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Ulcerative Colitis
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Description
Ulcerative colitis is an inflammatory bowel disease in which the
inner lining of the large intestine (colon or bowel) and rectum
become inflamed. Inflammation usually begins in the rectum and lower
(sigmoid) intestine and spreads upward to the entire colon.
Ulcerative colitis rarely affects the small intestine except for the
lower section, the ileum.
The cause is unknown, and it may affect any age group although there
are peaks at ages 15 to 30 and then again at ages 50 to 70.
The disease usually begins in the rectal area and may eventually
extend through the entire large bowel. Repeated episodes of
inflammation lead to thickening of the wall of the intestine and
rectum with scar tissue. Death of colon tissue or sepsis may occur
with severe disease. The symptoms vary in severity and their onset
may be gradual or sudden. Attacks may be provoked by many factors,
including respiratory infections or stress.
Symptoms
· Abdominal pain
· Bloody diarrhea
· Fatigue
· Weight loss
· Loss of appetite
· Rectal bleeding
· Loss of body fluids and nutrients
· Anemia caused by severe bleeding
Incidence and Carriers
Although all ethnic groups may
develop the disease, it is most prevalent among people of Jewish descent. Risk
factors include a family history of ulcerative colitis or Jewish ancestry. The
incidence is 5 out of 10,000 people.
Treatment
Treatment for ulcerative colitis depends on the
seriousness of the disease. Each person may experience ulcerative colitis
differently, so treatment is adjusted accordingly.
· Medication - Most people are
treated with medication.
· Surgery - In severe cases, a
patient may need surgery to remove the diseased colon. Surgery is the only cure
for ulcerative colitis.
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· Elimination Diet - 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
dairy products (lactose).
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 makes it difficult to determine when a
treatment actually helps.
Drug Therapy
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 the inflammation. 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.
Doctors carefully monitor 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 patient 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 the diarrhea,
loss of blood, fluids, and mineral salts. The patient may need a special diet,
feeding through a vein, medications, or sometimes surgery.
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
the 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. A pouch is worn over the opening to collect the waste,
and the patient empties the pouch as needed.
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.
Testing
· Stool
sample: checks for bleeding or infection
· Colonoscopy:insertion of a
flexible tube to look inside the colon
· Biopsy: examination of tissue
removed from the colon
· Barium enema: barium shows up
white on x-ray film, revealing growths and other abnormalities in the colon
Research
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. Several studies have shown that
using the nicotine patch may help provide short-term relief from ulcerative
colitis flare-ups. How nicotine helps relieve symptoms of the disease isn't
clear, although doctors believe it may protect your colon by thickening and
increasing mucus in it. Nicotine may also play a role in reducing inflammation
in your colon.
Heparin - Researchers overseas are examining whether the anticoagulant
heparin can help control colitis by preventing blood clots
Resources and More
Crohn's & Colitis Foundation of
America, Inc.
National Headquarters
386 Park Avenue South, 17th Floor
New York, NY 10016-8804
Telephone: 212-685-3440
Toll Free: 800-932-2423
Fax: 212-779-4098
Email:
Pediatric Crohn's & Colitis Association, Inc.
P.O. Box 188
Newton, MA 02468
Telephone: (617) 489-5854
Website:
Email:
United Ostomy Association, Inc.
19772 MacArthur Blvd., #200
Irvine, CA 92612-2405
Telephone: 949-660-8624
Toll Free: 800-826-0826
Fax: 949-660-9262
Website:
Email:
The Israel Foundation for Crohn's Disease and Ulcerative
Colitis
P.O. Box 5231
Herzlia
Israel
Fax: 09-9567628
Support Groups
Reach Out for Youth with Ileitis and Colitis, Inc.
15 Chemung Place
Jericho, NY 11753
Telephone: 516-822-8010
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