invaders in the body, including viruses, bacteria, and fungi. In response to such organisms, the body's immune system begins to produce a variety of cells and chemicals intended to stop the invasion. These immune cells and chemicals, however, also have direct effects on the body's tissues, resulting in heat, redness, swelling, and loss of function. No one knows what starts the cycle of inflammation in IBD, but the result is a swollen, boggy intestine.

In ulcerative colitis, the inflammation affects the lining of the rectum and large intestine. It is thought that the inflammation begins in the last segment of the large intestine, which empties into the rectum (sigmoid colon). This inflammation may spread through the entire large intestine, but only rarely affects the very last section of the small intestine (ileum). The rest of the small intestine remains normal.

Ulcerative colitis differs from Crohn's disease, which is a form of IBD that affects both the small and large intestines. The inflammation of ulcerative colitis occurs only in the lining of the intestine (unlike Crohn's disease which affects all of the layers of the intestinal wall). As the inflammation continues, the tissue of the intestine begins to slough off, leaving pits (ulcerations) which often become infected.

Like Crohn's disease, ulcerative colitis occurs in all age groups, with the most common age of diagnosis being 15-35 years of age. Men and women are affected equally. Whites are more frequently affected than other racial groups, and people of Jewish origin have 3-6 times greater likelihood of suffering from any IBD. IBD is familial; an IBD patient has a 20% chance of having other relatives who are fellow sufferers.

Causes and symptoms

No specific cause of ulcerative colitis has been identified. Although no organism (virus, bacteria, or fungi) has been found to set off the cycle of inflammation that occurs in ulcerative colitis, some researchers continue to suspect that some such organism is responsible for initiating the cycle. Other researchers are concentrating on identifying some change in the cells of the colon that would make the body's immune system accidentally begin treating those cells as foreign invaders. Other evidence for such a disorder of the immune system includes the high number of other immune disorders that tend to accompany ulcerative colitis.

The first symptoms of ulcerative colitis are abdominal cramping and pain, a sensation of urgent need to have a bowel movement (defecate), and blood and pus in the stools. Some patients experience diarrhea, fever, and weight loss. If the diarrhea continues, signs of severe fluid loss (dehydration) begin to appear, including low blood pressure, fast heart rate, and dizziness.

Severe complications of ulcerative colitis include perforation of the intestine (in which the wall of the intestine develops a hole), toxic dilation of the colon (in which the colon become quite large in diameter), and the development of colon cancer.

Intestinal perforation occurs when long-standing inflammation and ulceration of the intestine weakens the wall to such a degree that a hole occurs. This is a life-threatening complication, because the contents of the intestine (which under normal conditions contains a large number of bacteria) spill into the abdomen. The presence of bacteria in the abdomen can result in a massive infection called peritonitis.

Toxic dilation of the colon is thought to occur because the intestinal inflammation interferes with the normal function of the muscles of the intestine. This allows the intestine to become lax, and its diameter begins to increase. The enlarged diameter thins the walls further, increasing the risk of perforation and peritonitis. When the diameter of the intestine is quite large, and infection is present, the condition is referred to as "toxic megacolon."

Patients with ulcerative colitis have a significant risk of developing colon cancer. This risk seems to begin around 10 years after diagnosis of ulcerative colitis. The risk becomes statistically greater every year:

• At 10 years, the risk of cancer is about 0.5-1%.
• At 15 years, the risk of cancer is about 12%.
• At 20 years, the risk of cancer is about 23%.
• At 24 years, the risk of cancer is about 42%.

The overall risk of developing cancer seems to be greatest for those patients with the largest extent of intestine involved in ulcerative colitis.

Patients with ulcerative colitis also have a high chance of experiencing other disorders, including inflammation of the joints (arthritis), inflammation of the vertebrae (spondylitis), ulcers in the mouth and on the skin, the development of painful, red bumps on the skin, inflammation of several areas of the eye, and various disorders of the liver and gallbladder.

Diagnosis

Diagnosis is first suspected based on the symptoms that a patient is experiencing. Examination of the stool will usually reveal the presence of blood and pus (white blood cells). Blood tests may show an increase in the number of white blood cells, which is an indication of inflammation occurring somewhere in the body. The blood test may also reveal anemia, particularly when a great deal of blood has been lost in the stool.

The most important method of diagnosis is endoscopy, during which a doctor passes a flexible tube with a tiny, fiberoptic camera device through the rectum and into the colon. The doctor can then examine the lining of the intestine for signs of inflammation and ulceration that might indicate ulcerative colitis. A tiny sample (biopsy) of the intestine will be removed through the endoscope, which will be examined under a microscope for evidence of ulcerative colitis. Because of the increased risk of cancer in patients with ulcerative colitis, endoscopic exam will need to be repeated frequently. Biopsies should be taken regularly, to closely monitor the intestine for the development of cancer or precancerous changes.

X-ray examination is helpful to determine the amount of intestine affected by the disease. However, x-ray examinations requiring the use of barium should be delayed until treatment has begun. Barium is a chalky solution that the patient drinks or is administered through the rectum and into the intestine (enema). The presence of barium in the intestine allows more detail to be seen on x-ray pictures. However, because of the risk of intestinal perforation in ulcerative colitis, most doctors begin treatment before stressing the wall of the intestine with the barium solution.

Treatment

Treatment for ulcerative colitis addresses the underlying inflammation, as well as the problems occurring due to continued diarrhea and blood loss.

Inflammation is treated with a drug called sulfasalazine. Sulfasalazine is made up of two parts. One part is related to the sulfa antibiotics; the other part is a form of the anti-inflammatory chemical salicylic acid (related to aspirin). Sulfasalazine is not well-absorbed from the intestine, so it stays mostly within the intestine, where it is broken down into its components. It is believed to be primarily the salicylic acid component that is active in treating ulcerative colitis, by fighting inflammation. For patients who do not respond to sulfasalazine, steroid medications (such as prednisone) are the next choice.

Depending on the degree of blood loss, a patient with ulcerative colitis may require blood transfusions and fluid replacement through a needle in the vein (intravenous or IV). Medications that can slow diarrhea must be used with great care, because they may actually cause the development of toxic megacolon.

A patient with toxic megacolon requires close monitoring and care in the hospital. He or she will usually be given steroid medications through an IV, and may be put on antibiotics. If these measures do not improve the situation, the patient will have to undergo surgery to remove the colon. This is done because the risk of death after perforation of toxic megacolon is greater than 50%.

Similarly, a patient with proven cancer of the colon, or even a patient who shows certain signs thought to indicate a precancerous condition, will need his or her colon removed. Removal of the colon is called a colectomy. When a colectomy is performed, a piece of the small intestine (ileum) is pulled through an opening in the abdomen. This bit of intestine is fashioned surgically to allow a special bag to be placed over it, in order to catch the body's waste (feces) which no longer can be passed through the large intestine and out of the anus. This opening, which will remain for the duration of the patient's life, is called an ileostomy.

Prognosis

Remission refers to a disease becoming inactive for a period of time. The rate of remission of ulcerative colitis (after a first attack) is nearly 90%. Those individuals whose colitis is confined primarily to the left side of the large intestine have the best prognosis. Those individuals with extensive colitis, involving most or all of the large intestine, have a much poorer prognosis. Recent studies show that about 10% of these patients will have died by 10 years after diagnosis. About 20-25% of all ulcerative colitis patients will require colectomy. Unlike the case for patients with Crohn's disease, however, such radical surgery results in a cure of the disease.

Resources

Organizations

Crohn's and Colitis Foundation of America, Inc. 386 Park Avenue South, 17th Floor, New York, NY 10016-8804. (800) 932-2423.

Key terms

Endoscopy — A type of medical examination in which an instrument called an endoscope is passed into an area of the body (the bladder or intestine, for example). The endoscope usually has a fiberoptic camera, which allows a greatly magnified image to be projected onto a video screen, to be viewed by the operator. Many endoscopes also allow the operator to retrieve a small sample (biopsy) of the area being examined, in order to more closely view the tissue under a microscope.

Immune system — The system of the body that is responsible for producing various cells and chemicals that fight off infection by viruses, bacteria, fungi, and other foreign invaders. In autoimmune disease, these cells and chemicals are turned against the body itself.

Inflammation — The result of the body's attempts to fight off and wall off an area that is infected. Inflammation results in the classic signs of redness, heat, swelling, and loss of function.

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colitis /co·li·tis/ (ko-li´tis) inflammation of the colon; see also enterocolitis.

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amebic colitis  see under dysentery.

antibiotic-associated colitis  see under enterocolitis.

collagenous colitis  a type of colitis of unknown etiology characterized by deposits of collagenous material beneath the epithelium of the colon, with crampy abdominal pain and watery diarrhea.

granulomatous colitis  transmural colitis with the formation of noncaseating granulomas.

ischemic colitis  acute vascular insufficiency of the colon, affecting the portion supplied by the inferior mesenteric artery; symptoms include pain at the left iliac fossa, bloody diarrhea, low-grade fever, and abdominal distention and tenderness.

mucous colitis  former name for irritable bowel syndrome.

regional colitis , segmental colitis transmural or granulomatous inflammatory disease of the colon; regional enteritis involving the colon. It may be associated with ulceration, strictures, or fistulas.

transmural colitis  inflammation of the full thickness of the bowel, rather than just mucosa and submucosa, usually with formation of noncaseating granulomas. It may be confined to the colon (segmentally or diffusely) or be associated with regional enteritis in the small intestine. Clinically, it may resemble ulcerative colitis, but with deeper ulcerations, stricture formation, and fistulas, particularly in the perineum.

ulcerative colitis  chronic ulceration in the colon, chiefly of the mucosa and submucosa, manifested by cramping abdominal pain, rectal bleeding, and loose discharges of blood, pus, and mucus with scanty fecal particles.

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ulcerative colitis

n.

A chronic disease of unknown cause, characterized by ulceration of the colon and rectum with bleeding, mucosal crypt abscesses, and inflammatory pseudopolyps, often causing anemia, hypoproteinemia, and electrolyte imbalance.

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ulcerative colitis,

a chronic, episodic, inflammatory disease of the large intestine and rectum. It is characterized by profuse watery diarrhea containing varying amounts of blood, mucus, and pus. Some of the many systemic complications of ulcerative colitis include peripheral arthritis, ankylosing spondylitis, kidney and liver disease, and inflammation of the eyes, skin, and mouth. People with severe disease may develop toxic megacolon, a dangerous complication that may lead to perforation of the bowel, septicemia, and death. Also called inflammatory bowel disease. See also Crohn's disease.

observations The attacks of diarrhea are accompanied by tenesmus, severe abdominal pain, fever, chills, anemia, and weight loss. Children with the disease may suffer retarded physical growth. The debilitating symptoms often prevent people with ulcerative colitis from carrying on the normal activities of daily living. Diagnosis of the disease is based on clinical signs, the results of barium x-ray films of the colon, and colonoscopy with biopsy. It is often difficult to differentiate between ulcerative colitis and Crohn's disease.

interventions Medical treatment with corticosteroids or other antiinflammatory agents may help control the symptoms in some people. Those with severe disease or life-threatening complications may require surgery. Total proctocolectomy with ileostomy is a permanent cure. Ulcerative colitis carries an increased risk of cancer of the colon, and periodic colonoscopy is performed to rule out this complication. A person with ulcerative colitis is suffering from a chronic, life-threatening illness and requires frequent evidence of support and understanding during prolonged hospitalization.

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ulcerative colitis (ulˈ·s·rāˑ·tiv k·līˑ·tis),

n episodic, chronic autoimmune disease of the large intestine; marked by diarrhea consisting of varying amounts of pus, blood, and mucus. Also called
inflammatory bowel disease (IBD). See also Crohn's disease.

Ulcerative colitis.

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ulcerative

pertaining to or characterized by ulceration.

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ulcerative balanitis

see enzootic balanoposthitis.

ulcerative cellulitis

see ulcerative lymphangitis.

ulcerative colitis

see eosinophilic ulcerative colitis, histiocytic ulcerative colitis.

ulcerative dermal necrosis

a skin disease of the head of Atlantic salmon and sea trout as they enter fresh water from the sea. The cause is unknown.

ulcerative dermatitis

disease of Belgian Landrace sows; lesions occur on the ear margins, anterior aspects of the limbs and around the teats; the cause is unknown.

ulcerative dermatosis

an infectious ulceration of the skin of the lips, feet, legs and external genitalia of sheep, of uncertain etiology, caused possibly by a paravaccinia virus. The lesions are ulcerative and destructive but the disease is not fatal and the morbidity rate is not high.

ulcerative enteritis

see ulcerative enteritis.

ulcerative gingivitis

see necrotizing ulcerative gingivitis.

ulcerative glossitis, stomatitis

in cats, a proliferative inflammation and ulceration of the oral cavity, particularly gum margins and mucosa at the fauces, a common disease of old cats characterized by painful ulcers at the fauces and surrounding tissues including the tongue. The cause is not known.

ulcerative granuloma of swine

an infectious disease of pigs caused by Borrelia suilla (unofficial nomenclature), and manifested by large, deep, ulcerative lesions on any part of the body. On the face they may cause destruction of the cheeks. The portal of infection is skin wounds and spread of the disease is enhanced by fighting in the group. Called also necrotic ulcer.

infectious bovine ulcerative stomatitis

an innocuous stomatitis of calves occurring in outbreak form but recorded rarely and not in recent years. Its existence separate from bovine virus diarrhea is not proven.

ulcerative keratitis

see corneal ulcer.

ulcerative lymphangitis

see ulcerative lymphangitis.

ulcerative mammilitis

see bovine herpes mammillitis.

ulcerative pododermatosis

see ulcerative pododermatitis.

ulcerative posthitis

occurs sporadically in rams and bulls and as part of ulcerative dermatosis in rams.

ulcerative shell disease

see shell rot.

ulcerative stomatitis

1. several virus infections cause oral ulcers in calves without any other clinical illness unless the calves are stressed, especially with hyperkeratosis caused by secondary nutritional deficiency of vitamin A.

2. outbreaks in horses are caused by grass with bristly seedheads and pasture infested with bristly caterpillars.

ulcerative typhlocolitis

one of the causes of idiopathic chronic diarrhea in horses; salmonellosis and intoxication with nonsteroidal anti-inflammatory drugs are possible culprits.

ulcerative vulvitis

of ewes, see ulcerative dermatosis (above).

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ulcerative colitis

Gastroenterology A chronic inflammatory bowel disease that primarily affects the colorectum, characterized by bloody diarrhea and abdominal pain Epidemiology High incidence in US, UK, Australia, Northern Europe, 3-15/105/yr in whites; Jews, 13/105; non-Jews, 3.8/105; age of onset 20-40; smaller peak in elderly Clinical Diarrhea, intermittent rectal bleeding, passage of mucus, abdominal colic; if severe, fever, tachycardia, anemia, ↑ ESR Associated lesions Inflammation in joints, spine, skin, eyes, liver, bile ducts Diagnosis Colonoscopy, radiology–barium enema–distention and dilation, collar-stud ulcers; if long-standing, loss of haustration Management IV corticosteroids; in non-responders, sulfasalazine, mesalazine, IV cyclosporine; if refractory to cyclosporine, colectomy; transdermal nicotine may induce complete remission in acute UC, improving the clinical status, as well as histologic grade, ↓ the stool frequency and sense of urgency, at a cost of nausea, lightheadedness, headache and sleep disturbances; nicotine is of no use in maintaining remission

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Patient discussion about ulcerative colitis.

Q. What are the symptoms of Ulcerative Colitis? I am 40 years old and suffer from a lot of stomach aches and diarrhea. Do I have Ulcerative Colitis? What are its symptoms?

A. I found a movie which explains about Ulcerative Colitis, which might interest you:
http://www.5min.com/Video/What-are-Colitis-Crohns-Disease-and-Ulcerative-Co-7082

Q. What is the connection between bowel disease and arthritis? My son suffers from ulcerative colitis, and the doctor said that his recent joint pain can be as a result of the colitis. Why is that?

A. Although ulcerative colitis happens mainly in the colon, it is a systemic disease, and patients may present with symptoms and complications outside the colon. These include musculoskeletal complications such as arthritis (for instance- ankylosing spondylitis). The exact mechanism of this injury is unknown.