Ulcerative Colitis: Curable Auto-immune Gastroenterological Disorder

One day in November 2006 our family life changed, irrevocably. My thirteen-year-old daughter, who had been complaining of stomach pains and elimination problems, was the color of chalk. The whites of her eyes, her skin, even her lips were pale. Diagnosed with mononucleosis a year prior, she'd still been sleeping more than usual and felt lethargic. Chief among a litany of complaints were occasional bouts of dizziness and lethargy.

After some earlier testing in summer where nothing was found, she began to hide her symptoms from others. Alarmed by her pediatrician's announcement that further problems would necessitate hospitalization and testing, she later admitted her best and safest bet was to pretend nothing was wrong.

All of this culminated in months of slight but steady internal bleeding and pain she failed to divulge to anyone else. Which eventually resulted in a trip to the emergency room that day in November.

Doctors drew her blood and were immediately alarmed: her hemoglobin (red blood cell) count was down to 5 grams per deciliter (g/dL). A normal red blood cell count hovers somewhere in the vicinity of 12 or 13 grams per deciliter. The g/dL measurement can be explained in this way: a gram is equal to the weight of one milliliter or 16 drops of water. It is about 1/40 of an ounce. A deciliter measures fluid volume equal to 1/10 of a liter. A liter is a little bigger than a quart of fluid, according to www.webmd.com.

Initial Symptoms and Diagnosis

The initial diagnosis was clearly severe secondary anemia brought on by internal bleeding. Based on the symptoms of stomach pains, intermittent bouts of bleeding during bowel movements (the actual amount quite underrepresented by my daughter) and the rest of her overall blood measurements being normal, the doctors suspected Ulcerative Colitis or Crohn's Disease.

Ulcerative Colitis and Crohn's Disease are similar auto-immune disorders of unknown origin that affect different areas of the digestive tract. Autoimmune disorders are caused by the body's immune system responding inappropriately, either excessively, inappropriately or not at all, according to MedlinePlus Health Information online.

Some research has indicated that cytomegalovirus is the culprit behind the onset of Ulcerative Colitis. Cytomegalovirus is in the genus of the Herpes virus, specifically called Human herpesvirus 5 (HHV-5) and literally translates into "very big cell virus" according to Wikipedia. It infects between 50% and 85% of the human population before the age of 40. However, it does not always result in Ulcerative Colitis.

Cytomegalovirus sufferers often experience infectious mononeucleosis symptoms as she had the prior year.

Other research has indicated a genetic predisposition for both Crohn's and Ulcerative Colitis. In our family's case, my aunt had the same disease and it began when she was the same age as my daughter. However, generally the illness is heritable through first generation relatives: fathers, mothers, aunts and uncles, rather than skipping a generation.

Further Testing and Confirmation

When the illness has progressed undetected for a protracted amount of time, as it had in my child's case, some immediate steps ensue.

1. Blood must be provided to the patient.

Because she was so low in hemoglobin count, my daughter received four bags of blood immediately following initial hospitalization. An intervenous saline drip was also ordered. Both of these are necessary to stabilize the patient and counter the effects of blood loss.

2. Stool samples are collected to rule out parasitic infection that can mimic ulcerative colitis.

3. Food intake is prohibited immediately and the colon is cleansed through enema or oral ingestion of laxatives to prepare it for further testing.

The following day after initial hospitalization my daughter was prepared for an exploratory colonoscopy and sigmoidoscopy. The test involves the insertion of flexible tubes into the colon through the rectum for direct visualization of the colon's lining. This makes it possible for the doctor to determine the extent of damage done to the colon and isolate the location of internal bleeding.

A forty-five minute procedure on average, the colonoscopy and sigmoidoscopy results are reviewed by the doctor with the patient and/or patient's family and a course of action is strongly suggested. In our case, my daughter's ulcerative colitis was considered advanced and several medications were immediately initiated.

Medicines and Treatment

She was put on prednisone, a cortical steroid that helps to immediately allay inflammation. Frequently used to treat ulcerative colitis, prednisone is an immediate, but seldom long-term, solution. Side effects include a huge increase in appetite, rounded facial features (commonly referred to as "moon face" appearance), dizziness, headaches, sudden weight gain, shortness of breath, vision problems and even seizures.

Along with the prednisone, she was prescribed Pentasa (mesalamine). This is an anti-inflammatory drug that helps eliminate symptoms of ulcerative colitis, including stomach and rectal pain.

She was prescribed a daily vitamin with extra iron to combat the existing anemia.

Also recommended was methotrexate, a somewhat controversial immuno-modulator drug that's also used to treat cancer and psoriasis. Immuno-modulators alter a person's DNA production and maintenance. The goal is to diminish the immune system in order to keep it from attacking the colon in the case of ulcerative colitis. However, side effects from the drug can be life threatening. Because the immune system is inhibited overall for those people taking methotrexate, they are very susceptible to other air-borne viruses, contracting them more easily and suffering more severe symptoms than the average person.

Methotrexate can also cause liver, blood and bone marrow disorders, according to the website drugs.com. For this reason, a patient suffering from ulcerative colitis who is placed on methotrexate must have monthly blood toxicology and count screenings.

Finally, individuals taking methotrexate are advised to stop taking the drug several months before attempting pregnancy. It's known to cause birth defects.

After just a few months on the prednisone and other medications, my daughter began to decrease her daily intake slowly while introducing the methotrexate in a once-weekly tablet. This combination of medications stabilized her condition, alleviating the internal bleeding and swelling, controlling pain and reducing her immune system response in order to keep it from attacking her system.

Three months later, though under continued care of a gastroenterologist and likely to be on methotrexate, pentasa and iron pills forever, my daughter is back to being quite healthy, active and primarily symptom-free.

Ulcerative colitis is a lifelong illness with remissions and flare-ups. Contrary to popular belief, it is not caused by eating habits or stress, though both of those can contribute to the extremity of a flare-up. With proper care and treatment, a person diagnosed with ulcerative colitis most often can lead a happy, active, healthy life without facing more drastic measures, such as surgery. However, chronic ulcerative colitis often results in sections of the colon requiring removal. Our family has been informed of this fact and my daughter knows that further treatment depends on her adherence to the gastroenterologist's current recommendations.