Ulcerative colitis is a type of IBD or inflammatory bowel disease. Colitis is a disease that is the inflammation oof the large intestine or colon. Ulcerative Colitis is colitis with open sores or ulcers on the lining of the colon. This disease can become systemic affecting the entire body. The occurrence of this disease is rare affecting only one person per 10,000 in the United States, occurring more commonly in the northern states.
Gastrointestinal symptoms of ulcerative colitis are diarrhea that contains mucus and blood. Weight loss, blood with a rectal exam and abdominal pain can also be present. The symptoms depend on the severity of the disease. This disease is systemic and can affect many other body parts, but usually is not diagnosed until gastrointestinal symptoms appear.
The disease is broken down into four types, mild, moderate, severe and fulminant. The mild form presents symptoms of fewer than four bowel movements per day with or without blood, mild abdominal pain, no systemic toxicity. Patients with mild ulcerative colitis often believe that are constipated, when in fact they are experiencing tenesmus, which is a constant feeling of needing to have a bowel movement. The moderate form of ulcerative colitis has symptoms that consist of more than four bowel movements per day, slight systemic toxicity, mild anemia, low grade fever and moderate pain in the abdomen. The severe form of this disease will present with symptoms of more than six bowel movements per day, systemic toxicity (high fever will be the first indicator), tachycardia, and anemia. Fulminant type of ulcerative colitis has these symptoms: more than ten bowel movements per day, continuous bleeding, colonic dilation, and distension of the abdomen with tenderness. This type of ulcerative colitis if not treated can quickly cause death.
Since ulcerative colitis is a systemic disease, symptoms that are not gastrointestinal related occur in the patient. These symptoms can be ulcers of the mouth, including the lips tongue and pharynx, inflammation of the iris, seronegative arthritis, arthritis of the spine and lower spine, inflammation of subcutaneous tissue of the lower extremities (also known as erythema nodosum), ulcerative lesion of the skin, deep vein clots or pulmonary embolism, anemia and inflammation of the bile ducts.
To diagnose ulcerative colitis the following tests are performed:
CBC (complete blood count) to determine anemia
ESR – which detects the presence of systemic inflammation
Liver function tests
Electrolyte studies – to make sure chronic diarrhea is not leading to renal failure
An endoscopy is the most effective diagnostic tool for ulcerative colitis. A full colonoscopy (of the entire colon) is performed if the diagnosis is not significantly evident. If the diagnosis is probable, a sigmoidoscopy is performed. If severe colitis is suspected, then a minimal exam is performed to prevent perforation of the colon. In ulcerative colitis, the colon will have a decrease in vascular appearance, redness and thinning of the mucosa or lining, superficial ulceration or a moderate amount of pseudo polyps.
The cause of ulcerative colitis is not known. Several factors are believe to be significant or of note in the occurrence of ulcerative colitis such as genetic predisposition, environmental factors, a possible autoimmune condition, metabolic conditions, and toxic effects of hydrogen sulfide on the cells lining the colon, known as the mucosa.
Treatment is dictated by the severity and extent of the disease. The goal of treatment is to induce a remission with medications – at first and then to maintain remission. Medications for inducing and maintaining remission may be the same, but they are not administered in the same way. Remission is obtained by relieving symptoms and healing the mucosa.
Drugs used to obtain and maintain remission are aminosalycylates, sulfasalazines, corticosteroids, immunosuppressive drugs and biological treatment.
Ulcerative colitis can be cured with surgical treatment that removes the colon. If hemorrhage, perforation or carcinoma is present then surgery is performed.
Dietary modification can be utilized to reduce the symptoms of the disease. Many patients with ulcerative colitis are lactose intolerant, so reducing lactose containing foods may help ease the symptoms. Patients who experience cramping and diarrhea may obtain relieve by reducing caffeine, fruits and certain vegetables. Another dietary approach that has been used by patients is an anti-fungal and specific carbohydrate diet. Fish oil and short chain fatty acid enemas have also been used to treat the symptoms of this disease, but there has been no conclusive research performed on their effectiveness. Probiotics and bacterial re-colonization of bacteria in the colon have also had a positive affect on patients with ulcerative colitis.
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