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Ulcerative Colitis
What is ulcerative colitis?
Ulcerative colitis is a type of inflammatory bowel disease primarily of the large intestine (colon and rectum). The disease affects both men and women equally. Although the disease can occur at any age, most people are diagnosed in their mid-30s. Men are more likely than women to be diagnosed with the disease at a later age – often in their 50s and 60s.
The condition almost always involves the lower portion of the colon, or rectum (proctitis), and may also involve the surrounding areas of the colon, as well (proctocolitis). The inflammation itself involves only the innermost layers of the bowel wall, and typically, the anus is not involved. There are also non-gastrointestinal symptoms of ulcerative colitis, which can affect the skin, eyes and joints.
Since ulcerative colitis affects only the colon, it differs from other similar inflammatory bowel diseases, including Crohn’s disease. However, both ulcerative colitis and Crohn’s disease are marked by an abnormal response in the body’s immune system and should not be confused with irritable bowel syndrome.
What are the risk factors?
Family History – Ulcerative colitis can tend to occur in families and some studies show that up to 20% of people with ulcerative colitis will have a close relative with either the same condition or Crohn’s disease. Unfortunately, there is no way to predict which, if any, family members will be affected with the disease.
Ethnicity – There is a greater incidence of ulcerative colitis among Caucasians, particularly of Jewish descent.
What causes ulcerative colitis?
Despite years of research, there is still no known cause of ulcerative colitis at this time.
However, there seem to be several risk factors, including inherited genes, problems with a person’s immune system or environmental causes.
What are the symptoms?
Common symptoms of ulcerative colitis include fatigue, abdominal pain and diarrhea (usually bloody). Other symptoms are fever and weight loss. Non-gastrointestinal symptoms include visual changes, arthritis, jaundice and skin rashes/lesions.
Symptoms tend to come and go, and patients can experience long periods of remission in which there are no symptoms. However, symptoms eventually return. Because of the unpredictable nature of the disease, it is important for patients to work closely with their physician so that appropriate treatments can be determined.
How is ulcerative colitis diagnosed?
The first step to determining whether an individual has ulcerative colitis is to perform a complete clinical exam. Since the disease begins similarly to infectious causes of diarrhea, it is important that tests can differentiate the two. A typical ulcerative colitis examination includes bloodwork, stool samples and a colonoscopy with biopsies.
When ulcerative colitis is diagnosed, intermittent repeat colonoscopies are often recommended for the detection of dysplasia (a precursor to colorectal cancer).
What treatments are available?
Medication Management
Effective medical treatment can suppress inflammation, and medications are helpful in both allowing the colon to heal and relieving the symptoms associated with the disease. Medical therapies include aspirin-related 5-ANA agents (such as sulfasalazine), steroids (such as prednisone), immunomodulators (such as azathioprine), and monoclonal antibodies (such as inflizimab). Some of these medications are taken orally, some are given intravenously and some via the rectum. Proctitis is usually treated with suppositories or enemas, and probiotics are also gaining popularity.
It is important to note that medical therapy is not successful in one-quarter to one-third of patients. When this occurs, a colectomy (removal of the colon) may be an option. Unlike Crohn’s disease which often recurs following surgery, ulcerative colitis is potentially “cured” once the colon is removed.
Surgical Intervention
When severe dysplasia (or cancer) occurs or medications have failed (particularly in the setting of toxic megacolon), surgery is recommended. Surgery typically involves the removal of the entire colon and rectum (total proctocolectomy) or just the colon (total abdominal colectomy). Reconstruction is often performed via a permanent ileostomy or connection to the anus (“J” pouch procedure). Temporary ileostomy is sometimes indicated, as well. More recently, many of these procedures are being performed laparoscopically, or by using a minimally invasive approach.
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