Ulcerative Colitis

Inflammatory Bowel Disease

Inflammatory Bowel Disease (IBD) is an immune-mediated chronic inflammation of your gastrointestinal tract. Normally, the cells and proteins that make up the immune system protect you from infection. In people with IBD, however, the immune system mistakes food, bacteria, and other materials in the intestine for foreign or invading substances. When this happens, the body sends white blood cells into the lining of the intestines, where they produce chronic inflammation and ulcerations—called autoimmune response.

There are two types of IBD, Crohn’s disease and ulcerative colitis; both manifest as chronic immune-mediated inflammation of your gastrointestinal system. While they both cause similar symptoms, they are managed differently. Crohn’s disease may affect any part of your gastrointestinal system, from your mouth to the anus. Ulcerative colitis, however, is limited to the colon, otherwise known as the large intestine.

It is estimated that 1.4 million Americans have IBD, which tends to run in families and affect males and females equally.

Ulcerative colitis is a chronic disease of the large intestine, also known as the colon, in which the lining of the colon becomes inflamed and develops tiny open sores, or ulcers, that produce pus and mucous. The combination of inflammation and ulceration can cause abdominal discomfort and frequent emptying of the colon.

What Are the Symptoms of Ulcerative Colitis?

It is often difficult to diagnose which form of IBD is present because both Crohn’s disease and ulcerative colitis cause similar symptoms. Both illnesses are marked by an abnormal response by the body’s immune system, leading to chronic inflammation of the gastrointestinal tract.

Symptoms related to inflammation of the GI tract include:

  • Diarrhea
  • Rectal bleeding
  • Urgent need to move bowels
  • Abdominal cramps and pain
  • Sensation of incomplete evacuation
  • Constipation (can lead to bowel obstruction)

General symptoms:

  • Fever
  • Loss of appetite
  • Weight loss
  • Fatigue
  • Night sweats
  • Loss of normal menstrual cycle

Individuals with ulcerative colitis may also experience swelling and pain in the hip and knee joints and pain in the eyes or skin. The symptoms of ulcerative colitis tend to come and go, with fairly long periods in between flare-ups, during which patients may experience no distress at all. These periods of remission can span months or even years. The unpredictable course of ulcerative colitis can make medical management quite challenging.

How is Ulcerative Colitis Diagnosed?

Doctors usually perform a sigmoidoscopy, or a similar test called a colonoscopy, to diagnose ulcerative colitis. For these tests, the doctor puts a thin tube into your rectum (the lower part of the large intestine) and threads it up into your colon. The tube has a camera attached to it, so the doctor can look inside your colon. The tube also has tools attached, so the doctor can take samples of tissue to look at under the microscope.

How is Ulcerative Colitis Treated?

People with ulcerative colitis often need lifelong treatment, which may consist of medicine, surgery, and lifestyle changes; however, with effective treatment, many people are able to live fairly normal lives with ulcerative colitis.

Medicine

There are many different medicines that help reduce the symptoms of ulcerative colitis. Almost all of these medicines work by reducing inflammation and the body’s immune response.  The newest drugs available to treat IBD are biologic therapies, which help to reduce inflammation by blocking specific proteins that play a role in inflammation.

  • Aminosalicylates are fast-acting anti-inflammatory drugs typically used to treat flare-ups and are intended for short term use. They can be administered orally or directly into your rectum. These drugs help control the inflammation by delivering a compound containing 5-aminosalicylic acid (5-ASA) to the bowel. Examples of aminosalicylates include sulfasalazine, mesalamine, olsalazine, and balsalazide. These medications are used for both ulcerative colitis and Crohn’s disease; however, they are much more effective for ulcerative colitis and are being used less often for Crohn’s disease.
  • Corticosteroids inhibit the bodies inflammatory response in IBD.
  • Immunomodulators are medicines that work by quieting down the immune system, helping to reduce inflammation can be used to control the disease. These medicines are called immunomodulators, and they can be administered orally or by injection. Examples of immunomodulators include azathioprine, 6-mercaptopurine, and methotrexate.
  • Biologic Therapies are divided into two main classes: The first, anti-TNF agents, block the protein tumor necrosis factor alpha; the second, anti-integrins, block integrins, which are proteins used by white blood cells to travel to areas of active inflammation, such as the intestine. There are several anti-TNF agents available; there is one integrin receptor antagonist available; and, other biologics are in development. Currently, infliximab and adalimumab are the biologic therapies that are approved to treat ulcerative colitis.
  • Antibiotics can reduce intestinal bacteria 

Surgery

Surgery may be helpful if medicines are unable to control your symptoms, or if the medicines cause side effects that you can’t tolerate. There are two main types of surgery used to treat ulcerative colitis:

  1. Proctocolectomy (removing the colon and rectum) with ileostomy: If ulcerative colitis is severe, surgery may be required to remove the entire colon and rectum, plus bring the ileum (end of the small intestine) through a stoma (opening) in the abdominal wall to allow drainage of intestinal waste out of the body. The second part of the procedure is called ileostomy. After the procedure, an external bag must be worn over the opening to collect waste.
  2. Restorative proctocolectomy, also known as ileoanal pouch anal anastomosis (IPAA). In this surgery the colon and rectum are removed, but the patient can continue to pass stool through the anus. In place of an ileostomy, the ileum is fashioned into a pouch and pulled down and connected to the anus.

Lifestyle Changes

There are many things you can do that may improve your symptoms, including:

  • Reduce consumption of foods that make your symptoms worse. Some people have problems with foods that have a lot of fiber, such as fruits and vegetables. Note that if you start cutting foods out of your diet, your doctor might suggest that you take a multivitamin and a folic acid supplement. If you stop eating dairy, you should take calcium and vitamin D. These supplements will make up for nutrients you might be missing.
  • If you smoke, quit. Smoking makes symptoms worse and increases the chances that you will need surgery.
  • Avoid medicines such as ibuprofen (brand names include Motrin or Advil) and naproxen (brand name Aleve)

Does Ulcerative Colitis Lead to Colon Cancer?

Ulcerative colitis can lead to colon cancer. People with ulcerative colitis get screened early and often for colon cancer. Screening guidelines recommend a colonoscopy performed a few years after diagnosis, and repeated every 1 to 2 years thereafter.

What are the Causes of IBD? Who is Effected?

Although considerable progress has been made in IBD research, investigators do not yet know what causes this disease. Studies indicate that the inflammation in IBD involves a complex interaction of factors: the genes the person has inherited, the immune system, and environmental factors.

Foreign substances (antigens) in the environment may be the direct cause of the inflammation, or they may stimulate the body’s defenses to produce an inflammation that continues without control. The body’s immune system usually eliminates foreign invaders (substances), such as bacteria, viruses, and fungi. Normally, harmless bacteria (many of which aid in digestion) are protected in the GI tract; however, for people with IBD, the immune system reacts to these bacteria with inflammation. Environmental triggers initiate these immune responses, which can lead to chronic inflammation, ulceration, and thickening of the intestinal wall. Researchers believe that once the IBD patient’s immune system is “turned on,” it does not know how to properly “turn off”. As a result, inflammation damages the intestine and causes the symptoms of IBD. That is why the main goal of medical therapy is to help patients regulate their immune system better.

Environmental factors

The environmental factors that trigger IBD are not known, but several potential risk factors have been studied, including:

  • Smoking — Active smokers are more than twice as likely as nonsmokers to develop Crohn’s disease. Surprisingly, the risk of developing ulcerative colitis is decreased in current smokers compared with people who have never smoked. The numerous potentially harmful health effects of smoking (e.g., cancer, heart disease) largely overcome any benefits of smoking for people with ulcerative colitis.
  • Antibiotics — The use of these medicines may increase the risk for IBD.
  • Nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, naproxen) — The use of these drugs may increase the risk for getting IBD and may worsen the condition.
  • Appendicitis in children — Children who undergo an appendectomy (removal of the appendix) are less likely to develop ulcerative colitis later in life. However, appendectomy in childhood may increase the risk for Crohn’s disease.

Genetics

While ulcerative colitis tends to run in families, researchers have been unable to establish a clear pattern of inheritance. Studies show that up to 20 percent of people with ulcerative colitis will also have a close relative with the disease. The disease is more common among white people of European origin and among people of Jewish heritage. While genetics is clearly a factor, the association is not simple. It is likely that more than one gene is at work, and just having the genes associated with IBD doesn’t absolutely predict that the disease will occur. These genes are known as susceptibility genes as they increase the chances for getting the disease. It is clear that other factors, including environmental factors, must also come into play.