A Family Doctor's Tale - ULCERATIVE COLITIS

DOC I HAVE ULCERATIVE COLITIS

Ulcerative colitis is almost similar to Crohn's Disease except that it is mainly localized in the colon.

The symptoms are similar : abdominal pain, diarrhea, and bleeding.

Because of the ulcerations and bleeding, ulcerative colitis is more dangerous than Crohn's Disease.

Immunosuppressive drugs are used to control the disease.

In severe cases surgery may be necessary.


Ulcerative Colitis is a inflammatory disease of the colon and rectum which causes ulcers in the lining of the colon and rectum.
These ulcers can then bleed, produce pus, and lead to the rapid emptying of the colon and diarrhea.



Ulcerative Colitis is more common in Jews than non-Jews and in whites than non-whites

Most cases begin at the age range of 15-30 years and occurs less frequently between the age of 50-70 years.

Those above the age of 60 years have more severe symptoms and signs.

It occurs equally in men and women and can be found in families.



The exact cause of Ulcerative Colitis is not known.

It has been suggested that an autoimmune disease is the main cause of Ulcerative Colitis disease.

Psychological problems like stress and anxiety is not a cause of Ulcerative Colitis but has been known to trigger off the disease.



Symptoms:
The symptoms can range from mild to severe.

Mild cases (about 50%)usually have:

1.an insidious onset

2.lower abdominal pain

3.Slight blood stained diarrhea

4.malaise

In the more severe cases, the main symptoms may be:

1.abrupt onset

2.severe diffuse abdominal pain

3.Bloody diarrhea

4.fever

5.shock

6.fatigue

7.weight loss

8.loss of appetite

9.loss of body fluids and nutrients

10.joint pain

Signs:
1.Abdominal distension and tenderness

2.Rectal examination may show blood in the stool
There is also tightness of the anal sphincter

3.pallor due to anemia

4.Wasting of muscles

5.skin lesions

Diagnosis of Ulcerative Colitis is made by:


1.A history of lower abdominal pain , bloating and bloody diarrhea

2.The physical exam consists of
a.palpation of the abdomen for tenderness

b.digital rectal exam to detect tenismus or blood.

3.stool may be tested for blood

4.blood tests( HB, WBC, ESR, blood culture) are done for evidence of infection.

5.Xrays of the abdomen and barium enema may be done to show evidence of extent of ulcers in the colon

6.Colonoscopy is also done to confirm evidence of ulcerative colitis and exclude malignant tumors.

Complications of Ulcerative Colitis:

Bowel complications:

1.Strictures of colon

2.Fistula

3.Toxic dilatation(toxic megacolon)

4.Perforation of the colon

5.hemorrhage

6.shock

7.rarely carcinoma(5%)

Non-bowel complications:

1.Bones: arthritis, sacroiliatis
osteoporosis

2.Eyes: uveitis, iritis

3.Skin: eczema

Treatment of Ulcerative Colitis is by:


Mild Cases:
Medications:

1.Antidiarrheal and bulk forming agents

2.Antispasmotic medication for spasm of the colon

3.Sulfasalazine (immunosuppressant) given indefinitely
Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, may be used by people who cannot take sulfasalazine.

4.Topical corticosteroids as retention enema or suppositories only where the rectum is involved.

5.Correction of anemia

6.Regular hemoglobin, blood counts and liver function tests

Severe cases:

1.Hospitalization with bed rest, fluids, electrolyte replacement and blood transfusion if necessary

2.Systemic corticosteroids(intravenous initially, followed by oral medications) These should not be given for long term usage.

3.Sulphasalazine (immuno-suppressant) given indefinitely

4.azathioprine and 6-mercapto-purine (6-MP) can also reduce inflammation by suppressing the immune system

5.Antibiotics in toxic megacolon syndrome

5.surgery if the attacks are severe, do not respond to treatment, toxic megacolon or uncontrollable bleeding.
Surgery is also done for complications such as a fistula or intestinal obstruction.

In more severe cases a total proctocolectomy with ileostomy( a stoma is left in the abdomen for disposal of faeces) is done and is usually curative.

Ileoanal anastomosis in which the ileum is attached to the anus allows the patient to have normal bowel movements because the anus is preserved.

Emergency surgery may be done for perforation, peritonitis, or continued bleeding.



The prognosis depends on the severity of the disease

Mortality is o.4% for mild cases, 2.2% for moderate disease and 10-25% for severe disease.

5% will die within the first year.

75% will have recurrence for the rest of their life.

Only 10% will have remissions lasting 15 years.