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School of Medicine
What is ulcerative colitis?
Ulcerative colitis is an inflammatory bowel disease of unknown cause in which the gastrointestinal tract is unable to distinguish foreign from self-antigens. It is characterized by chronic inflammation of the colonic mucosa and submucosa, atrophy and possibly dysplasia limited to the colon. The extent of disease varies and may involve only the rectum (ulcerative proctitis), the left side of the colon to the splenic flexure or the entire colon (pancolitis).
What causes ulcerative colitis?
Hereditary factors seem to play a role in the etiology of ulcerative colitis. The most significant risk factor for the development of ulcerative colitis is a family history. Environmental factors are also involved, as evidenced by higher rates of this disease in urban locales.
The pathogenesis of ulcerative colitis is still unknown. Theories have been proposed that include: vascular impairment, autoimmune mechanisms, bacterial-immunological interactions and allergic or hypersensitivity reactions.
What are the symptoms of ulcerative colitis?
The most common symptom of ulcerative colitis is diarrhea that is often bloody. Other symptoms include abdominal and/or rectal pain, fever and weight loss. Some patients complain of constipation and rectal spasm. Arthritis symptoms may occur in as many as 26 percent of patients with ulcerative colitis, dermatological changes in fewer patients and ocular manifestations in about 5 percent.
How is ulcerative colitis diagnosed?
The disease is diagnosed using clinical presentation, CT scans, endoscopy, and usually confirmed by endoscopic biopsy. Because the initial presentation of the disease is indistinguishable from other forms of acute colitis, diagnosis of ulcerative colitis should not be made until all infectious causes are ruled out and symptoms have persisted for at least two weeks. Barium enema is not necessary if all other forms of colitis are excluded and if it is believed that the disease is more than proctosigmoiditis.
Who is affected by ulcerative colitis?
Both sexes are equally affected, and there is a higher prevalence of the disease in Ashkenazi Jews. Heredity does play an important role in this disease. Approximately 10 percent of patients with UC have a first-degree relative with the disease. The peak onset for this disease is the second or third decade of life. A secondary peak is seen in late middle age.
Is there a relationship between smoking cigarettes and developing UC?
Data from population surveys indicate that patients with ulcerative colitis are less likely to be smokers than matched controls from the general population. The relative risk of developing ulcerative colitis among current smokers is about 40 percent. Former smokers are about 1.7 times more likely to develop the disease than those who have never smoked. Recent controlled trials of nicotine patch therapy for ulcerative colitis suggest that nicotine may play a role in preventing the disease. There have been anecdotal reports of improvement in active stages when former smokers resumed smoking. However, other forms of medical therapy should be attempted and exhausted before resorting to this method. A high proportion of nonsmokers experienced unacceptable side effects from nicotine patches.
What is the treatment for ulcerative colitis?
The treatment for ulcerative colitis is targeted to active disease and then maintenance of remission. Medical and surgical modalities are used to treat ulcerative colitis. The majority of patients respond favorably to medical regimens. Surgery is reserved for those patients who are unresponsive to medical therapy and have a severely compromised quality of life.
Will I eventually need to have surgery for ulcerative colitis?
If acute colitis does not respond to intensive medical therapy, surgery may be considered. Patients who have had this disease for eight to 10 years and are steroid resistant or dependent have an increased risk of colon cancer and should consider colectomy.
What type of surgery is done for ulcerative colitis?
Current surgical alternatives for patients include total proctocolectomy with Brooke ileostomy, intra-abdominal Koch pouch and restorative proctocolectomy with ileal pouch-anal anastomosis. Elective colectomy cures ulcerative colitis and has a very low mortality.
What is pouchitis?
Pouchitis is a nonspecific acute or long-term inflammation of the pouch formed during surgery. The cause is uncertain, but the risk of developing pouchitis is greater in patients with chronic ulcerative colitis.
How common are extraintestinal manifestations of ulcerative colitis?
The minor extraintestinal manifestations of ulcerative colitis, such as canker sores, joint pain and tender lumps on the legs, are common and tend to accompany flare-ups. Arthritis complications occur in about 25 percent of patients. Dermatological changes are commonly associated with this disease. Ocular manifestations occur in 5 percent of patients with extensive disease. In most situations, extraintestinal manifestations respond to medical therapy.
How does diet affect the management of ulcerative colitis?
It is important, especially in children, to maintain a healthy, balanced nutritional intake. No general dietary recommendations exist, except for the avoidance of milk and milk products for patients with lactose intolerance. Common sense suggests that foods prone to induce more frequent bowel movements, such as caffeine, alcohol, red pepper and laxative fruits (prunes, fresh cherries and peaches), should be avoided. In patients with proctitis and constipation, added bulk in the form of psyllium or bran may be helpful.
Does stress play a role in causing or exacerbating symptoms?
There has been no evidence correlating disease activity with personality type, personal history or stressful life events. Additionally, there has been no evidence of definable mental illness in patients with ulcerative colitis as compared with patients comparably ill with other forms of intestinal disease.
How will this disease change my life?
The effects of any long-term illness can be emotionally and physically draining. Learning to live with the unpredictable flare-ups, pain and diarrhea can be especially difficult for some patients. Patients with ulcerative colitis can lead a relatively normal life, however, with effective medical therapy.