What is ulcerative colitis?
Ulcerative colitis is a disease that causes inflammation and sores, called ulcers, in the lining of the rectum and colon. Ulcers form where inflammation has killed the cells that usually line the colon, then bleed and produce pus. Inflammation in the colon also causes the colon to empty frequently, causing diarrhea.
When the inflammation occurs in the rectum and lower part of the colon it is called. ulcerative proctitis. If the entire colon is affected it is called pancolitis. If only the left side of the colon is affected it is called limited or distal colitis.
Ulerative colitis is an inflammatory bowel disease (IBD), tire general name for diseases that cause inflammation in the small intestine and colon. It can be difficult to diagnose because its symptoms are similar to other int4Stinal disorders and to another type of IBD called Crohn’s disease. Crohn’s disease differs because it causes inflammation deeper within the intestinal wall and can occur in other parts of the digestive system including the small intestine, mouth, esophagus, and stomach.
Ulcerative colitis can occur in people of any age, but it usually starts between the ages of 15 and 30, and less frequently between 50 and 70 years of age. It affects men and women equally and appears to run in families, with reports of up to 20 percent of people with ulcerative colitis having a family member or relative with ulcerative colitis or Crohn’s disease. A higher incidence of ulcerative colitis is seen in Whites and people of Jewish descent.
What are the symptoms of ulcerative colitis?
The most common symptoms of ulcerative colitis ari abdominal pain and bloody diar- rhea. Patients also may experience
About half of the people diagnosed with ulcerative colitis have mild symptoms. Others suffer Sequent fevers, bloody diarrhea, nausea, and severe abdominal cramps. Ulcerative colitis may also cause problems such as arthritis, inflammation of the eye, liver disease, and osteoporosis. It is not known why these problems occur outside the colon. Scientists think these complications may be the result of inflammation triggered by the immune system. Some of these problems go away when the colitis is treated.
What causes ulcerative colitis?
Many theories exist about what causes ulcerative colitis. People with ulcerative colitis have abnormalities of the immune system, but doctors do not know whether these abnormalities are a cause or a result of the disease. The body’s immune system is believed to react abnormally to the bacterial in the digestive tract.
Ulcerative colitis is not caused by emotional distress or sensitivity to certain foods or food products, but these factors may trigger symptoms in some people. The stress of living with ulcerative colitis may also contribute to a worsening of symptoms.
How is Ulcerative colitis diagnosed?
Many tests are used to diagnose ulcerative colitis. A physical exam and medical history are usually the first step. Blood tests nay be done to check for anemia, which could indicate bleeding in the colon or rectum, or they may uncover a high white blood cell count, which is a sign of inflammation somewhere in the body.
A stool sample can also reveal white blood cells, whose presence indicates ulcerative colitis or inflammatory disease. In addition, a stool sample allows the doctor to detect bleeding or infection in the colon or rectum caused by bacteria, a virus, or parasites.
A colonosco2y or sigmoidoscopy are the most accurate diet methods for making a diag nosis of ulcerative colitis and ruIling-out other possible conditions, such as Crohn’s disease, diverticular disease, or cancer. For both tests, the doctor inserts an endoscope a long, flexible, lighted tube connected to a computer and TV monitor into the anus to see the inside of the colon and rectum. The doctor will be able to see any inflammation, bleeding, or ulcers on the colon call. During the exam, the doctor may do a biopsy, which involves taking a sample of tissue from the lining of the colon to view with a microscope. Sometimes x rays such as a barium enema or CT scans are also used to diagnose ulcerative colitis or its complications.
What is the treatment for ulcerative colitis?
Treatment for ulcerative colitis depends on the severity of the disease. Each person experiences-ulcerative colitis differently, so treatment is adjusted for each individual.
The goal of drug therapy is to induce and maintain remission, and to improve the quality of life for people with ulcerative colitis. Several types of drugs are available.
Other drugs may be given to relax the patient or to relieve pain, diarrhea, or infection. Some people have remissions—periods when the symptoms go away that last for months or even years. However, most patients’ symptoms eventually return.
Occasionally, symptoms are severe enough that a person must be hospitalized. For example, a person may have severe bleeding or severe diarrhea that causes dehydration. In such cases the doctor Al try to stop diarrhea and loss of blood, fluids and mineral salts. The patient may need a special diet, feeding through a rein, medications, or sometimes surgery.
About 25 to 40 percent of ulcerative colitis patients must eventually have their colons removed because of massive bleeding, severe illness, rupture of the colon, or risk of cancer. Sometimes the doctor will recommend removing the colon if medical treatment fails or if the side effects of corticosteroids or other drugs threaten the patient’s health.
Surgery to remove the colon and rectum, known as proctocolectomy, is followed by one of the following:
Not every operation is appropriate for every person. Which surgery to have depends on the severity of the disease and the patient’s needs, expectations, and lifestyle. People faced with this decision should get as much information as possible by talking to their doctors, to nurses who work with colon surgery patients (enterostomal therapists), and to other colon surgery patients. Patient advocacy organizations can direct people to support groups and other information resources
Is colon cancer a concern?
About 5percent of people with ulcerative colitis develop colon cancer. The risk of cancer increases with the duration of the disease and how such the colon has been damaged. For example, if only the lower colon and rectum are involved, the risk of cancer is no higher than normal. howrever, if the entire colon is involved, the risk of cancer may be as much as 32 times the normal rate.
Sometimes precancerous changes occur in the cells lining the colon. These changes are called “dysplasia” People who have dysplasia are more Rely to develop cancer than those who do not Doctors look for signs of dysplasia when doing a colonoscopy or sigmoidoscopy and when examining tissue removed during these tests.
According to the 2002 updated guidelines for colon cancer screening, people who have had IBD throughout their colon for at least 8 years and those who have had IBD in only the left colon for 12 to 15 years should have a colonoscopy with biopsies every 1 to 2years to check for dysplasia. Such screening has not been proven to reduce the risk of colon cancer, but it may help identify cancer early. These guidelines were produced by an independent expert panel and endorsed by numerous organizations, including the American Cancer Society, the American College of Gastroenterology, the American Society of Colon and Rectal Surgeons, and the Crohn’s & Colitis Foundation of America.
Hope Through Research
NIDDK, through the Division of Digestive Diseases and Nutrition, conducts and supports research into many kinds of digestive disorders, including ulcerative colitis.
Researchers are studying how and why the immune system is activated, how it damages the colon, and the processes involved in healing. Through this increased understanding, new and more specific therapies can be developed. Currently, there are numerous clinical trials being conducted that are investigating ulcerative colitis. A complete listing of research studies on ulcerative colitis may be found at www.Cl inicalTrials.gov.
For more Information
Crohn’s & Colitis Foundation of America
386 Part Avenue South, 17th floor
New York, NY 10016—8804
Phone: 1—800-932-2423 or 212—685-3440
Reach Out for Youth With Ileitis and Colitis
84 Northgate Circle
Melville, NT 11747
United Ostomy Association
19772 MacArthur Boulevard Suite 200
Irvine, CA 92612—2405
Phone: 1—800—826—0826 or 949-660-8624
The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the content of the information provided. .If a proud is not mentioned, the omission does not mean or imply that the product is unsatisfactory.
National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892—3570
The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1980, the Clearing- house provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.
Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This fact sheet was reviewed by the Crohn’s fi Colitis Foundation of America.
This publication is not copyrighted. The clearinghouse encourages users of this tact sheet to duplicate and distribute as many copies as desired. This fact sheet is also available at www.niddk.nih.gov under “Health Information”.