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Ulcerative
colitis
Return to common ulcerative colitis main page
What
is ulcerative colitis?
Ulcerative colitis is inflammation or irritation of the lining of the
colon, which starts in the rectum. This shows up on endoscopic exams as
a diffuse redness that may have spontaneous bleeding or mucus on the surface.
Discrete ulcers are not seen visually although they are readily seen under
the microscope. The most common area to be affected is the rectum (this
may be called ulcerative proctitis). In time it may advance higher in
the colon or it may start with the entire colon being diseased. Inflammation
and scar tissue (sclerosing cholangitis) can affect the bile ducts. Liver
disease or pericholangitis occurs occasionally. As part of the overall
ulcerative colitis disease, 5% of people experience joint and low back
pain, a variety of skin and eye diseases, fever and anemia.
What
is the cause for ulcerative colitis?
Although no one knows what starts this disease, many aspects of the inflammatory
process are known. There appears to be a genetic predisposition to the
disease. Ulcerative colitis may start after a gastrointestinal infection
where certain inflammatory cells get stimulated and stay that way for
uncertain reasons.
What
is the long-term outlook for people with ulcerative colitis?
This disease becomes active and goes into remission without any predictability.
After a person gets into a drug-induced remission, relapse occurs in 25-50%
after 1 year and 40-65% after 2 years. Approximately one third to one
half of people with ulcerative colitis require surgery to remove the colon.
In surgical cases, an internal intestinal pouch can be created so there
is no external bag or ostomy. When the colitis has been extensive the
risk for colon cancer starts to increase after having the disease for
a period of 7-10 years. After this time period approximately 1% of patients
per year develop colon cancer. Undergoing a regular surveillance program
with colonoscopy and biopsies can prevent
cancer. If a biopsy shows evidence of dysplasia, colon surgery can prevent
cancer.
What
is the treatment for ulcerative colitis?
Usually the first treatment is one of the 6-ASA medications: Asacol, Rowasa,
Pentasa, Dipentum, Colazal and Azulfidine. Colazal has been shown in a
recent study to be more effective and better tolerated than Asacol in
the treatment of ulcerative colitis. This class of medications decreases
mucosal permeability, inhibits antibody production, inhibits chemotactic
factor production and stimulates prostaglandin production. For moderate
or severe disease, an anti-inflammatory steroid called prednisone is commonly
prescribed. This drug is similar to a chemical that our own body makes
but when used in high doses it has many short-term and long-term side
effects. A third class of medications called immunosupressants or immunomodulating
medications are useful in minimizing the dose or replacing the use of
steroids. Examples include Purinethol (6-MP: 6-mercaptopurine), Imuran
(azathiaprine) and Methotrexate. Each of these medications potentially
has significant side effects that require careful monitoring by your doctor.
Heparin and Plaquenil are ocaisonally useful treatments. Finally, surgery
is indicated for patients who have dysplasia or when medical therapy has
failed. Surgery is a curative procedure as opposed to Crohn’s disease.
A surgery called the internal ileoanal pull through pouch is a good alternative
to an ileostomy (extended appliance or bag). Inflammation of the internal
pouch may require antibiotic therapy.
How
should the diet be modified?
Certain modifications in diet are indicated. When there is active inflammation
in the intestine, raw fruits and vegetables should be avoided. Caffeine
may also be a factor in contributing to diarrhea. We do not limit dairy
products although a lactose enzyme supplement is indicated for those who
are intolerant to the milk sugar. A balanced nutritious diet with vitamin
supplementation is important. A vitamin called folic acid may be protective
against the development of cancer. After surgical resection of part of
the small intestine a low oxylate diet and increased fluid intake may
be indicated to prevent kidney stones.