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Ulcerative colitis

Definition


Disease: Ulcerative colitis Ulcerative colitis
Category: Digestive diseases

Disease Definition:

Abdominal pain and diarrhea are the two characteristics of ulcerative colitis, which is an inflammatory bowel disease (IBD) that causes chronic inflammation of the digestive tract. This disease may sometimes be impairing and may end up causing life-threatening complications, just like Crohn's disease.

 

Only the innermost lining of the large intestine (colon) and rectum are affected by ulcerative colitis. Unlike Crohn's syndrome that occurs in patches anywhere in the digestive tract and spreads deep into the layers of affected tissues, this disease occurs only through continuous stretches of the colon.

 

Although some treatments may dramatically reduce the signs and symptoms of ulcerative colitis and bring about a long-term remission, but there's no cure for this disease.
 

Work Group:


Symptoms, Causes

Symptoms:

Depending on the location and severity of inflammation, the signs and symptoms of ulcerative colitis may vary. Usually, ulcerative colitis is classified according to its location.

 

Based on the classification of ulcerative colitis, some of the signs and symptoms that are associated with it may be:

Ulcerative proctitis:

Ulcerative proctitis is the mildest form of ulcerative colitis.
In some cases, rectal bleeding may be the only sign of ulcerative proctitis, because the inflammation that occurs with this form of the disease will be confined to the rectum. While in other cases, a person with ulcerative proctitis may be unable to move the bowels in spite of the urge to do so (tenesmus), or may experience rectal pain or a feeling of urgency.

Proctosigmoiditis:

This type of ulcerative colitis usually causes bloody diarrhea, pain and tenesmus in addition to abdominal cramps. The rectum and the lower end of the colon (sigmoid colon) are affected by this form of the disease.

Left-sided colitis:

Unintentional weight loss, bloody diarrhea and pain on the left side and abdominal cramps are the signs and symptoms of this type. In this type, the inflammation extends from the rectum up the left side through the sigmoid and descending colon.

Pancolitis:

Abdominal cramps and pain, bouts of bloody diarrhea that may be severe, significant weight loss and fatigue are some of the signs and symptoms of this type, which usually affects the entire colon.

Fulminant colitis:

Dehydration, severe pain, profuse diarrhea and shock may be caused by this rare and life-threatening form of colitis that affects the whole colon. Additionally, colon rupture and toxic megacolon, a condition that occurs when the colon becomes severely distended, are some of the serious complications that having fulminant colitis puts a person at risk of.

 

Usually, periods of remission alternates with periods of acute illness in the course of ulcerative colitis. However, the severity of the disease will remain the same over time. More-severe signs and symptoms don’t develop in people with a milder form of the disease, such as ulcerative proctitis.

 

In case a person experiences abdominal pain, an unexpected fever that lasts more than a day or two, bloody stool, ongoing bouts of diarrhea that don’t respond to over-the-counter medications, in addition to a persistent change in the bowel habits, he/she should see a doctor.

 

Ulcerative colitis is considered a serious disease that may cause life-threatening complications, despite the fact that it isn’t fatal.
 

Causes:

The exact cause of ulcerative colitis is still not known. Stress, which was believed in the past to be the main culprit, may make the symptoms of this condition worse; however, it is no longer believed to be the cause of the disease.

 

Some of the possible causes of this disease include:

Immune system:

Some experts believe that the cause of ulcerative colitis is a virus or bacterium. When the immune system tries to fight off the invading pathogen, the digestive tract becomes inflamed. Another possibility could be the response of the immune system even though there’s no pathogen.

Heredity:

Genetics may contribute to this disease because a person who has a sibling or parent with this disease is more likely to develop it.
This disease affects men and women equally.

 

Some of the factors that may place a person at a risk of developing ulcerative colitis include:

Age:

In most cases, this disease occurs around the age of 30; but some people may not develop it until their 50s or 60s. Nevertheless, this doesn’t mean that ulcerative colitis can’t affect people of all ages.

Race or ethnicity:

After people of Jewish descent, white people have the highest risk of developing this disease.

Family history:

In case a person has a sibling or child with this disease, their risk of developing this disease will be higher.

The use of isotretinoin:

In some cases, the type of acne that doesn’t respond to other treatments or scarring cystic acne is treated with isotretinoin. The development of inflammatory bowel disease is increased with the use of isotretinoin.

NSAIDs:

NSAIDs cause signs and symptoms that are similar to ulcerative colitis and despite the fact that they don’t cause this condition itself; however, they may make it worse and make the initial diagnosis quite difficult. Some examples are diclofenac, ibuprofen, piroxicam and naproxen.
 

Complications

Complications:

Some of the complications that ulcerative colitis may end up causing include:

 

  • Severe dehydration
  • Inflammation of the skin, joints and eyes
  • Perforated colon
  • Toxic megacolon
  • Severe bleeding
  • Osteoporosis
  • An increased risk of colon cancer
  • Liver disease
     

Treatments:

Reducing the inflammation that triggers the signs and symptoms is what treatment for this disease will focus on. When this method works well, it may lead to a long-term remission, in addition to relief from symptoms. Drug therapy and surgery are the two methods of ulcerative colitis treatment.

 

A variety of medications are used in treating ulcerative colitis that control inflammation in different ways. However, finding the right medication is not an easy thing because what works well for one person doesn’t necessarily work well for another. Additionally, people should be careful with these medications because of their serious side effects.

 

ANTI-INFLAMMATORY DRUGS:

Usually, the first choice of medications for treating inflammatory bowel disease is anti-inflammatory medications. Some examples are:

Sulfasalazine:

This medication shouldn’t be used if a person is allergic to sulfa medications. Sulfasazaline reduces the symptoms of ulcerative colitis quite effectively, however, it has some side effects, such as vomiting, heartburn, nausea, headache and diarrhea.

Balsalazide, olsalazine and mesalamine:

These medications can be used either orally or rectally, in the form of enemas or suppositories, based on the area of the colon that is affected. A person can be prescribed a combination of an oral medication and an enema. More than 90% of people with mild ulcerative colitis are relieved from their signs and symptoms with the use of mesalamine. People who have left-sided colitis with mild to moderate symptoms, a combination of oral mesalamine and mesalamine enemas work best. In the case of proctitis, a combination of oral mesalamine and supporitories work best. The side effects of these medications are fewer than those of sulfasalazine.

Corticosteroids:

These medications are used only if a person has moderate to severe inflammatory bowel disease that doesn't respond to other treatments. Corticosteroids can help reduce inflammation, however, they aren't prescribed for long-term use, but only for a period of three to four months because they have lots of side effects, some of which are:

 

  • Type 2 diabetes
  • Excessive facial hair
  • An increased susceptibility to infections
  • Weight gain
  • High blood pressure
  • Osteoporosis

 

Corticosteroids can also induce remission when they are used in conjunction with other medications. For instance when they are used with an immune system suppressor, the corticosteroids induce remission and the suppressors help maintain the remission. In some cases, in order to treat disease in the lower colon or rectum, a person may be prescribed steroid enemas for short-term use.

 

IMMUNE SYSTEM SUPPRESSORS:

These medications reduce inflammation by targeting the immune system. These medications have proven effective in treating ulcerative colitis, which has led scientists to conclude that the damage induced to digestive tissues is caused by the response of the immune system to an invading virus or bacterium, or even to the body's own tissue. Inflammation is reduced by suppressing this response. Some types of immunosuppressant medications are:

Mercaptopurine and azathioprine:

These medications are sometimes initially combined with corticosteroids because they take about three months to start working, however, they start producing benefits on their own after a period of time. These medications increase the risk of developing cancer. Some of their other side effects are:

 

  • Infections
  • Bone marrow suppression
  • Inflammation of the pancreas and liver
  • Allergic reactions

 

In case a person is taking either of the medications mentioned above, a close follow-up is needed with the doctor, in addition to checking the blood regularly to look for side effects. Before starting these medications, a person who has had cancer should discuss it with a doctor.

Cyclosporine:

People who require surgery due to severe ulcerative colitis, or those who don't respond well to other medications can use this powerful medication. In some cases, these medications can be used in controlling signs and symptoms until less toxic drugs start working, while in other cases, it can delay surgery until the patient is strong enough. The benefits and risks of this treatment should be discussed with a doctor before using it because although it begins working in one to two weeks, but it carries the possibility of causing some severe side effects, such as fatal infections and kidney damage. Additionally, in case a person has had cancer previously, they should talk to their doctor before starting these medications because they carry a small risk of developing cancer.

Infliximab: 

Tumor necrosis factor (TNF) is a protein produced by the immune system. Infliximab works by neutralizing this protein. Before TNF can cause inflammation in the intestinal tract, infliximab removes it from the bloodstream. People with moderate to severe ulcerative colitis who can't tolerate or don't respond to other treatments can use this medication.

 

However, this medication has been associated with an increased risk of infection, particularly reactivation of viral hepatitis and tuberculosis. Before taking infliximab, a person should have a skin test for tuberculosis.
People who can't use infliximab are those with multiple sclerosis, heart failure, cancer or a history of cancer. This medication can also cause some serious allergic reactions because it contains mouse protein. These reactions may start showing initially after days or even weeks of starting the medication. If no problems occur, this medication will be used as long-term therapy, despite the fact that its effectiveness may wear off over time.

 

NICOTINE PATCHES:

The flare-ups of mild ulcerative colitis may be relieved in some people with the use of nicotine patches. A person should consult a doctor before trying this medication because the overall health risks from smoking far outweigh the potential benefit that nicotine may provide. Additionally, exactly how nicotine patches work and how they provide relief isn't known and doctors are still debating if nicotine provides better relief than other treatments.

 

OTHER MEDICATIONS:

There are some medications that can relieve the signs and symptoms of ulcerative colitis as well as control the inflammation. The type of medications prescribed to a patient will depend on the severity of his/her condition:

Antibiotics:

In order to help control or prevent infection, people with ulcerative colitis who also have a fever should be given antibiotics.

Anti-diarrheals:

By adding bulk to the stool, the signs and symptoms of mild to moderate diarrhea can be managed with a fiber supplement, such as methylcellulose or psyllium powder. Loperamide may be helpful in the cases of severe diarrhea. However, because anti-diarrheals increase the risk of toxic megacolon, they should be used with great caution.

Pain relievers:

NSAIDs can make the symptoms of ulcerative colitis worse, because of this people shouldn't use aspirin, naproxen or ibuprofen. However, a person may be recommended acetaminophen in the case of experiencing mild pain.

Iron supplements:

Iron deficiency anemia may develop in people with chronic intestinal bleeding. After the bleeding has stopped or diminished, taking iron supplements may reduce this type of anemia and help restore the normal levels of iron.

 

SURGERY:

Surgery may be recommended in case drug therapy, lifestyle changes or other treatments don't ease the signs and symptoms of ulcerative colitis. Eventually, 25 to 40% of people with ulcerative colitis end up needing surgery.

 

Ulcerative colitis may be eliminated by undergoing a surgery called proctocolectomy, in which the entire colon and rectum are removed. After this surgery, to collect stool, the patient used to wear a small bag over an opening in the abdomen (ileostomy). But nowadays, the need to wear a bag has been eliminated thanks to a procedure called ileoanal anastomosis, in which a pouch is constructed from the end of the small intestine and attached directly to the anus. After this surgery, because the patient will no longer have colon to absorb water, he/she may have more frequent bowel movements that are soft or watery. The doctor should discuss with the patient whether having ileostomy or an ileoanal pouch is appropriate.

 

PREGNANCY:

If a woman with ulcerative colitis can keep the disease in remission, then she can have a successful pregnancy. During pregnancy, especially during the first trimester, some medications shouldn't be used. Additionally, certain medications can still affect the pregnant woman even after it is stopped. Before a woman becomes pregnant, she should discuss with her doctor about the best way to manage the illness.

 

There's less than 5% risk of passing ulcerative colitis to the offspring in case the partner doesn't have the condition. Additionally, a woman with ulcerative colitis may have a slightly increased risk of delivering babies with low birth weights and experiencing premature delivery.

 

Prognosis:

Not available

Expert's opinion

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