Ulcerative Colitis: Causes, Symptoms, Diagnosis and Treatment
Author: Thomas C. Weiss : Contact: disabled-world.com
Published: 2009-06-13 : (Rev. 2018-03-16)
Synopsis and Key Points:
Ulcerative Colitis involves a chronic inflammation of the persons large intestine also referred to as their colon.
Ulcerative Colitis involves a chronic inflammation of the person's large intestine, also referred to as their, 'colon.' The colon is a part of a person's digestive system where waste material is stored. Persons with ulcerative colitis experience inflammation and ulcers of the inner lining of their colon that lead to diarrhea, rectal bleeding, and abdominal pain.
In medicine, colitis is defined as an inflammation of the colon and is often used to describe an inflammation of the large intestine (colon, caecum and rectum).
There are many types of colitis. They are usually classified by the etiology. Colitis may be acute and self-limited or chronic, i.e. persistent, and broadly fits into the category of digestive diseases.
Signs and symptoms of colitides are quite variable and dependent on the etiology (or cause) of the given colitis and factors that modify its course and severity.
Ulcerative Colitis is closely related to Crohn's disease; they are commonly referred to as, 'Inflammatory Bowel Disease (IBD).' The two diseases are chronic, and may last from years to decades, affecting between half a million to two-million persons in America alone. Both men and women are affected by these diseases equally, most commonly during the person's teenage years and during young adulthood, although they can also start during either childhood or later in adulthood.
Ulcerative Colitis is found around the world, although it is found most commonly in England, America, and northern Europe. Ulcerative Colitis is particularly common among persons of Jewish decent. The disease is rare in Asia, eastern Europe, and South America; it is also rare among black populations. For reasons that are not understood, ulcerative colitis is increasing in frequency among persons in developing nations.
Ulcerative Colitis is an inflammatory bowel disease (IBD), but when it occurs in the rectum and lower part of the colon it is referred to as, 'Ulcerative Proctitis.' Should the person's entire colon be affected, it is referred to as, 'Pancolitis.' If only the left side of the person's colon is affected, it is referred to as, 'Limited,' or, 'Distal Colitis.'
Ulcerative colitis can be difficult to diagnose because its symptoms are similar to other intestinal disorders and to another type of IBD called Crohn's disease. Crohn's disease differs because it causes inflammation deeper within the intestinal wall and can occur in other parts of the digestive system including the small intestine, mouth, esophagus, and stomach. Ulcerative Colitis apparently runs in families, with up to twenty-percent of persons who have the disease also having a family member or relative with the disease as well.
Causes of Ulcerative Colitis
There are a number of theories about the causes of ulcerative colitis. Persons with the disease present abnormalities of their immune system, yet doctors cannot figure out if these abnormalities are the cause or the result of the disease. The person's immune system is believed to react abnormally to the bacteria in their digestive tract. What is known is that ulcerative colitis is not caused by specific foods or food products; neither is it caused by emotional distress, although these factors can trigger symptoms in some persons. Stress from living with the disease can contribute to worsening symptoms. There is no evidence that either ulcerative colitis or Chrohn's disease are caused by an infection of some form; neither of the diseases are contagious.
Ulcerative Colitis is caused by an abnormal activation of the person's immune system in their intestines. A person's immune system is composed of immune cells and proteins that these cells produce. The cells and proteins are there to defend the person's body against viruses, fungi, bacteria, and additional foreign invaders. Activation of the person's immune system results in inflammation within the tissues where the activation has occurred, something that usually only happens when the person's body is exposed to something that is harmful. Persons with ulcerative colitis have an immune system that is chronically activated despite the absence of a known threat or invader. Continual activation of the person's immune system results in inflammation and ulceration that is chronic as well. Susceptibility to this abnormal activation of the immune system is something that is inherited genetically, with sisters, brothers, children, and parents of persons with IBD being more likely to develop the diseases.
Symptoms of Ulcerative Colitis
Approximately half of persons with ulcerative colitis experience mild symptoms. Other persons can have bloody diarrhea, nausea, fevers, and severe abdominal cramps. Persons with the disease may experience additional problems to include eye inflammation, arthritis, osteoporosis, or liver disease. Medical science does not understand why these issue happen outside of the person's colon. Some scientists believe the complications can be the result of the person's immune system. Some of the complications may disappear when the disease is treated. The more common symptoms of ulcerative colitis may include:
- Loss of body fluids and nutrients
- Bloody diarrhea
- Abdominal pain
- Loss of appetite
- Rectal bleeding
- Growth failure
- Skin lesions
- Weight loss
- Joint pain
The variability of symptoms a person experiences in association with ulcerative colitis reflects the amount of inflammation they are experiencing in their rectum and colon. Persons with inflammation that is confined to their rectum and a short segment of their adjacent colon generally experience milder symptoms than those with inflammation that is more widespread. There are different types of ulcerative colitis, classified by the location and extent of inflammation involved. These classifications include:
Ulcerative Proctitis refers to inflammation which is limited to the person's rectum. For many persons with ulcerative proctitis, mild intermittent rectal bleeding may be the only symptom. Other persons with more severe rectal inflammation may experience rectal pain, urgency and tenesmus.
Proctosigmoiditis involves inflammation of the person's rectum as well as their sigmoid colon. Symptoms of proctosigmoiditis include rectal bleeding, urgency, and tenesmus. Some persons with proctosigmoiditis may also develop bloody diarrhea and cramps.
Left-sided Colitis involves inflammation that starts at the person's rectum and extends up their left colon. Symptoms of left-sided colitis include bloody diarrhea, abdominal cramps, weight loss, and left-sided abdominal pain.
Pancolitis refers to inflammation affecting the entirety of the person's colon. Symptoms of pancolitis include bloody diarrhea, abdominal pain and cramps, weight loss, fatigue, fever, and night sweats. Some persons with pancolitis experience low-grade inflammation and mild symptoms which respond readily to medications. Generally, persons with pancolitis experience more severe disease and are more difficult to treat than persons with limited forms of ulcerative colitis.
Fulminant Colitis is a rare but severe form of pancolitis. Persons with fulminant colitis experience dehydration, severe abdominal pain, protracted diarrhea with bleeding, and perhaps even shock. They may develop toxic mega-colon and colon rupture. Persons with fulminant colitis and toxic mega-colon are treated in the hospital with potent intravenous medications. If they do not respond to treatment quickly, surgical removal of their colon becomes necessary in order to prevent colon rupture.
The intensity of colon inflammation related to ulcerative colitis changes over time, easing and increasing. The location and extent of the disease tends to stay constant. When a person with ulcerative colitis experiences a relapse of the disease, the inflammation they have tends to remain confined to their rectum. Nonetheless, a small percentage of persons with ulcerative proctitis or proctosigmoiditis may later develop extensive colitis. Persons who have ulcerative proctitis may go on to develop left-sided colitis, or perhaps pancolitis. Persons who experience ulcerative colitis for eight years or longer are at greater risk of developing colon cancer.
Diagnosis of Ulcerative Colitis
In order to diagnose ulcerative colitis, a doctor will ask the person about the symptoms they have been experiencing, perform a physical examination, ask the person about their family medical history, and perform a number of additional tests. The tests a doctor will perform can help them to rule out other problems that may present similar symptoms, such as irritable bowel syndrome, Crohn's disease, or diverticulitis. Tests that a doctor can perform include a colonoscopy, a barium enema, blood testing, and stool sampling.
- Colonoscopy: A colonoscopy involves insertion of a thin, lighted tool to look at the inside of the person's entire colon. At the same time, the doctor may take a biopsy of the lining of the person's colon.
- Barium Enema: A barium enema X-ray or an X-ray of the person's belly to show pictures of their colon.
- Blood Testing: Blood tests, which are done in order to look for infection or inflammation.
- Stool Sampling: Stool sample testing in order to look for blood, infection, and white blood cells.
A diagnosis of ulcerative colitis is suggested by symptoms of rectal bleeding, diarrhea, and abdominal pain. Stool specimens are collected for analysis to rule out either parasites or infection because they may cause colitis that mimics the disease. Blood testing may reveal anemia, as well as an elevated white blood cell count or sedimentation rate which reflect inflammation of the person's colon. Confirming ulcerative colitis requires either a colonoscopy or sigmoidoscopy which allows a doctor to visually confirm the extent of the colitis the person is experiencing.
Treatment of Ulcerative Colitis
- Aminosalicylates: Sulfasalizine, Sulfapyridine, Olsalazine, Mesalamine, Balsalazide, Sulfasalazine
- Corticosteroids: Prednisone, Methylprednisone, Hydrocortisone
- Immunomodulators: Azathioprine, 6-Mercapto-Purine
Treatment for ulcerative colitis depends on the severity of the disease and the individual. Each person experiences the disease differently, making treatment just as individual. Medication treatment of the disease has the goals of inducing and maintaining remission of the disease, as well as improvement of the quality of life for the person. There are a number of medications available that may be administered. These medications include:On occasion, persons with ulcerative colitis experience symptoms that are severe enough that they must be hospitalized in order to receive appropriate treatment. A person may experience severe bleeding or diarrhea which causes dehydration, for example. A doctor will treat the person in the hospital to stop the diarrhea and loss of blood, mineral salts and fluid. The person may require medications, surgery, intravenous feeding, or a special diet.
Approximately twenty-five to forty-percent of persons with ulcerative colitis eventually have their colons removed entirely due to massive bleeding, rupture of their colon, risk of cancer, or severe illness. At times a doctor will recommend removal of the person's colon if medical treatment has failed, or if the side-effects of medications threaten the person's life. Surgery to remove a person's colon and rectum is referred to as a, 'Proctocolectomy,' and is followed by one of the following procedures:
An Ileostomy involves the surgical creation of a small opening in the person's abdomen, called a stoma, and attachment of the end of the small intestine, called the ileum, to it. Waste will travel through the small intestine and exit the body through the stoma. A pouch is worn over the opening to collect waste, and the person empties the pouch as needed.
An Ileoanal Anastomosis allows the person to have normal bowel movements because it preserves part of the anus. A surgeon removes the colon and the inside of the rectum, leaving the outer muscles of the rectum. The surgeon then attaches the ileum to the inside of the rectum and the anus, creating a pouch. Waste is stored in the pouch and passes through the anus in the usual manner.
- Ulcerative colitis differs from another inflammatory bowel condition, Crohn's disease.
- Treatment of ulcerative colitis may involve both medications and surgery.
- While genetics and environmental triggers may aid in the development of ulcerative colitis, a poor diet won't.
- Once you know you have UC, reducing the frequency of flare-ups and finding a medication that works best for your symptoms are key next steps.
- Long-standing ulcerative colitis is a risk factor for colon cancer.
- Ulcerative colitis also can cause inflammation in joints, spine, skin, eyes, and the liver and its bile ducts.
- Scientists believe one cause of ulcerative colitis may be an abnormal immune reaction in the intestine.
- People of Asian origin are less likely to be affected.
- Men and women are equally affected.
- About 10 to 25 percent of people who have ulcerative colitis also have a brother, sister, or parent with ulcerative colitis or the other common type of inflammatory bowel disease, Crohn's.
- Ulcerative colitis is rare in the UK, with one new case per 10,000 people per year. There are approximately 146,000 patients with ulcerative colitis and usually they are diagnosed between the ages of 15 and 25-years-old, with a smaller peak between 55 and 65 years old.
- Colitis affects approximately 700,000 Americans, with an additional 30,000 new cases of IBD being diagnosed each year.
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