Ulcerative Colitis

What is ulcerative colitis?

Ulcerative colitis is a chronic, long-term inflammatory disease of the gastrointestinal tract, specifically involving ulcers and sores of the large intestine (colon) and the rectum. Ulcerative colitis often begins gradually and worsens over time with periods of remission interspersed with flare-ups of symptoms.

It is characterized as an inflammatory bowel disease meaning it results in widespread irritation and swelling of the intestines. Symptoms include abdominal pain and cramping, bloody diarrhea, rectal pain, increased urgency to defecate, weight loss, fever, fatigue, nausea, a loss of appetite, and skin irritation or rashes.

Treatments include medications both prescribed and over-the-counter to target certain associated issues as well as surgery.

You should visit your primary care physician within the next 24 hours, who, depending if he/she agrees with the symptoms you have, he/she will have you get a colonoscopy for a biopsy to confirm the diagnosis. Treatment depends on the severity of disease, but they are all medications to reduce your inflammatory response in the gut.

Symptoms of ulcerative colitis

Symptoms of ulcerative colitis can depend on the location and severity of the inflammation of the GI tract. These symptoms can be mild to moderate and happen every couple of months or may be very severe and happen frequently to the point that hospitalization is required.

Most people with this condition experience:

• Abdominal pain and cramping
• Bloody diarrhea that sometimes includes pus
• Rectal pain
• Increased urgency or need to defecate
• Weight loss
• Fever
• Fatigue
• Nausea
• Loss of appetite
• Skin irritation or rashes

Causes of ulcerative colitis

Why this widespread inflammation occurs is not completely understood; however, research suggests that an overactive immune system, genetics, or environment factors may play a role in the development of this disease.

Dysfunctional/overactive intestinal immune system

The immune system is designed to identify invading pathogens such as viruses and bacteria that may be dangerous to the body and destroy these potentially harmful foreign substances. However, instead:

• The immune system attacks itself: In ulcerative colitis, the immune system mistakenly identifies the cells of the large intestine as foreign and begins to attack its components.
• The body becomes inflamed: The triggered immune response results in widespread, chronic inflammation.

Genetics

Ulcerative colitis often runs in families, suggesting that there may be a genetic component to this condition. Nevertheless, scientists have not been able to find a clear link between abnormal genes and ulcerative colitis.

Environmental factors

Although these are not definitive causes, some studies suggest that environmental factors may increase the risk of developing ulcerative colitis, such as:

• Certain foods
• Physical or emotional stress
• Diet
• Medications

Who is at risk for developing ulcerative colitis

Given the proposed causes of ulcerative colitis, there are certain populations that have a greater risk of developing the condition, including:

• People with a family history: Ulcerative colitis can occur if even if there was presence of another inflammatory bowel disease.
• People between the ages of 15 and 30: However, ulcerative colitis can also develop in people older than 60.
• White people: White people have the highest risk of the disease, though it can occur in any race. Ashkenazi Jews have the highest risk of developing the condition.

Complications

Complications of ulcerative colitis can be severe and sometimes life-threatening, making it very important for individuals affected to maintain appropriate follow-up and treatment for their symptoms. Such complications include:

• Anemia: This is a condition that can result from severe bleeding in which the body has fewer blood cells than normal.
• Perforated colon: This is a hole in the colon that forms from continued exacerbation and irritation of ulcers.
• Toxic megacolon: This is arapidly swelling colon that is often a medical and surgical emergency.
• Inflammation: This may be of the skin, joints, and eyes.
• Increased risk of colon cancer
• Severe dehydration

Treatment options and prevention for ulcerative colitis

Ulcerative colitis is a debilitating condition that can significantly affect your life. Although there is no definitive cure for ulcerative colitis, there are many treatment options that can help control symptoms and keep you in remission for longer periods. Drug therapies and surgical procedures can even bring about remission in some people.

Medications

There have been multiple medications developed to treat ulcerative colitis. These include:

• Anti-inflammatory drugs: This is often the first-line treatment for ulcerative colitis as it combats the inflammation that is destroying the large intestine. These medications include corticosteroids and 5-aminosalicylates.
• Immune system suppressors: This type of drug reduces inflammation by suppressing the abnormal immune response triggered in ulcerative colitis. These medications include azathioprine and cyclosporine.
• Supportive medications: Supportive medications such as pain relievers, anti-diarrheal medications, and iron supplements can treat the specific complications and symptoms of ulcerative colitis.

Surgery

About 23 to 45 percent of people with ulcerative colitis will require surgery. Surgery for ulcerative colitis involves:

• Removing the entire colon and rectum: This eliminates the part of the body where ulcerative colitis occurs and sometimes can "cure" you of the condition.
• Use of a bag or pouch: After this surgery, people can no longer use their large intestine to process and dispel stool, so surgery must create a pouch or bag through which stool can be passed.

When to seek further consultation for ulcerative colitis

If you have ulcerative colitis, close follow-up with a medical team is important for ensuring your symptoms are properly treated and for preventing the development of serious complications.

Scheduling more frequent colon screenings

According to the Mayo Clinic, you will need more frequent screenings for colon cancer, but the recommended schedule will depend on the location of your disease as well as how long you have had ulcerative colitis.

If your disease involves more than your rectum, you will require a surveillance colonoscopy every one to two years. You will need a surveillance colonoscopy beginning as soon as eight years after diagnosis if the majority of your colon is involved, or 15 years if only the left side of your colon is involved.