Ulcerative Colitis Fact Sheet
Ulcerative Colitis is a chronic form of colitis located in the large intestine or colon and is characterised by the presence of ulcers in the lining of the colon and the rectum. Ulcerative colitis is closely associated to Crohn’s disease; together they are called inflammatory bowel disease (IBD). Like Chron’s disease, ulcerative colitis is a long-term (chronic) intermittent disease. It alternates periods of activity during which symptoms flare-up with long periods of remission that can last months or years. Stress may be one of the factors which activate the disease.
The causes of the disease are still unknown, although a genetic component is widely presumed. It seems that environmental factors could trigger the disease in individuals who have a certain predisposition.
Some of these risk factors may be:
- Age - the majority of people develop the disease during adolescence or in their 20s, although a smaller group may develop it during their 50s and 60s
- Ethnicity – it is more common amongst people of European origin; a higher incidence has been recorded amongst people of Jewish background; it is very rare amongst people of African descent
- Geographical location - it is more common in the Nordics, although it appears to be increasing in developing countries for reasons still not clear
- Although diet may have an impact on patients’ symptoms, the disease does not seem to be caused by nutritional factors.
Ulcerative colitis is relatively common, affecting about one person in 600 in the United States.
Ulcerative Colitis Symptoms
- There are different types of Ulcerative colitis and symptoms can vary slightly according to the location and the extent of the inflammation. The main types are:
- Ulcerative proctitis which affects the rectum
- Left-side colitis which affects the rectum and the left colon
- Proctosigmoitidis which affects the rectum and the short segment of the colon adjacent to the rectum
- Universal colitis which affects the entire colon
The main symptoms of active disease are diarrhoea mixed with blood and mucus; and anaemia. Other symptoms include:
- Abdominal pain, the intensity of which can vary from mild to severe
- Rectal pain
- Weight loss
- Loss of appetite
- Rectal bleeding or blood on rectal examination
- Tenesmus ( an ineffective and painful urge to empty the bowel)
- Fever
- Dehydration
However, Ulcerative colitis is a systemic disease and may affect other parts of the body. It can sometimes cause arthritis and other extra-intestinal symptoms.
While the course of the disease is intermittent, the location of the inflammation tends to remain the same. Only about 10% of the patients who suffer from a confined type of ulcerative colitis can later develop more extensive colitis.
Ulcerative Colitis Diagnosis
The diagnostic route starts by excluding those pathologies that have similar symptoms such as: Chron’s disease, diverticolitis, colorectal cancer, irritable bowel syndrome (IBS) and infections.
Subsequently, the patient undergoes a number of different tests:
- A blood test to ascertain the presence of anaemia
- A stool test
- A x-ray test which can help to assess the extent of the condition
- C reactive protein test (CRP) is also very important to assess the extent of the inflammation
- Specific blood tests look at the presence of antibodies which in some cases can reveal a particular type of ulcerative colitis..
In order to confirm the indications given by blood and stool tests, doctors will then suggest some further examinations. These are:
Sigmoidoscopy
A thin flexible camera tube is inserted into the rectum to examine only the terminal tract of the colon (sigmoid). The procedure is not painful – although a sedative is usually provided – and the procedure lasts a few minutes. There is a little risk of perforation of the colon wall.
Colonoscopy
This diagnostic test is employed to view the entire colon. It requires preparation using a strong laxative, as the colon needs to be completely empty before the examination. A thin, flexible camera tube is inserted through the rectum to reach the colon. A tissue sample (biopsy) is usually taken. Colonoscopy is not painful –although a sedative is usually provided – and lasts up to half an hour. There is a little risk of perforation and bleeding of the colon wall.
Barium Enema
It is employed to look at the entire large intestine. A contrast dye is inserted into the intestine using an enema. The contrast fills and highlights the lining of the entire intestine which is then inspected with an x-ray machine.
Ulcerative Colitis Treatment
Treatments aim to either control a flare-up or maintain the patient in remission for the longest possible time. The disease occurs periodically and it is impossible to predict when the next flare-up will happen. The types of treatment depend on the severity of the condition which is assessed looking at different factors, such as how many times the bowel is emptied, the presence of blood in the faeces and other symptoms.
Treatments include:
Aminosalicylates
These are anti-inflammatory drugs and are used for mild to moderate forms of ulcerative colitis. Mild forms will require an oral administration, while more severe forms will require the drug to be inserted in the rectum using an enema.
Corticosteroids
These are used when the patient is not responding to anti-inflammatory drugs or during a flare-up. Corticosteroids are effective but they can provoke serious side effects. Therefore their long-term use is not recommended.
Immunosuppressants (medicines that suppress the immune system)
These can treat ulcerative colitis by reducing the inflammation. Although the majority of patients tolerate them well, these drugs can still provoke significant side effects such us: anaemia, liver damage, increased risk of infection and increased risk of bruising. They take approximately three months before starting to reduce the inflammation. They usually work in the long term, but they also reduce considerably the effectiveness of the immune system. Regular monitoring through blood tests is necessary.
Ulcerative Colitis Prognosis
The prognosis depends on how frequent and severe are the flare-ups. The aim should be to maintain remission for the longest time possible and therefore a lifelong maintenance therapy is advisable.
A small regular dose of aminosalicylates helps to prevent or delay the symptoms from recurring. However, if symptoms constantly recur an ongoing therapy with immunosuppressants may be necessary.
In some particular severe cases, patients do not respond to any treatments and surgery may become the only solution. Doctors suggest surgery when maintenance therapy does not work at all. Surgery also reduces the risk of developing cancer.
The operation performed is called Colectomy and involves the permanent removal of the colon. Since the disease is usually confined to the colon, the operation can successfully cure the disease.
Ulcerative Colitis Help and Support Groups
Below are a list of support grous and imformation sites for clcerative colitis
http://www.nacc.org.uk/content/home.asp
The National Association for Colitis and Crohn’s Disease (NACC) brings together people of all ages who have Crohn’s Disease or Ulcerative Colitis and their caregivers,
http://www.ulcerativecolitis.org.uk/
Colitis UK is a online imformation and support group for patients with colitis.
http://hcd2.bupa.co.uk/fact_sheets/html/ulcerative_colitis.html
Bupa fact sheet
http://www.nhs.uk/Conditions/Ulcerative-colitis/Pages/Introduction.aspx?url=Pages/what-is-it.aspx&r=1&rtitle=Ulcerative+colitis+-+Introduction
NHS Direct fact sheet
