Ulcerative colitis is a type of inflammatory bowel disease (IBD) that affects the large intestine (colon) and rectum.
See also: Crohn's disease
Inflammatory bowel disease - ulcerative colitis; IBD - ulcerative colitis
The cause of ulcerative colitis is unknown. It may affect any age group, although there are peaks at ages 15 - 30 and then again at ages 50 - 70.
The disease usually begins in the rectal area and may eventually extend through the entire large intestine. Repeated swelling (inflammation) leads to thickening of the wall of the intestine and rectum with scar tissue. Death of colon tissue or sepsis (severe infection) may occur with severe disease.
The symptoms vary in severity and may start slowly or suddenly. Many factors can lead to attacks, including respiratory infections or physical stress.
Risk factors include a family history of ulcerative colitis, or Jewish ancestry.
Other symptoms that may occur with ulcerative colitis include the following:
Colonoscopy is also used to screen people with ulcerative colitis for colon cancer. Ulcerative colitis increases the risk of colon cancer. If you have this condition, you should be screened with colonoscopy about 8-12 years after being diagnosed. You should have a follow-up colonoscopy every 1-2 years.
Othe tests that may be done to help diagnose this condition include:
The goals of treatment are to:
Hospitalization is often required for severe attacks. Your doctor may prescribe corticosteroids to reduce inflammation. You may be given nutrients through an intravenous (IV) line (through a vein).
DIET AND NUTRITION
Certain types of foods may worsen diarrhea and gas symptoms, especially during times of active disease. Diet suggestions:
Medications that may be used to decrease the number of attacks include:
Surgery to remove the colon will cure ulcerative colitis and removes the threat of colon cancer. Surgery is usually for patients who have:
Most of the time, the entire colon, including the rectum, is removed. Afterwards, patients may need an ileoostomy (a surgical opening in the abdominal wall), or a procedure that connects the small intestine to the anus to help the patient gain more normal bowel function.
Social support can often help with the stress of dealing with illness, and support group members may also have useful tips for finding the best treatment and coping with the condition.
For more information visit the Crohn's and Colitis Foundation of America (CCFA) web site at www.ccfa.org.
About half of patients with ulcerative colitis have mild symptoms. Patients with more severe ulcerative colitis tend to respond less well to medications.
Permanent and complete control of symptoms with medications is unusual. Cure is only possible through complete removal of the large intestine.
The risk of colon cancer increases in each decade after ulcerative colitis is diagnosed.
Call your health care provider if you develop persistent abdominal pain, new or increased bleeding, persistent fever, or other symptoms of ulcerative colitis.
Call your health care provider if you have ulcerative colitis and your symptoms worsen or do not improve with treatment, or if new symptoms develop.
Because the cause is unknown, prevention is also unknown.
Nonsteroidal anti-inflammatory drugs (NSAIDs) may make symptoms worse.
Due to the risk of colon cancer associated with ulcerative colitis, screening with colonoscopy is recommended.
The American Cancer Society recommends having your first screening:
Have follow-up examinations every 1 - 2 years.
Graham L. AGA reviews the use of corticosteroids, immunomodulators, and infliximab in IBD. Am Fam Physician. 2007;75:410-412.
Moyer MS. Chronic ulcerative colitis in childhood. J Pediatr. 2006;148:325.
Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 50.
Rutgeerts P, Vermeire S, Van Assche G. Biological therapies for inflammatory bowel diseases. Gastroenterology. 2009 Apr;136(4):1182-97. Epub 2009 Feb 26.