UC is a chronic autoimmune disease that causes inflammation and ulcers in the lining of the colon, or large intestine. The inflammation sometimes occurs only in the lower part of the colon and the rectum, but it may also affect the entire colon. Ulcerative colitis is a lifelong illness that has a profound emotional and social impact on the affected patients.
Although the exact cause of inflammatory bowel diseases like UC is not yet known, extensive research has been conducted in this area and the disease appears to be multifactorial and polygenic. The proposed causes include environmental factors, immune dysfunction, and a likely genetic predisposition. It is believed that UC occurs when the patient's immune system inappropriately responds to something it perceives to be a foreign substance in the body (e.g., the bacteria normally found in the colon). Once triggered, this abnormal immune response leads to inflammation and intestinal damage.
Both men and women have an equal chance of developing UC, and it is known that genetics play a role in determining who is at greater risk. Although the disease usually develops between the ages of 15 and 30, UC can occur at any age. There are many factors involved with the disease. While it is believed that UC is not caused by emotional stress, food or drugs (like NSAID's, antibiotics), these factors may aggravate its symptoms.
Patients with ulcerative colitis predominantly complain of rectal bleeding, with frequent stools and mucous discharge from the rectum. Some patients also describe tenesmus (Severe urgency to have a bowel movement). Onset is typically insidious. In severe cases, purulent rectal discharge causes lower abdominal pain and severe dehydration, especially in the elderly population.
Diagnosing UC involves a series of tests. Blood tests are performed to check for anemia (a low red blood cell count).
Often, an evaluation of the colon is performed using endoscopy - either a sigmoidoscopy, where the doctor passes a flexible instrument into the rectum and lower colon, or a colonoscopy, a similar procedure, which gives the doctor a visualization of the entire colon. Multiple biopsy samples are obtained from both inflamed and normal-appearing mucosa.
Radiographic imaging has an important role in the workup of patients with suspected inflammatory bowel disease and in the differentiation of ulcerative colitis and Crohn disease. Plain abdominal radiographs are a useful adjunct to imaging in cases of ulcerative colitis of acute onset. In severe cases, the images may show colonic dilatation, suggesting toxic megacolon; evidence of perforation; obstruction; or ileus.
Stool studies are used to exclude other causes of similar complaints. These include evaluation of fecal leukocytes, ova and parasite studies, culture for bacterial pathogens, and Clostridium difficile titer.
Whether or not you have been diagnosed with UC, you should consult a doctor if you experience any of its symptoms, including those listed below:
The treatment of ulcerative colitis relies on initial medical management with corticosteroids and antiinflammatory agents, such as sulfasalazine, in conjunction with symptomatic treatment with antidiarrheal agents and rehydration. Surgery is contemplated when medical treatment fails or when a surgical emergency (eg, perforation of the colon) occurs. Surgical options include total colectomy (panproctocolectomy) and ileostomy, total colectomy, and ileoanal pouch reconstruction or ileorectal anastomosis.
While there are a variety of drugs currently used to treat the symptoms of UC, there remains an unmet medical need. The location and severity of your disease, specific complications, and your response to previous treatment will all influence the choice of therapy.The current treatment options include:
Surgery may be required to provide relief for patients who have not responded to medical treatment or whose health has been threatened by bleeding, severe illness, rupture of the colon or other complications of treatment. In addition, surgery is required when colon cancer or dysplasia, a condition that precedes it, develops. Removing the colon is called a colectomy and may be performed in 5-10% of patients.
As with any surgical procedure, complications may arise. Common long-term complications include:
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