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What is Ulcerative Colitis?
Ulcerative colitis is an inflammatory disease of the large intestine (colon) involving the inner mucosal lining, typically consisting of fine ulcerations on the surface, with infiltration by special types of inflammatory white blood cells. Two key characteristics of ulcerative colitis are that the inflammation:
does not penetrate beyond the inner mucosal lining to the outer muscle coat, and
begins at the lower end of the colon, just above the anus and can extend continuously upwards into the rest of the colon to variable distances. In some patients, only a short distance is affected and in others, the inflammation travels much farther along the colon, right up to the point it meets the small intestine.
It is important to note that ulcerative colitis is unrelated to ulcers that occur elsewhere in the gastrointestinal tract, such as stomach or duodenal ulcers, but it has many similarities to another chronic inflammatory bowel disease, Crohn's disease.
What causes Ulcerative Colitis?
While the cause of ulcerative colitis is unknown, researchers have looked at many potential causes of this condition such as infection, stress, allergies, and toxins but have not revealed definite links. It is possible that ulcerative colitis is an autoimmune disease whereby, after some initial insult, the patient develops a reaction against his or her own bowel. Genetic links are still under investigation, as there seems to be an increased occurrence of inflammatory bowel disease in certain family groups.
What are the symptoms of Ulcerative Colitis?
The most common symptom is blood in the bowel movement. This occurs in over 90% of patients. The amount of
blood varies. Sometimes moderate amounts, including clots, may be passed. The second characteristic symptom
is diarrhea, this occurring in 80% of patients. Crampy abdominal pain may occur with the diarrhea and the
severity can range from mild to severe. If the diarrhea and blood loss are severe, weight loss may occur.
Sometimes a fever is experienced.
Some patients have what are referred to as extra intestinal manifestations of ulcerative colitis, such
manifestations including inflammation of the eyes or joints, ulcers of the mouth, or tender, inflamed
modules on the shins. The cause of these conditions is also unknown.
How is Ulcerative Colitis diagnosed?
Ulcerative colitis is primarily diagnosed by looking into the lower bowel with a sigmoidoscope. The nature of
the inflammation is usually confirmed by taking a small biopsy for examination under a microscope. The extent
of the disease may be determined by a barium enema X-ray or by colonoscopy. Blood tests do not make the diagnosis
but are helpful in assessing the amount of bleeding, activity of the inflammation, and the nutritional state of
the patient.
How is Ulcerative Colitis treated?
The treatment of ulcerative colitis falls into two broad categories: the management of symptoms; and the management
of the inflammation.
The management of symptoms includes treating such things as diarrhea, cramps, pain, anemia, etc. This treatment
does not affect the basic disease but is important in making the patient feel better and function better.
Management of the inflammation includes a number of basic principles. The first principle is that of rest, since
inflammation resolves quicker if the area is rested. The bowel is rested by means of a diet that is easy to digest
and devoid of irritants and bowel stimulants. The second principle is that of nutrition, since the body heals better
when it is nutritionally replete. Improving nutrition may require dietary supplements, occasionally special elemental
(pre-digested) diets, and occasionally intravenous nutrition.
The third principle of treatment is medication therapy. There are several drugs that have a beneficial effect by
reducing inflammation of the bowel. The original drug used for ulcerative colitis was sulfasalazine (Salazopyrin®,
SAS 500®). It combines a sulfa antibiotic and 5-ASA with the latter being the active ingredient. Subsequently other
combinations of 5-ASA have been released -- mesalamine (Asacol®, Mesasal®, Mezavant®, Pentasa®, Salofalk®) and olsalazine
(Dipentum®). These drugs act directly inside the bowel and only small amounts are absorbed. They are very safe
and well tolerated for long-term use. They work by topical action and not by being absorbed into the body. The
oral tablets are formulated to release the active medication in the colon and allow the drug to come into contact
with the inflamed mucosa. 5-ASA not only helps to settle the acute inflammation but taken on a long term basis tends
to keep the inflammation inactive.
Oral corticosteroids such as prednisone, have a significant role to play but are usually reserved for more serious
exacerbations of ulcerative colitis. Prednisone is a potent inhibitor of inflammation but does have side effects
that need to be weighed against its benefit.
A newer rectal suspension steroid, budesonide (Entocort®), is similar to other rectal suspension steroids but with
low systemic activity. This means its side effects are substantially less than prednisone.
In some resistant cases, azathioprine (Imuran®), an immuno-suppressive drug, is often effective in combination with
low dose prednisone. Again, there are also side effects that must be assessed.
Some antibiotics can be effective in treating ulcerative colitis. The drugs used are metronidazole (Flagyl®) and
ciproflaxacin (Cipro®). Their mechanism of action is unknown.
For colitis just inside the anus (ulcerative proctitis), topical or rectal treatment is best. 5-ASA can be
administered rectally by a liquid suspension (Salofalk®, Pentasa®) or by suppositories. Steroids can also be
administered rectally in the form of either a foam (Cortifoam®) or a liquid (Cortenema®, Entocort®).
In patients with ongoing active disease that fails to respond to all forms of management, surgery may be
indicated. If surgery is necessary, the whole colon usually must be removed. In most of these patients, the
anus can be spared and a pouch can be created from the small bowel. In these cases, bowel movements can pass
through the anus rather than necessitating an ileostomy.
What is the course of Ulcerative Colitis?
Ulcerative colitis can follow one of a number of courses. The patient may have an initial episode and then go
into remission for a long period of time. Other patients may have occasional flare-ups, still others may have
ongoing continuous disease. Because of the tendency for relapses (recurrence) patients are maintained on treatment
(5-ASA) for long periods of time, usually two years or longer, since this will significantly decrease the recurrence
rate. Ulcerative colitis patients should be monitored by their physician on a regular basis, even if they are in
remission.
Are you taking prescription medication for any of the following stomach problems/symptoms:
Stomach pain or discomfort
Heartburn
Sour taste in mouth/acid regurgitation
Excessive burping/belching
Increased abdominal bloating
Nausea
Early satiety
If you answer yes to any one of the symptoms listed above then take this test to see if your current medication is adequately controlling your stomach symptoms.
The PASS Test
PPI* Acid Symptom Suppression Test
*PPI is short for proton pump inhibitor, a class of medication used to suppress the acid in your stomach. These include Losec®, Nexium®, Pantoloc®, Pariet™, and Prevacid®.
