Ulcerative Colitis

Ulcerative colitis is a chronic disease of the colon, marked by inflammation and ulceration of the colon mucosa or inner lining. Ulcers form on the surface of the lining causing bleeding and mucus or pus to form. This inflammation increases the colon emptying and symptoms of bloody diarrhea and crampy abdominal pain are common. The inflammation usually begins in the rectum and lower colon, but it can involve the entire colon. When it affects only the rectum, it is called Ulcerative Proctitis. If it involves the entire colon, the term pancolitis is used. Ulcerative colitis differs from Crohn’s Disease, the other major inflammatory bowel disease. Crohn’s can affect any area of the GI tract, including the small intestine and colon and has areas of normal intestine in between areas of diseased intestine, called “skip” areas. In Ulcerative Colitis, the diseased/inflamed intestine starts at the rectum and continues up the colon. Also the area of inflammation differs. With Ulcerative Colitis just the inner lining is involved, but Crohn’s Disease can affect the entire thickness of the bowel wall.

What Causes Ulcerative Colitis?

As with Crohn’s Disease, it is not yet known what causes the disease. It appears to be a complex interaction of factors: genetic component, immune system malfunction, and perhaps environmental factors. Research has shown that the inflammatory bowel disease (IBD) patient’s immune system is haywire. Once it is turned on, it won’t turn off at the proper time. As a result, inflammation damages the intestine and causes the symptoms.

How Common Is Ulcerative Colitis?

As many as one million Americans have IBD, evenly split between Ulcerative Colitis and Crohn’s Disease. Males and females are equally affected. Patients diagnosed with Ulcerative Colitis on average are in their mid-30’s, but the disease can occur at any age. Men are more likely than women to be diagnosed with the disease in their 50’s and 60’s. There is an increased incidence among white Jews. About 20% of people with Ulcerative Colitis will have a close relative with either Ulcerative Colitis or Crohn’s Disease, but there is no clear cut pattern of inheritance.

Types Of Ulcerative Colitis And Their Associated Symptoms:

  • Proctosigmoiditis: Colitis affecting the rectum and sigmoid colon. Symptoms include bloody diarrhea, cramps, and tenesmus, moderate pain on the lower left side of the abdomen with active disease.
  • Left-Sided Colitis: Continuous inflammation from the rectum to the splenic flexure. Symptoms include: Loss of appetite, weight loss, diarrhea, severe pain on the left side of the abdomen and bleeding.
  • Pan-Ulcerative (total) Colitis: Affects the entire colon. Symptoms are severe with potentially serious complications including massive bleeding, acute dilation of the colon (megacolon), which can lead to perforation, requiring surgery.

What Are The Symptoms Of Ulcerative Colitis?

  • Progressive loosening of stool (First symptom)
  • Bloody diarrhea
  • Crampy abdominal pain
  • Loss of appetite and weight loss
  • Associated skin lesions, joint pain, eye inflammation, and liver disorders
  • Unpredictable course - Symptoms may be mild to severe, with long periods in between flare-ups (remission) that may span months to years

What Medications Are Used To Treat Ulcerative Colitis?

  • Aminosalicylates
  • Corticosteroids
  • Immune modifiers
  • Antibiotics

What Is The Role Of Surgery In Ulcerative Colitis?

One quarter to one third of patients with Ulcerative Colitis will require surgery at some point due to complications or medical therapy failure. Unlike Crohn’s Disease, which can recur after a surgery, Ulcerative Colitis is “cured” once the colon and rectum are removed. The procedure depends on a number of factors including the extent of the disease, patient’s age and overall health.

Removal of the colon will also eliminate the increased risk of adenocarcinoma associated with Ulcerative Colitis.