Ulcerative Colitis

ULCERATIVE COLITIS

DEFINITION

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Ulcerative colitis (pronounced UHL-suh-RATE-ihv kuh-LY-tiss) is an inflammation of the large intestine that causes swelling, ulcerations (open sores), and loss of function in the large intestine.

DESCRIPTION

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Ulcerative colitis is a form of inflammatory bowel disease (IBD). The term inflammatory bowel disease refers to a large group of disorders that affect the gastrointestinal (pronounced gas-troh-ihn-TESS-tuh-nuhl) system. Also known as the digestive system, the gastrointestinal (GI) system includes the stomach, small intestine, and large intestine.

Inflammation is a process that occurs when the body's immune system begins to fight off foreign invaders, such as viruses, bacteria, and fungi. The immune system is a network of organs, tissues, cells, and chemicals designed to kill invading organisms. Some of the chemicals produced by the immune system irritate the body's own tissues. They cause heat, redness, swelling, and loss of function. These changes are all characteristic of inflamed tissue.

In ulcerative colitis, inflammation occurs in the lining of the large intestine and the rectum. In rare cases, it may extend into the small intestine. In most cases, however, the small intestine remains normal.

Ulcerative colitis is one of two common forms of IBD. The other form is called Crohn's disease (see Crohn's disease entry). The major difference between the two diseases is that Crohn's disease may occur in both large and small intestines while ulcerative colitis is usually found only in the large intestine and rectum. Another difference is the damage done to tissues. Ulcerative colitis occurs only in the lining of the intestine while the damage caused by Crohn's disease can extend to all layers of the intestinal wall.

The inflammation associated with ulcerative colitis can eventually cause portions of the intestinal lining to peel off, exposing open pits, or ulcerations, which can easily become infected.

Ulcerative colitis occurs in all age groups and affects men and women equally. The most common age of diagnosis is between fifteen and thirty-five years of age.

CAUSES

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No one knows for sure what causes inflammatory bowel disease. A number of theories have been developed to explain the condition. Some researchers believe that the disorder is caused by some organism, such as a bacterium or virus. No such organism has been found, however. Other researchers think the body's immune system becomes confused and begins to attack the body's own cells as though they were foreign invaders that needed to be killed.

Ulcerative Colitis: Words to Know

Colonoscopy:

A procedure in which a long, thin tube is inserted through a patient's rectum into the colon to permit examination of the inner walls of the colon.

Crohn's disease:

A form of inflammatory bowel disease that affects the large and small intestine.

Inflammation:

A series of events that may result from the immune system's attempt to fight off foreign invaders. Inflammation involves heat, redness, swelling, and loss of function in the part of the body that is affected.

Inflammatory bowel disease:

A group of disorders that affect the gastrointestinal (digestive) system.

Intestinal perforation:

A hole in the lining of the intestine, which allows partially digested foods to leak into the abdominal cavity.

Sulfasalazine:

A drug commonly used to treat inflammatory bowel diseases, consisting of an aspirin-like part to reduce inflammation and an antibiotic part to fight bacteria.

Toxic dilation of the colon:

An expansion of the colon that may be caused by inflammation due to ulcerative colitis.

Ulcer:

An open sore.

SYMPTOMS

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The first symptoms of ulcerative colitis are abdominal pain and cramping. The patient is likely to feel an urgent need to have a bowel movement. Blood and pus may appear in the stool. Some patients experience diarrhea, fever, and weight loss. If the diarrhea continues, signs of dehydration may appear. Dehydration occurs when the body loses water too rapidly. It results in low blood pressure, fast heart rate, and dizziness.

There are three serious complications of ulcerative colitis: intestinal perforation, toxic dilation of the colon, and colon cancer (see colon cancer entry).

Intestinal perforation is a life-threatening condition. It develops when a hole forms in the intestinal wall, which is caused by long-standing inflammation of the intestinal lining. First, an ulcer forms. Then the ulcer expands and breaks through the intestinal wall. The danger arises because contents of the intestine may spill out into the abdomen. These contents contain bacteria that can cause massive infection. The infection can quickly become so severe that it causes death. An infection of this kind is called peritonitis (pronounced per-i-tuh-NIE-tiss).

Toxic dilation of the colon refers to a significant increase in the size of the intestine. Inflammation is thought to cause intestinal muscles to relax. As they relax, the intestine gets larger and larger. Stretching of the intestinal walls

causes them to become thinner. At some point, the intestinal lining may break. When this happens, peritonitis may result.

Colon cancer occurs when cells in the intestinal lining begin to grow uncontrollably. The cells may form tumors that can interfere with normal body functions or spread to other parts of the body. The risk of colon cancer increases in the years after ulcerative colitis is diagnosed. Ten years after diagnosis, the risk for colon cancer is less than 1 percent. After fifteen years, however, the risk increases to about 10 percent. After twenty and twenty-five years, the risk increases to about 23 percent and 42 percent, respectively.

DIAGNOSIS

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A doctor may suspect a patient has ulcerative colitis if the patient has the symptoms described. Examination of the stool may reveal the presence of blood and pus. Pus consists largely of white blood cells. The presence of white blood cells suggests an infection somewhere in the body.

The usual method used to confirm a diagnosis of ulcerative colitis is colonoscopy (pronounced KO-lon-OSS-kuh-pee). Colonoscopy is a procedure that involves inserting a long, thin tube into a patient's rectum. The tube is then pushed upward into the colon. The tube may have a light, a camera, and a small knife attached at the end. The light and camera allow the doctor to examine the walls of the large intestine. The knife makes it possible to remove a small sample of tissue, which can then be studied under a microscope. The appearance of white blood cells in the tissue may confirm the presence of ulcerative colitis.

TREATMENT

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The first step in treating ulcerative colitis is to reduce inflammation. A drug known as sulfasalazine (pronounced SULL-fuh-SAL-uh-zeen) is used for this purpose. Sulfasalazine consists of two parts. One part is a form of salicylic acid, the major component of aspirin. The salicylic acid compound helps reduce inflammation. The second part of sulfasalazine is an antibiotic. The antibiotic kills any harmful bacteria that may be present in the intestine.

Complications caused by ulcerative colitis may require other treatments. For example, a patient with toxic dilation of the colon may require hospitalization. The patient may be given steroids and antibiotics intravenously (through a needle in the vein). Steroids are a powerful anti-inflammatory medication. In the most severe cases, surgery may be required to remove the colon.

Colon cancer is treated in much the same way as other forms of cancer: with surgery, radiation treatments, or chemotherapy.

Alternative Treatment

There are natural remedies that may help reduce inflammation associated with ulcerative colitis. Omega-3 fatty acids, which are found in fish oil and flaxseed, are available in pill form or as enemas.

PROGNOSIS

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The prognosis for ulcerative colitis depends on how severe the first attack is. About 10 percent of all patients die if the first attack comes on suddenly and is quite severe. Prognosis is especially poor for patients over the age of sixty. Among these patients, a severe initial attack is fatal in more than 25 percent of cases.

Mild cases of the disorder can usually be treated quite successfully. However, the disease can reappear after it has been inactive for a period of time. Overall, about 20 to 25 percent of all patients eventually require removal of the colon. This procedure is very successful, however, and generally results in a complete cure of the disease.

PREVENTION

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There are no known methods of preventing ulcerative colitis.

FOR MORE INFORMATION

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Books

Long, James W. The Essential Guide to Chronic Illness. New York: Harper-Perennial, 1997.

Saibil, Fred. Crohn's Disease and Ulcerative Colitis. Buffalo, NY: Firefly Books, 1997.

Thompson, W. Grant. The Angry Gut: Coping With Colitis and Crohn's Disease. New York: Plenum Press, 1993.

Organizations

Crohn's & Colitis Foundation of America, Inc. 386 Park Avenue South, 17th Floor, New York, NY 10016–8804. (800) 932–2423.