Ulcerative colitis

What is Ulcerative colitis?

Ulcerative colitis is a diffuse, continuous and superficial inflammation of the large colon's mucosal lining. The peak incidence of ulcerative colitis is between ages 15 to 30. The disease is uncommon with a prevalence of 50 per 100,000. It tends to seen most often among related family members.

How is it diagnosed?

History: Individuals will present with the following complaints: rectal bleeding, having to strain to produce stools (tenesmus), repeated bouts of diarrhea then constipation, rectal urgency, abdominal cramping, fever, malaise, nausea and vomiting, joint pains (arthralgias), and night sweats. If individuals have a severe bout of ulcerative colitis, they will present to the physician with fever, body fluid loss (dehydration), increased heart rate (tachycardia), and abdominal tenderness.

Physical exam: Any of the following signs and symptoms can be seen: fever, dehydration, increased heart rate (tachycardia), abdominal tenderness, pallor, joint tenderness, rebound tenderness on abdominal exam, and anal tenderness upon rectal exam.

Tests to ascertain the presence of ulcerative colitis include a complete blood count (CBC) with differential, blood iron and ferritin levels, C-reactive protein, sedimentation rate, Chem. 20 (blood test for liver, kidney and electrolyte levels), GGTP (liver enzyme test), fecal leukocytes (white blood cells in the stool), flat plate x-ray of the abdomen, barium enema (a radiographic x-ray of the colon), and endoscopy (an invasive procedure where a scope is placed through the rectal opening and passed up into the colon).

How is ulcerative colitis treated?

Individuals who have an acute exacerbation are initially stabilized on high dose steroids. Once their disease is under control, they are maintained on either a single medication or a combination of medications that can include sulfonamides, immunosuppressives, steroids, antibiotics, and antimetabolites.

If the individual has continuous exacerbations of the disease or is found to have changes in the colon wall consistent with cancer, a surgical resection of the colon (colectomy) may be necessary.

Medications

• Aminosalicylates
• Don't use aspirin. It increases the bleeding risk.
• Antidiarrhea medication for minimal symptoms.
• Sulfa drugs, such as sulfasalazine, for moderate symptoms.
• Medicated enemas (usually with hydrocortisone).
• Cortisone drugs for severe disease.
• Immunosuppressive drugs in patients with chronic disease.

Information	Brand	Generic	Label	Rating
	Flagyl	Metronidazole
	Cipro	Ciprofloxacin
	Principen	Ampicillin
	Imuran	Azathioprine

What might complicate it?

Individuals can have many complications including rectal bleeding, enlarged colon (toxic megacolon), cancer of the colon, inflammation of various parts of the eye (conjunctivitis, iritis, uveitis, episcleritis), bone loss (osteoporosis), and arthritis of the knees, ankles, elbows and wrists. Stress may aggravate the disease. After ten years of active disease, cancer of the colon may be found.

Predicted outcome

Individuals who undergo treatment for their disease can expect to be able to keep it under control by staying on their medications and keeping an eye on their stress levels. If the disease is not well controlled or the individual refuses therapy, the disease will progress. Non-compliance with medical regimens can also lead to dehydration, infection and possible sepsis (overwhelming systemic infection with a high mortality). If the disease is left to progress over a period, it may eventually lead to an enlarged colon (toxic megacolon) or colon cancer.

Alternatives

The different diseases that need to be excluded from consideration are gastroenteritis, infectious diarrhea, amebiasis (infection of the GI tract by amoeba), mesenteric adenitis (inflammation of the mesenteric lymph nodes), appendicitis, mesenteric ischemia (lack of blood supply to the small bowel and/or colon), diverticulitis (infection and inflammation of the colon), HIV, and colitis due to drug ingestion (NSAID induced).

Appropriate specialists

Gastroenterologist and general surgeon.

Last updated 27 May 2012