What is Ulcerative Colitis?

Ulcerative Colitis is an inflammatory bowel disease that causes inflammation and ulcers in the colon and the lining of the rectum. Inflammation in the colon causes it to empty frequently resulting in diarrhea. Ulcerative Colitis, also known as UC, usually occurs in people between the ages of fifteen and thirty but can occur at any age. It affects men and women equally but does appear to have a higher incidence in Caucasians and people of Jewish descent. It afflicts between one and two million people in the United States and many more worldwide. It is, however, more common in the United States, England, and Northern Europe. It is rarely see in Eastern Europe, Asia, and South America.

What are the Symptoms of Ulcerative Colitis?

The most common symptoms of UC are abdominal pain, bloody diarrhea, rectal bleeding, weight loss, anemia, fatigue, loss of appetite, loss of body fluids and malnutrition, and joint pain. The majority of people diagnosed with UC experience mild symptoms; others suffer from severe abdominal cramps, nausea, vomiting, and frequent fevers. The inflammation produced by the immune system is also thought to cause other symptoms and conditions including osteoporosis, arthritis, and liver disease. Patients will periodically experience episodes of remission in which they seem to be free of any symptoms of colitis. Although this may occur ongoing treatment is required to maintain remission.

What Causes Ulcerative Colitis?

Although the cause of UC is not known, up to twenty percent of all cases report having a family member with inflammatory bowel disease, thus suggesting a genetic predisposition. Scientists believe that the immune system is responding abnormally to the bacteria that live in the digestive tract. Ulcerative Colitis is not caused my emotional stress or sensitivity to certain foods. The symptoms of colitis may be exacerbated by these factors but they are not the cause of the disease itself. The risks of UC are reduced when associated with appendectomy, breast-feeding, and smoking cigarettes. Depression and consuming a "western diet" consisting of a large amount of meat may contribute to an increased risk of getting UC.

How is Ulcerative Colitis Diagnosed?

Several tests may be used to diagnose colitis. Blood tests are usually done to test for anemia and to check white blood cell counts. A high white blood cell count usually indicates infection or inflammation somewhere in the body. Stool samples may also be collected and tested for white blood cells present in the stool itself. White blood cells in the stool would be an indicator of inflammatory bowel disease. Stool samples also allow doctors to look for rectal bleeding, bacteria in the intestines, and any viruses or parasites that may be in the digestive tract. The most accurate way of diagnosing inflammatory bowel disease is to perform a colonoscopy. During a colonoscopy the patient is sedated and a long, flexible tube that is lighted is inserted into the anus so that the doctor may examine the rectum and the colon. A colonoscopy also enables a doctor to take samples of tissue from the lining of the colon to do biopsies. CT scans, barium enemas, and other x-rays may also be used to aid in the diagnosis of Ulcerative Colitis.

What is the Treatment for Ulcerative Colitis?

The course of treatment for colitis depends upon the severity of the illness in an individual. Most patients can be treated with medication and remain in remission for long periods of time. Other patients experience severe enough symptoms that surgery may be required to remove the diseased parts of the intestine. There is no medication that can cure Ulcerative Colitis. The goals of treatment consist of improved quality of life, inducing and maintaining periods of remission, and minimizing the symptoms of the disease. Some of the medications used to treat colitis include:

5-ASA Compounds: These are anti-inflammatory medications including Asacol, Pentasa, and Rowasa Enemas. These medications are only effective if they come in direct contact with the inflammation in the tissue. 5-ASA Compounds are similar to aspirin and should be used with caution in patients who are known to have kidney disease or are at risk for kidney disease.

Corticosteroids: These drugs include prednisone, prednisolone, and hydrocortisone. They may also be used to treat inflammation but these drugs usually have undesired side effects with long-term use. Common side effects consist of water retention (mainly in the face), glaucoma, cataracts, diabetes, high blood pressure, muscle weakness, weight gain, increased body hair, insomnia, depression, and osteoporosis. Because these drugs have so many side effects they should be used for the shortest length of time possible.

Immunomodulators: These are medications that are designed to weaken the body's immune system. Because inflammatory bowel disease is thought to be an autoimmune disease, meaning that a patient's immune system attacks it's own body, weakening the immune system is effective in reducing symptoms and inducing and maintaining remission. The two most common drugs in this class are Azathioprine (Imuran) and 6-Mercaptopurine (Purinethol). These drugs weaken the immune system by reducing a category of immune cells known as lymphocytes. Immunomodulators are used as a last resort, before surgery, because of the seriousness of side effects. Side effects may include inflammation of the liver (hepatitis), inflammation of the pancreas (pancreatitis), vulnerability to infections, and bone marrow toxicity.

Methotrexate: This drug is an immunomodulator and an anti-inflammatory. It is used when Azathioprine, 6-MP, and Corticosteroid drugs do not have any effect. It can be taken orally or administered by injection either under the skin or in a muscle. Injections are usually administered on a weekly basis. A major complication of Methotrexate is cirrhosis of the liver when medication is used for a prolonged period of time.