Ulcerative Colitis
Disease Information

Disease Information

Ulcerative colitis (UC) and Crohn's disease (CD) are types of inflammatory bowel disease (IBD). These disorders are inflammatory conditions of the gastrointestinal tract. CD is usually present in many parts of the gastrointestinal tract, while UC is usually present in the colon (large intestine).

UC and CD are different from Irritable Bowel Syndrome (IBS). IBS is a disorder of the intestines that leads to a change in bowel habits; however, it does not involve inflammation. There is no direct relationship between IBS and IBD.

People with UC are said to have either active disease or to be in remission. While the disease is active, people experience "flare-ups" or the symptoms of UC. Flare-ups can vary in intensity and duration. Remission is when people are symptom-free. The duration of remission can vary from a few days to several years.

Even though UC is a serious chronic disease that requires long-term medication, it is still possible to lead a normal and productive life with proper treatment. In-between exacerbations, patients usually feel well.

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Signs and Symptoms

The main symptoms of IBD typically include diarrhea and rectal bleeding. In addition to blood, the feces may also contain mucus. Some patients complain of constipation and abdominal tenderness or pain.

The signs that your doctor may check for are fever, increased heart rate, weight loss, hypotension (low blood pressure) and anemia (abnormally low number of red blood cells).

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Who has IBD?

Approximately 1 million people suffer from IBD in the U.S., with roughly 2/3 having UC, and the other 1/3 having CD. Adults and adolescents aged 15 to 35 years are most susceptible to IBD. Men and women are affected by IBD almost equally. There is a greater incidence of UC in Caucasians than in minorities, and a higher incidence in the Jewish population.

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Causes of IBD

The cause of IBD is unknown, although there are some theories. Scientists think that a person's genetic predisposition, an immune system dysfunction, and environmental triggers may play a role in the development or exacerbation of IBD.

Genetic Predisposition – IBD tends to run in families. Approximately 20% of people with UC have a close relative with IBD. At this time, however, there is no way to predict if certain family members will develop the disease.

Immune Dysfunction – Some researchers believe that the body's immune system may inappropriately respond to normal proteins in the body, creating inflammation in order to try and fight "foreign" substances. Normally, inflammation occurs to protect the body from infection, but if it occurs under the wrong circumstances, or for too long of a period, the inflammation can damage the body. This may be what happens in UC.

Environmental Triggers – Ulcerative colitis is known to be a disease largely of non-smokers. Research suggests that cigarette smoking may have a preventive effect against the development of UC. Whereas the opposite seems to be true in persons with Crohn's disease. Investigation is currently being made into whether nicotine is of therapeutic value to patients suffering from UC. Other possible triggers such as living in an urban setting and psychological factors (i.e., stress) may play a role in the development or exacerbation of UC.

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Diagnosis

Your doctor may complete a physical exam to check for the common signs and symptoms of ulcerative colitis (bleeding from the rectum, diarrhea, fever, weight loss), and also review your medical history to determine if ulcerative colitis runs in your family. If your physician is suspicious that UC may be the reason for your symptoms, he or she may order a series of tests to confirm those suspicions. Some important tests that your doctor may order are:

Laboratory Workups – Your doctor may take blood and stool samples. A blood test can detect anemia, which occurs when the concentration of hemoglobin, the protein tha carries oxygen in the blood, is below normal. The blood test will also detect any vitamin, mineral, and electrolyte deficiencies.

Sigmoidoscopy – This test is a visual examination of part of the colon and rectum. An instrument with a light source at one end will be inserted into your rectum to detect any areas of bleeding and ulcerations that may exist.

Colonoscopy – Similar to the sigmoidoscopy examination, colonoscopy also requires that an instrument with a light source be inserted into the rectum. With this test, more of the large intestine can be observed. Some devices have the ability to take a tissue sample, take pictures of your intestine, or allow your doctor to perform minor surgery.

Barium Enema – The barium enema includes a substance called barium sulfate, which is pumped into the large intestine through the anus, to allow the colon to be visualized. An X-ray is then taken of the large intestine to reveal any abnormalities in its shape and surface.

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Treatment

Currently, there is no cure for UC, except through surgical removal of the colon. However, symptoms can be controlled by anti-inflammatory medications prescribed by your doctor.

Today, UC is treated by the following classes of medication, which can be given either orally or rectally.

Aminosalicylates (5-ASAs) – These are medications that control inflammation, such as balsalazide (COLAZAL^®).

Steroids – Steroids, such as prednisone, are typically reserved for more severe cases.

Immunosuppressants – These medications (given orally) include 6-mercaptopurine (6-MP) and azathioprine, and are usually given to patients who do not respond well to 5-ASAs.

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Surgery

Usually surgery is needed only when medical therapy isn't successful, or when there is a malignancy complicating the UC. It is estimated that about 25% to 40% of ulcerative colitis patients may eventually require surgery. Surgery is currently the only treatment that can cure UC.

Patients who require surgery usually undergo a procedure called a proctocolectomy, which is the removal of the large intestine (colon), rectum and anus. An external opening in the abdominal wall, called an ileostomy, is created to allow waste to be collected. Following surgery, intestinal contents are collected in a plastic bag called a stoma bag.

Sometimes surgery can be done in a way that preserves the patient's ability to eliminate through the anus. For these patients, an ileostomy is not necessary and with time normal elimination may occur. Two types of surgery may be done: one is called colectomy with ileorectal anastomosis, where the large intestine is removed but the rectum is preserved; the other is called procto-colectomy with ileal pouch-anal anastomosis. In this surgery, the large intestine and part of the rectum are removed. The surgeon then creates an internal pouch from remaining tissue and connects it to the remaining part of the rectum to take the place of the rectum.

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