What Causes Ulcerative
What Are the Symptoms of Ulcerative Colitis?
How Is Ulcerative Colitis Diagnosed?
What Is the Treatment for Ulcerative Colitis?
Is Colon Cancer a Concern?
Ulcerative colitis is a disease that causes inflammation
and sores, called ulcers, in the top layers of the lining of the large
intestine. The inflammation usually occurs in the rectum and lower part
of the colon, but it may affect the entire colon. Ulcerative colitis rarely
affects the small intestine except for the lower section, called the ileum.
Ulcerative colitis may also be called colitis, ileitis, or proctitis.
The inflammation makes the colon empty frequently, causing
diarrhea. Ulcers form in places where the inflammation has killed colon
lining cells; the ulcers bleed and produce pus and mucus.
Ulcerative colitis is an inflammatory bowel disease (IBD),
the general name for diseases that cause inflammation in the intestines.
Ulcerative colitis can be difficult to diagnose because its symptoms are
similar to other intestinal disorders such as irritable bowel syndrome
and to another type of IBD called Crohn's disease. Crohn's disease differs
from ulcerative colitis because it causes inflammation deeper within the
intestinal wall. Crohn's disease usually occurs in the small intestine,
but it can also occur in the mouth, esophagus, stomach, duodenum, large
intestine, appendix, and anus.
Ulcerative colitis occurs most often in people ages 15
to 40, although children and older people sometimes develop the disease.
Ulcerative colitis affects men and women equally and appears to run in
Theories about what causes ulcerative colitis abound, but none have been
proven. The most popular theory is that the body's immune system reacts
to a virus or a bacterium by causing ongoing inflammation in the intestinal
wall. People with ulcerative colitis have abnormalities of the immune
system, but doctors do not know whether these abnormalities are a cause
or a result of the disease. Ulcerative colitis is not caused by emotional
distress or sensitivity to certain foods or food products, but these factors
may trigger symptoms in some people.
What Are the
Symptoms of Ulcerative Colitis?
The most common symptoms of ulcerative colitis are abdominal pain and
bloody diarrhea. Patients also may experience
- Weight loss.
- Loss of appetite.
- Rectal bleeding.
- Loss of body fluids and nutrients.
About half of patients have mild symptoms. Others suffer
frequent fever, bloody diarrhea, nausea, and severe abdominal cramps.
Ulcerative colitis may also cause problems such as arthritis, inflammation
of the eye, liver disease (fatty liver, hepatitis, cirrhosis, and primary
sclerosing cholangitis), osteoporosis, skin rashes, anemia, and kidney
stones. No one knows for sure why problems occur outside the colon. Scientists
think these complications may occur when the immune system triggers inflammation
in other parts of the body. These problems are usually mild and go away
when the colitis is treated.
How Is Ulcerative
A thorough physical exam and a series of tests may be required to diagnose
Blood tests may be done to check for anemia, which could
indicate bleeding in the colon or rectum.Blood tests
may also uncover a high white blood cell count, which is a sign of inflammation
somewhere in the body. By testing a stool sample, the doctor can tell
if there is bleeding or infection in the colon or rectum.
The doctor may do a colonoscopy. For this test, the doctor
inserts an endoscope--a long, flexible, lighted tube connected to a computer
and TV monitor--into the anus to see the inside of the colon and rectum.
The doctor will be able to see any inflammation, bleeding, or ulcers on
the colon wall. During the exam, the doctor may do a biopsy, which involves
taking a sample of tissue from the lining of the colon to view with a
microscope. A barium enema x-ray of the colon may also be required. This
procedure involves filling the colon with barium, a chalky white solution.
The barium shows up white on x-ray film, allowing the doctor a clear view
of the colon, including any ulcers or other abnormalities that might be
the Treatment for Ulcerative Colitis?
Treatment for ulcerative colitis depends on the seriousness of the disease.
Most people are treated with medication. In severe cases, a patient may
need surgery to remove the diseased colon. Surgery is the only cure for
Some people whose symptoms are triggered by certain foods
are able to control the symptoms by avoiding foods that upset their intestines,
like highly seasoned foods or milk sugar (lactose). Each person may experience
ulcerative colitis differently, so treatment is adjusted for each individual.
Emotional and psychological support is important.
Some people have remissions--periods when the symptoms
go away--that last for months or even years. However, most patients' symptoms
eventually return. This changing pattern of the disease means one cannot
always tell when a treatment has helped.
Someone with ulcerative colitis may need medical care
for some time, with regular doctor visits to monitor the condition.
Most patients with mild or moderate disease are first treated with 5-ASA
agents, a combination of the drugs sulfonamide, sulfapyridine, and salicylate
that helps control inflammation. Sulfasalazine is the most commonly used
of these drugs. Sulfasalazine can be used for as long as needed and can
be given along with other drugs. Patients who do not do well on sulfasalazine
may respond to newer 5-ASA agents. Possible side effects of 5-ASA preparations
include nausea, vomiting, heartburn, diarrhea, and headache.
People with severe disease and those who do not respond
to mesalamine preparations may be treated with corticosteroids. Prednisone
and hydrocortisone are two corticosteroids used to reduce inflammation.
They can be given orally, intravenously, through an enema, or in a suppository,
depending on the location of the inflammation. Corticosteroids can cause
side effects such as weight gain, acne, facial hair, hypertension, mood
swings, and increased risk of infection, so doctors carefully watch patients
taking these drugs.
Other drugs may be given to relax the patient or to relieve
pain, diarrhea, or infection.
Occasionally, symptoms are severe enough that the person
must be hospitalized. For example, a person may have severe bleeding or
severe diarrhea that causes dehydration. In such cases the doctor will
try to stop diarrhea and loss of blood, fluids, and mineral salts. The
patient may need a special diet, feeding through a vein, medications,
or sometimes surgery.
About 25 percent to 40 percent of ulcerative colitis patients must eventually
have their colons removed because of massive bleeding, severe illness,
rupture of the colon, or risk of cancer. Sometimes the doctor will recommend
removing the colon if medical treatment fails or if the side effects of
corticosteroids or other drugs threaten the patient's health.
One of several surgeries may be done. The most common
surgery is a proctocolectomy with ileostomy, which is done in two stages.
In the proctocolectomy, the surgeon removes the colon and rectum. In the
ileostomy, the surgeon creates a small opening in the abdomen, called
a stoma, and attaches the end of the small intestine, called the ileum,
to it. This type of ileostomy is called a Brooke ileostomy. Waste will
travel through the small intestine and exit the body through the stoma.
The stoma is about the size of a quarter and is usually located in the
lower right part of the abdomen near the beltline. A pouch is worn over
the opening to collect waste, and the patient empties the pouch as needed.
An alternative to the Brooke ileostomy is the continent
ileostomy. In this operation, the surgeon uses the ileum to create a pouch
inside the lower abdomen. Waste empties into this pouch, and the patient
drains the pouch by inserting a tube into it through a small, leakproof
opening in his or her side. The patient must wear an external pouch for
only the first few months after the operation. Possible complications
of the continent ileostomy include malfunction of the leakproof opening,
which requires surgical repair, and inflammation of the pouch (pouchitis),
which is treated with antibiotics.
An ileoanal anastomosis, or pull-through operation, allows
the patient to have normal bowel movements because it preserves part of
the rectum. This procedure is becoming increasingly common for ulcerative
colitis. In this operation, the surgeon removes the diseased part of the
colon and the inside of the rectum, leaving the outer muscles of the rectum.
The surgeon then attaches the ileum to the inside of the rectum and the
anus, creating a pouch. Waste is stored in the pouch and passed through
the anus in the usual manner. Bowel movements may be more frequent and
watery than usual. Pouchitis is a possible complication of this procedure.
Not every operation is appropriate for every person. Which
surgery to have depends on the severity of the disease and the patient's
needs, expectations, and lifestyle. People faced with this decision should
get as much information as possible by talking to their doctors, to nurses
who work with colon surgery patients (enterostomal therapists), and to
other colon surgery patients. Patient advocacy organizations can direct
people to support groups and other information resources. (See Resources
for the names of such organizations.)
Most people with ulcerative colitis will never need to
have surgery. If surgery ever does become necessary, however, some people
find comfort in knowing that after the surgery, the colitis is cured and
most people go on to live normal, active lives.
Researchers are always looking for new treatments for ulcerative colitis.
Several drugs are being tested to see whether they might be useful in
treating the disease:
- Budesonide. A corticosteroid called budesonide
may be nearly as effective as prednisone in treating mild ulcerative
colitis, and it has fewer side effects.
- Cyclosporine. Cyclosporine, a drug that suppresses
the immune system, may be a promising treatment for people who do not
respond to 5-ASA preparations or corticosteroids.
- Nicotine. In an early study, symptoms improved
in some patients who were given nicotine through a patch or an enema.
(Using nicotine as treatment is still experimental--the findings do
not mean that people should go out and buy nicotine patches or start
- Heparin. Researchers overseas are examining
whether the anticoagulant heparin can help control colitis by preventing
Cancer a Concern?
About 5 percent of people with ulcerative colitis develop colon cancer.
The risk of cancer increases with the duration and the extent of involvement
of the colon. For example, if only the lower colon and rectum are involved,
the risk of cancer is not higher than normal. However, if the entire colon
is involved, the risk of cancer may be as great as 32 times the normal
Sometimes precancerous changes occur in the cells lining
the colon. These changes are called "dysplasia." People who have dysplasia
are more likely to develop cancer than those who do not. (Doctors look
for signs of dysplasia when doing a colonoscopy and when examining tissue
removed during the test.)
According to 1997 guidelines on screening for colon cancer,
people who have had IBD throughout their colon for at least 8 years and
those who have had IBD in only the left colon for at least 15 years should
have a colonoscopy every 1 to 2 years to check for dysplasia. Such screening
has not been proven to reduce the risk of colon cancer, but it may help
identify cancer early should it develop. (These guidelines were produced
by an independent expert panel and endorsed by numerous organizations,
including the American Cancer Society, American College of Gastroenterology,
American Society of Colon and Rectal Surgeons, and the Crohn's & Colitis
Foundation of America Inc., among others.)
Crohn's & Colitis Foundation of America Inc.
386 Park Avenue South, 17th floor
New York, NY 10016-8804
Tel: (800) 932-2423 or (212) 685-3440
Home page: http://www.ccfa.org
Pediatric Crohn's & Colitis Association Inc.
P.O. Box 188 Newton,
Tel: (617) 489-5854
Reach Out for Youth with Ileitis and Colitis Inc.
15 Chemung Place
Jericho, NY 11753
Tel: (516) 822-8010
United Ostomy Association, Inc.
19772 MacArthur Blvd. #200
Irvine, CA 92612-2405
Tel: (800) 826-0826 or (949) 660-8624
Fax: (949) 660-9262
Home page: http://www.uoa.org
Colitis Tutorial - The National Library of Medicine