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by Beth O. Zink
Ulcerative colitis is a disease that falls under the general category of diseases known as Inflammatory Bowel Disease (IBD). This general category also includes Crohn’s disease as well as diverticulitis. Ulcerative colitis causes inflammation and ulcers, or sores, in the top layers of the lining of the large intestine. Ulcerative colitis differs from Crohn’s disease in that it affects the large bowel, the colon. Crohn’s disease causes inflammation deeper in the intestinal wall, usually in the small intestine, but it also occurs in the esophagus, stomach, mouth, large intestine, appendix and anus.
Abdominal pain and bloody diarrhea are the most common symptoms of ulcerative colitis, but patients may also experience weight loss, fatigue, loss of appetite, rectal bleeding and loss of nutrients and fluids. This chronic disease may also cause arthritis, eye inflammation, liver disease including hepatitis and cirrhosis, anemia, rashes and kidney stones. The major concern in long-standing ulcerative colitis is colon cancer. When the disorder begins in childhood, has been present for eight to 10 years, or when there is a family history of colon cancer, the risk for developing colon cancer greatly increases. When these risks exist, it is particularly important to undergo regular examination of the colon through a procedure known as a colonoscopy. Biopsies are taken during the colonoscopy procedure which may be analyzed and can often predict if colon cancer will occur. In these situations, preventive surgery is recommended.
The cause for ulcerative colitis remains unknown. Some experts believe it is caused by a defect in the immune system which triggers the body’s antibodies to actually injure the colon. Other experts believe that ulcerative colitis is caused by a microorganism or germ. Emotional stress and nutrition have also been cited by some as causes, but research seems to indicate that while stress and poor eating habits may exacerbate the symptoms of ulcerative colitis, they are not responsible for the disease.
It is estimated that approximately 500,000 Americans have ulcerative colitis. This chronic disease predominantly afflicts the young, generally beginning before age 30, but the disease can also occur in children as well as the later years of life. Ulcerative colitis affects men and women equally and heredity appears to be a factor. It has also been noted that Jews experience a greater incidence of ulcerative colitis than non-Jews.
Although there is no known cure for ulcerative colitis, there are various treatments available depending on the seriousness of the disease. In the most serious cases, the diseased colon may need to be surgically removed. It is estimated that 25–40 percent of ulcerative colitis patients must have their colons removed eventually due to excessive bleeding, risk of cancer or rupture of the colon. The most common surgery is a proctocolectomy with ileostomy, a two-stage procedure. In the first stage, the proctocolectomy, the surgeon removes the colon and rectum. In the ileostomy, the surgeon creates a small opening, called a stoma, in the abdomen and the end of the small intestine, called the ileum, is attached to the stoma. The stoma is about the size of a quarter located usually in the lower part of the abdomen near the beltline. Waste travels through the small intestine and exits the body through the stoma into a pouch worn over the opening. The pouch must then be emptied as necessary.
Most ulcerative colitis patients are treated with medications. The three classes of medication used today are Aminosalicylates, Corticosteroids and Immunomodulatory medicines. Aminosalicylates include aspirin-like medications such as sulfasalazine which alter the body’s ability to create and maintain inflammation. These medications are effective in mild to moderate cases of ulcerative colitis because without inflammation, symptoms such as diarrhea, rectal bleeding and abdominal pain can be greatly reduced. They are also helpful in preventing relapses of ulcerative colitis.
Corticosteroids are used in moderate to severe cases. This class of medication includes prednisone, hydrocortisone and budesonide. These powerful drugs are used at high doses to bring acute attacks under control. The physician will most often try to discontinue these drugs because of potential adverse long-term side effects such as hypertension and increased risk of infection. Immunomodulatory medicines include azathioprine, 6-mercaptopurine and cyclosporine. These medications alter the body’s immune cells from interacting with the inflammatory process. Immune system suppressors are generally only used in selected patients where aminosalicylates and corticosteroids have been ineffective. These medications can take up to three months to become effective.
There is much research being undertaken to find new treatments for ulcerative colitis. In an early study, some symptoms improved in patients who were given nicotine through an enema or a patch. This treatment is still experimental. Heparin is also being evaluated as a potential treatment for ulcerative colitis. Researchers are investigating whether the anticoagulant can help control colitis by preventing blood clots.
While ulcerative colitis is a serious, chronic disease, most people suffering from the disease are able to lead normal, productive lives, even though they may need to take chronic medication and be hospitalized occasionally. Although ulcerative colitis can be debilitating, long periods of time may pass between exacerbations. Maintenance medications have significantly decreased severe episodes and most patients feel well and relatively free of symptoms during times of remission.
About the Author
Beth O. Zink, RPR, is from Highland, Ill. Her son was diagnosed with ulcerative colitis.
- Aminosalicylates are also known as immune system suppressors.
- Examination of the upper portion of the rectum with an elongated speculum or scope is known as:
- Inflammatory Bowel Disease (IBD) is synonymous with Irritable Bowel Syndrome (IBS).
- Ulcerative colitis is caused by:
- a defect in the immune system
- emotional stress
- the cause is unknown
- The stoma is created by the surgeon during a proctocolectomy.
- Crohn’s disease differs from ulcerative colitis in that Crohn’s disease causes inflammation deeper within the intestinal wall, can occur in the esophagus and usually occurs in the small intestine.
- One of the most common symptoms of ulcerative colitis is:
- weight loss
- loss of appetite
- bloody diarrhea
- The mucosa is the mucous membrane or moist tissue layer that lines a hollow organ or body cavity.
- A steroid hormone with the same effects as cortisone is:
- Approximately 80 percent of patients with ulcerative colitis will develop colon cancer.
- ____________ taken during a colonoscopy can often predict colon cancer.
- A proctocolectomy is the first step in the treatment of patients with ulcerative colitis.
- Ulcerative colitis may also cause problems such as arthritis, liver disease, osteoporosis, anemia and kidney stones.
- Precancerous changes in the cells lining the colon is referred to as:
- The sigmoid flexure is located between the iliac crest and the rectum.
- Ulcerative colitis affects men more often than women.
- When ulcerative colitis affects the entire colon, it is referred to as:
- Pancoast Syndrome
- The condition resulting from excessive blood loss, excessive blood cell destruction or decreased blood cell formation is known as:
- The field of medicine involved in diagnosing and treating ulcerative colitis is termed:
- Emotional and psychological support are unnecessary in the treatment of ulcerative colitis.