Ulcerative Colitis

September 3rd, 2012 | Posted by admin in Diseases and Conditions

Ulcerative colitis (UC) is a disease where inflammation develops in the large intestine (colon and rectum). The most common symptom when outbreaks of the disease is diarrhea mixed with blood up. Generally, treatment may relieve symptoms outbreak. The disease can often prevent burning by taking medication, usually mesalazine, every day. Surgery to remove the colon is necessary in some cases. People with UC have an increased risk of developing colon cancer. This risk is reduced by taking mesalazine each day. After 8-10 years, an inspection of the interior of the colon every 1-3 years with a colonoscopy is usually advised for precancerous changes.

On this page

  • Understanding the intestine
  • What is ulcerative colitis?
  • Who gets ulcerative colitis?
  • What causes ulcerative colitis?
  • What are the symptoms during an outbreak of ulcerative colitis?
  • How progressing ulcerative colitis?
  • Are there any complications with ulcerative colitis?
  • How is ulcerative colitis diagnosed?
  • What are the treatment options for an outbreak of ulcerative colitis?
  • What are the treatment options for preventing outbreaks of symptoms?
  • Who needs a surgery?
  • General measures of treatment
  • Ulcerative colitis and colon cancer
  • What is the prognosis (outlook)?
  • What is inflammatory bowel disease?
  • Learn more
  • References

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The gut (gastrointestinal tract) is a long tube that begins at the mouth and ends at the anus.

Food passes through the esophagus (gullet), the stomach, and then into the small intestine.

The small intestine has three sections – the duodenum, jejunum and ileum. The small intestine is where food is digested and absorbed into the bloodstream. The structure of the small changes then become the large intestine (colon and rectum, sometimes called the large intestine).

The colon absorbs water and containing food has been digested, such as fiber. This is passed to the last part of the large intestine where it is stored as faeces.

Feces or stools (motions) is passed through the anus into the toilet.

Ulcerative colitis (UC) is a disease of the large intestine (colon and rectum).

  • Colitis is an inflammation of the colon.
  • Media ulcerous sores tend to develop, often in places where there is inflammation. An ulcer is where the lining of the intestine is damaged and underlying tissue is exposed. If you could see inside your stomach, ulcer crater looks like a small, red on the inside lining of the intestine. Ulcers occurring in the CU develop in the large intestine and has a tendency to bleed.

The inflammation and ulcers in the large intestine causing common symptoms of diarrhea and passing blood and mucus.

About two in every 1,000 people in the UK develop UC. It can occur at any age, but most commonly first develops between the ages of 10 and 40. Approximately one in seven cases first develop in people over age 60. Non-smokers are more likely to get smokers UC. However, smoking causes other health risks that outweigh this benefit.

The cause is not known. UC can affect anyone. About 1 in 5 people with UC have a close relative who also has UC. Therefore, it is likely to be some genetic factor. The common theory is that any factor can trigger the immune system to cause inflammation in the large intestine in people who are genetically predisposed to developing the disease.

The most likely cause of the UC for development is a bacteria or virus (germ). However, it is unclear whether bacteria or a virus is the culprit. But other triggers that can cause an asthma attack at the University of California include anti-inflammatory drugs and nicotine withdrawal in people who quit smoking. In people who are known to have UC, a common trigger for worsening of symptoms is an episode of gastroenteritis (intestinal infection) caused by various bacteria.

  • Diarrhea. This varies from mild to severe. The diarrhea may be mixed with mucus or pus. The urge to go to the bathroom is common. A feeling of wanting to go to the bathroom but nothing happens also common (tenesmus). Water not absorbed as well in the inflamed colon, causing watery diarrhea.
  • The blood is mixed with common diarrhea (bloody diarrhea).
  • Cramping pains in the abdomen.
  • Painful bowel movements.
  • Proctitis (inflammation of the rectum). Symptoms may be different if an outbreak affects only the rectum and colon. You may have fresh bleeding from the rectum and can form normal stools instead of having diarrhea. You can even become constipated above at the top colon unaffected, but with a common feeling of wanting to go to the bathroom.
  • General feeling of discomfort is typical if the outbreak affects a lot of the large intestine, or last long. Fever, fatigue, malaise, weight loss and anemia may develop.

UC is a chronic, relapsing disease. Chronic means it is persistent and continuous. Recurrent means that there are times when symptoms flare up (relapse) and the times when there are few or no symptoms (remission). The severity of symptoms and the frequency with which they occur vary from person to person. The first episode (flare-up) of symptoms is often worse.

UC begins in the rectum in most cases. This causes a proctitis, which means inflammation of the rectum. In some cases only affects the rectum and colon is not affected. In other cases, the disease spreads to affect some or all of the colon. Between outbreaks inflamed areas of the colon and rectum and cure the symptoms disappear. The severity of an asthma attack can be classified as mild, moderate or severe:

  • Suave – has fewer than four stools (motions) a day, with or without blood. Do not you feel generally unwell (no systemic disturbance).
  • Moderate – has four to six stools a day and feel slightly unwell in yourself (minimal systemic disturbance).
  • Severo – has more than six stools a day containing blood. Also feel generally unwell with more marked systemic alterations such things as fever, rapid pulse, anemia, etc.

On average, in a year, about half of people with UC in remission will with few or no symptoms. The other half will relapse with an outbreak of symptoms at some time during the year. During an asthma attack (relapse), some people develop symptoms slowly – in recent weeks. In other cases, symptoms develop very quickly – within a few days.

A severe asthma attack

This is rare, but if it occurs, can cause serious illness. In this situation the entire large intestine is ulcerated, swollen and dilated (megacolon). A portion of the colon may perforate (puncture) or severe bleeding can occur. Emergency surgery may be needed if an asthma attack is severe and does not respond to medication (see below).

Related conditions

Other problems elsewhere in the body are produced in approximately 1 in 10 cases. It is unclear why this occurs. The immune system can trigger inflammation in other parts of the body when there is inflammation in the intestine. These problems outside the intestine include:

  • Those who may erupt when bowel symptoms erupt. That is, they are related to the activity of colitis and intestinal symptoms go when solved. These include:
    • Erythema nodosum (unusual rash on the legs).
    • Canker sores (mouth ulcers).
    • Episcleritis (a type of eye inflammation).
    • Acute arthropathy (joint pain).
  • Those are usually related to the activity of ulcerative and usually, but not always, when intestinal symptoms settle. These include:
    • Pyoderma gangrenosum (an unusual skin disease).
    • Anterior uveitis (a type of eye inflammation).
  • Those that are not related to the activity of the colitis-like, may persist even when intestinal symptoms resolve. These include:
    • Sacroiliitis (inflammation of the joints between the sacrum and lumbar spine).
    • Ankylosing spondylitis (a type of arthritis that affects the spine).
    • Primary sclerosing cholangitis (which causes inflammation of the bile ducts of the liver).
    • Osteoporosis (a disease that causes brittle bones) associated with vitamin D deficiency and occurring primarily in people of long-term steroids.
    • Anemia, usually due to iron deficiency, but sometimes caused by vitamin B12 and / or folic acid deficiency.

Cancer

The risk of developing colon cancer increases if you have the UC (more details below).

The usual test is a doctor to look inside the large intestine passing a special telescope through the anus into the rectum and colon. It is a sigmoidoscope or colonoscope short flexible. See separate leaflets called 'sigmoidoscopy "and" colonoscopy "for more details. The appearance of the inner lining of the rectum and colon may suggest UC. Small samples (biopsies) are taken from the lining of the rectum and colon and viewed under the microscope. typical pattern observed cells under a microscope can confirm the diagnosis. addition, various blood tests done to check for anemia and to assess their general welfare.

Special X-ray tests such as a barium enema are not often these days as the previous tests are common to confirm the diagnosis and assess the severity of the disease.

A sample of feces (stool) is commonly done during each outbreak and sent to the laboratory for testing of bacteria and other infectious agents. Although not shown initially to cause seed UC various germs infection may trigger an outbreak known symptoms. If a seed is found, then this treatment may be needed in addition to any other treatment for asthma attacks (described later).

The first time the development of the University of California, it is customary to take medication for a few weeks until symptoms clear. A course of medication is then usually taken every flare when the symptoms above. The recommended drug may depend on the severity of symptoms and the principal site of inflammation in the intestine. Options include the following medications:

Aminosalicylate drugs

These include mesalazine, olsalazine, balsalazide, and sulfasalazine. The active ingredient of each of these drugs is 5-aminosalicylic acid, but each drug is different in the way in which the active ingredient is released or activated in the intestine. Mesalazine is the most commonly used. Each of these drugs are available in different brands and different preparations, such as oral tablets, sachets or suspension, liquid or foam enemas or suppositories. The type of preparation (for example, tablets or enemas) may depend on the primary site of inflammation in the intestine.

Aminosalicylate drugs often work well for mild outbreaks. The exact form of these agents work is not clear, but is believed to counteract the inflammation develops as UC. However, it does not work in all cases. Some people need to change with steroid medications if a drug aminosalicylate not work, or if the outbreak is mild or severe.

The side effects of the newer drugs (aminosalicylate mesalazine, olsalazine and balsalazide) are rare. The older drug, sulfasalazine, had a higher rate of side effects, so it is not commonly used these days.

Steroids

Steroids work by reducing inflammation. If you develop a moderate or severe outbreak of the University of California, a course of steroid tablets (corticosteroids) such as prednisolone usually relieve symptoms. The high initial dose is gradually reduced and then stopped once to relieve symptoms. A steroid enema or suppository is also an option for a mild outbreak of proctitis. Injections of steroids directly into a vein may be necessary for a severe asthma attack.

A course of steroids for a few weeks is generally safe. Steroids are not usually continued once a flare has settled. This is because side effects may develop if taken for a long time steroids (several months or more). The aim is to treat exacerbations, but to keep the total amount of steroid therapy in recent years as low as possible.

Immune-suppressing drugs

Powerful drugs that suppress the immune system (immunosuppressants) may be used if symptoms persist despite the above treatments. For example, azathioprine, cyclosporine or infliximab are sometimes needed to control an outbreak of CU.

Laxatives

Although most people with UC have diarrhea during an asthma attack, as mentioned, constipation may develop if you only have proctitis (rectal inflammation only). In this situation, laxatives to clear any constipation can help alleviate an outbreak of proctitis.

Note: antidiarrheal medicines such as loperamide should not be used during an outbreak of CU. This is because they do not reduce the diarrhea that occurs with CU and increase the risk of developing a megacolon (a serious complication of UC – see below).

Medication

Once a first outbreak of symptoms has been resolved, usually advised to take medication every day to prevent further outbreaks. If you have UC and not taking regular preventive medicine, has about a 5-7 in 10 chance of having at least one asthma attack each year. This is reduced to about 3 in 10 chances, if you take a daily preventive medication.

A drug aminosalicylate, usually mesalazine (described above), is commonly used to prevent asthma attacks. A maintenance dose lower than the dose used for the treatment of an asthma attack is usual. You can take this indefinitely to keep symptoms away. Most people have trouble taking one of these medications because the side effects are rare. However, some people develop side effects such as abdominal pain, feeling sick headache, or rash.

If the outbreak develops while you are taking a drug aminosalicylate then symptoms usually decreases rapidly with increasing dose, or if you switch to a short course of steroids. Another medication may be advised if aminosalicylate medication does not work, or makes difficult side effects. For example, 6-mercaptopurine or azathioprine are sometimes used.

Probiotics

Probiotics are dietary supplements containing 'good' bacteria. That is, the bacteria that normally live in the intestine and cause no damage. Taking probiotics can increase the "good" bacteria in the gut, which can help avoid "bad" bacteria that can trigger an outbreak of symptoms. There is little scientific evidence that probiotics help prevent asthma attacks. However, a probiotic strain (Escherichia coli Nissle 1917) and the probiotic preparation VSL3 have shown promise. More research is needed to clarify the role of probiotics.

Not all people with UC have their symptoms well controlled with medication. About a quarter of people with UC need surgery at some point. The common operation is to remove the large intestine. There are different techniques used for this. It is useful to discuss the pros and cons of the different operations with a surgeon. Removing the large intestine usually heals UC symptoms permanently.

Surgery is considered in the following situations:

  • During a deadly attack. Removing the large intestine may be the only option if swells enormously (megacolon), drilling (punctures) or uncontrolled bleeding.
  • If UC is not well controlled with medication. Some people remain in poor health, with frequent asthma attacks that do not seat properly. To remove the large intestine is a serious step, but for some people, it's a relief operation after a long period of ill health.
  • If the cancer or precancer develops large intestine.
  • A special diet is usually not necessary. A normal person, a healthy, well balanced diet is usually advised. If you only UC in the rectum (proctitis), a diet high in fiber can help prevent constipation.
  • You may be advised to take iron (oral or intravenous), vitamin B or folic acid tablets if you have anemia.
  • You may need pain medication when symptoms flare up.
  • You may be advised to have vaccinations to protect against infections such as pneumonia, hepatitis and human papillomavirus (HPV), especially if given treatment that affects the immune system.

The probability of developing cancer of the large intestine (colon) is above average in people who have had UC for several years or more. It's more of a risk if you have frequent outbreaks affecting the entire large intestine. For example, about 1 in 10 people with UC for 20 years, which affects a large part of your large intestine will develop cancer.

Because of this risk, people with UC are advised to have their large intestine routinely checked after having had UC for about 10 years. This is a look into the large intestine by a flexible telescope (colonoscopy) from time to time and take small intestine samples (biopsies) for analysis. Usually combined with chromoscopy (using spray dye that shows suspicious changes more easily). Depending on the results of this test and other factors such as the amount of intestine affected, if you have had complications such as polyps and if you have a family history of cancer, it is put in a low, intermediate or high.

The National Institute for Health and Clinical Excellence (NICE) recommends the following colonoscopy / chromoscopy should depend on the degree of risk of developing cancer of the colon or rectum, as follows:

  • Baja – 5 years.
  • Intermediate – 3 years.
  • High – 1 year.

After the next test, the risk is recalculated.

Recent studies indicate that the risk of cancer is reduced in people who regularly take long-term medication aminosalicylate (described above). In one study, people who regularly took mesalazine CU had a 75% lower risk of developing colon cancer.

With modern medical and surgical treatment, there is only a slight increase in the risk of death in the first two years after diagnosis, compared with the general population. After this, there is little difference in the life expectancy of the general population. However, a serious outbreak of UC remains a life-threatening illness and requires specialized medical care.

As mentioned, if you do not take medicines to prevent asthma attacks, about half of people with UC have a relapse on average once a year. This is much smaller taking regular medication. However, even in those taking regular medication, some people have frequent outbreaks and about a quarter of people with UC eventually have surgery to remove the colon.

One year after diagnosis, about 9 out of 10 people with UC are perfectly capable of working. Therefore, this means that, in most cases with the help of treatment, the disease is manageable enough to maintain a nearly normal life. However, the UC causes significant employment problems of a minority.

Treatment of UC is an evolving field. Several new drugs are under investigation and may change treatment options in the next ten years or less, and improve prognosis.

When doctors talk about inflammatory bowel disease, it usually means that people either have Crohn's disease or UC. Both conditions can cause inflammation of the large intestine with similar symptoms, such as bloody diarrhea, etc. Although these conditions are similar and the treatments are similar, there are differences. For example, UC inflammation tends to be only in the lining of the gut, whereas inflammation of Crohn's disease can spread throughout the bowel wall. In addition, UC only affects the colon while Crohn's disease can affect any part of the intestine. See separate leaflet called "Crohn's Disease" for more details.

However, up to 1 in 20 people with inflammatory bowel disease that affects only the colon can not be classified as either UC disease or Crohn's disease, as it has some characteristics of both. Sometimes called indeterminate colitis.

Note: Inflammatory bowel disease is sometimes shortened to IBD. This is not the same as IBS which is short for irritable bowel syndrome – a very different disease.

Crohn's and Colitis UK 4 Beaumont House, Sutton Road, St Albans, Herts, AL1 5HH
Tel: 0845 130 2233 Web: www.crohnsandcolitis.org.uk

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