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Ulcerative colitis
Ulcerative colitis is an inflammatory disease of the large intestine. Ulcers form in the inner lining, or mucosa, of the colon or rectum, often resulting in diarrhea, blood, and pus. The inflammation is usually most severe in the sigmoid and rectum and usually diminishes higher in the colon. The disease develops uniformly and consistently until, in some cases, the colon becomes rigid and foreshortened.
Although the causes of inflammatory bowel disease are not yet known, genetic factors certainly play some role. Up to 25% of people with IBD also have family members with the disease. The inherited risk is highest if a mother has the condition, followed by a sibling.
A father with IBD poses the least inherited risk to his children. Although different genes play weaker or stronger roles in ulcerative colitis and Crohn's disease, some experts believe that genetic mapping will allow detection of the genes responsible for both diseases, most likely on chromosomes 6, 12, and 16.
Some researchers believe that the disease develops in people who have a genetic susceptibility that enables an agent such as a virus or bacteria to trigger an abnormal immune response. If such
Symptoms
Symptoms can be mild or very severe and disabling. They can develop gradually or have a sudden onset. The severity of symptoms and relapse rates also vary with seasons, with highest risk in the winter and autumn and lowest in summer.
Diarrhea
The most common symptom of both ulcerative colitis is diarrhea. Blood may appear in the stools, especially with ulcerative colitis. The blood may be readily visible or visible only using a microscope, in which case it is called occult blood.
Constipation
Constipation may develop during active flare-ups of ulcerative colitis. In ulcerative colitis, constipation may occur when the inflamed rectum triggers a reflex response in the colon that causes it to retain the stool.
Abdominal Pain
Cramps can occur from intestinal contractions caused by inflammation. The severity of the pain usually depends on the severity of diarrhea. Intestinal pain may also be an indication of a serious condition, such as an abscess, or a perforation of the intestinal wall.
Other Symptoms
Fever, fatigue, and loss of appetite are often present, and the patient may lose weight. Tenesmus (a painful urge for a bowel movement even if the rectum is empty) can occur in response to inflammation. Neurologic or psychiatric symptoms may be early signs of Crohn's disease when accompanied by gastrointestinal problems.
Complications
1. Toxic megacolon is a serious complication that can occur if inflammation spreads into the deeper layers of the colon. In such cases, the colon enlarges and becomes paralyzed. In severe cases, it may rupture, a surgical emergency that carries a 30% mortality rate. Symptoms include weakness and abdominal pain and bloating; the patient may be disoriented or groggy
2.Cancer. Chronic ulcerative colitis increases the risk for colon cancer. In different studies, this risk has been estimated to be 5% to 10% after 10 years and 15% to 40% after 30 years. People with ulcerative colitis should consider annual screening with colonoscopy beginning as early as age 25, depending on other risk factors, particularly any evidence of precancerous tissue (dysplasia). Individuals should discuss with their physician the risks and benefits of these screening procedures. It should be noted that inflammation can produce changes in tissue that resemble precancerous or cancerous changes, increasing the chance for a false diagnosis of cancer. Inflammatory bowel disease in the rectum and lower (sigmoid) colon does not significantly increase the risk for cancer.
3.Complications Occurring Outside the Gastrointestinal Tract. Inflammation may occur in tissues beyond the gastrointestinal tract, most commonly in the joints, which can cause stiffness and arthritic-like symptoms. Inflammation in other sites can also cause skin ulcers, mouth sores, problems in the eyes, hepatitis, and complications in the kidneys. Sometimes the large airways in the lungs are impaired. Gallbladder disease and gallstones are common complications of IBD. The pancreas may be more often affected than previously thought in IBD, since the symptoms of these conditions are similar. Internal blood loss from ulcers in the intestine can cause anemia; it is a particular problem in Crohn's disease, because of the impaired ability of the small intestine to absorb vitamins and minerals necessary for blood production. People with IBD are at higher risk for forming blood clots (thromboembolism). Women with inflammatory bowel disease have a higher risk for menstrual abnormalities, with 25% reporting problems in fertility.
Diagnosis
Endoscopic Procedures. Flexible sigmoidoscopy and colonoscopy are procedures that involve snaking a fiberoptic tube called an endoscope through the rectum to view the lining of the colon. The physician can also insert instruments through it to remove tissue sample. Sigmoidoscopy, which is used to examine the rectum and left (sigmoid) colon, lasts about 10 minutes and is done without sedation. It may be mildly uncomfortable, but it is not painful. Colonoscopy allows a view of the entire colon and requires a sedative, but it is still performed on an outpatient basis.
Treatment
Drugs cannot cure inflammatory bowel disease, but they are effective in reducing the inflammation and accompanying symptoms in up to 80% of patients. Many such drugs are available, including corticosteroids, aspirin-like medications, and drugs that suppress the immune system. The primary goal of drug therapy is to reduce inflammation in the intestine. The success of therapy is determined by its ability to induce and maintain remissions without incurring significant side effects. The patient's condition is generally considered in remission when the intestinal lining has healed and symptoms, such as diarrhea, abdominal cramps and tenesmus, are normal or close to normal. Immunosuppresive drugs are also used. A recent development is the use of biologic response modifiers, such as infliximab. You should ask your doctor about specific treatment for ulcerative colitis.
For a consultation, please call the offices of Syracuse Gastroenterological Associates at 315-234-6677.
Please note: We do not answer questions regarding individual medical problems on this website. We advise you to contact your physician for your specific health related concerns.
©2007 Syracuse Gastroenterological Associates, P.C.
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