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Ulcerative Colitis

Ulcerative Colitis

Ulcerative colitis is an inflammatory bowel disease in which the inner lining of the large intestine and rectum become inflamed. Ulcerative colitis is characterized by diarrhea, abdominal pain and blood in the stool. The disease may vary in how much of the colon is affected, and it varies in severity as well.

Anatomic distribution of Crohn’s disease and ulcerative colitis.
Anatomic distribution of Crohn’s disease and ulcerative colitis. (Click to Enlarge)

Ulcerative Colitis Symptoms

The main symptom of ulcerative colitis is diarrhea, often with blood. Patients with ulcerative colitis experience frequent bowel movements that are small in volume, as a result of the inflamed rectum.Other symptoms may include:

  • Abdominal or rectal pain

  • Fever

  • Weight loss

  • Occasionally, constipation and rectal spasm

Ulcerative Colitis Diagnosis at Johns Hopkins

A thorough physical examination and careful monitoring help obtain an accurate diagnosis. Your doctor will monitor you before and during an ulcerative colitis attack; this allows for valuable information by noting the length and extent of the attack.

Another good indicator of the severity of the disease is the frequency and severity of diarrhea. You have severe disease if you experience six or more bowel movements per day. Your doctor is especially looking to see if the frequency of bowel movements increases during an attack.

Your doctor will also order blood tests to help confirm a diagnosis. Other diagnostic procedures include:

Imaging Scans

Imaging scans allow your doctor to obtained detailed images of the affected area. Abdominal X-rays show certain abnormalities on your colon and abdomen that can indicate the presence of ulcerative colitis.

Other imaging studies include:

  • Small-bowel series: You drink a contrast solution called barium suspension and X-rays are taken at 20- to 30-minute intervals and any irregularities can be seen. You may be asked to move around in different positions so your doctor can see the bowel from many angles.

  • Enteroclysis: This is a similar to a small-bowel series, but it is both more complex and more sensitive. You are placed under mild sedation, and a tube is passed through your nose into your colon. The barium is inserted through the tube in order to coat the small bowel.

  • Barium enema: A barium preparation is inserted through a rectal tube, coating the entire colon. X-rays are taken of the colon.

  • Upper gastrointestinal films: This test allows visualization of the esophagus, stomach and duodenum, the first part of the small intestine.

  • Computed tomography (CT) scan: A CT scan is a powerful X-ray that is very useful in diagnosing ulcerative colitis. It provides accurate images of the bowel wall.

Flexible Sigmoidoscopy

If you have lower abdominal symptoms, you may need a flexible sigmoidoscopy. A sigmoidoscopy is a type of endoscopic procedure that allows your doctor to examine your colon from the rectum. The test takes 10 to 20 minutes.

A flexible sigmoidoscopy examines the rectum and lower colon. During the procedure:

  1. Your colon must be clear of stool so your doctor has good visibility. Preparations may include a liquid diet, enema and laxatives.

  2. Your doctor inserts the sigmoidoscope, a thin, flexible tube, through the rectum and into the anus and large intestine to view the area.

  3. The procedure may cause some cramping or discomfort.

Colonoscopy

A colonoscopy is similar to a flexible sigmoidoscopy but takes longer (30 to 60 minutes) and allows your doctor to examine the entire large intestine.

During a colonoscopy:

  1. Your colon must be clear of stool so your doctor has good visibility. Preparations may include a liquid diet, enema and laxatives.

  2. You are sedated before the procedure.

  3. Your doctor inserts the colonoscope through the rectum and into the anus and large intestine.

  4. A biopsy forceps may be inserted through the scope in order to remove a small sample of tissue for further analysis.

  5. The procedure may cause some cramping or discomfort.

    Comparison of colonic mucosa in normal, Crohn’s and ulcerative colitis patients; (top), gross; (center), histological; (bottom), endoscopic appearance.
    Comparison of colonic mucosa in normal, Crohn’s and ulcerative colitis patients; (top), gross; (center), histological; (bottom), endoscopic appearance. (Click to Enlarge)

Ulcerative Colitis Treatment at Johns Hopkins

The goal of treating ulcerative colitis is to reduce the inflammation, hopefully leading to remission. The main treatment options available are medication and surgery. Learn more about ulcerative colitis treatment at Johns Hopkins.

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