Ulcerative colitis

Ulcerative colitis

Overview

Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine, also called the colon, and rectum. In most people, symptoms usually develop over time, rather than suddenly.

Ulcerative colitis can be draining and can sometimes lead to life-threatening complications. While it has no known cure, there are several new treatments that can greatly reduce signs and symptoms of the disease and bring about long-term remission.

Symptoms
Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs. Signs and symptoms may include:

*Diarrhea, often with blood or pus

*Rectal bleeding — passing small amount of blood with stool

*Abdominal pain and cramping

*Rectal pain

*Urgency to defecate

*Inability to defecate despite urgency

*Weight loss

*Fatigue

*Fever

*In children, failure to grow

Most people with ulcerative colitis have mild to moderate symptoms. The course of ulcerative colitis may vary, with some people having long periods when it goes away. This is called remission.

Types

Health care providers often classify ulcerative colitis according to its location. Symptoms of each type often overlap. Types of ulcerative colitis include:

*Ulcerative proctitis. Inflammation is confined to the area closest to the anus, also called the rectum. Rectal bleeding may be the only sign of the disease.

*Proctosigmoiditis. Inflammation involves the rectum and sigmoid colon — the lower end of the colon. Symptoms include bloody diarrhea, abdominal cramps and pain, and an inability to move the bowels despite the urge to do so. This is called tenesmus.

*Left-sided colitis. Inflammation extends from the rectum up through the sigmoid and descending portions of the colon. Symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and urgency to defecate.

*Pancolitis. This type often affects the entire colon and causes bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue, and significant weight loss.

When to see a doctor

See your health care provider if you experience a persistent change in your bowel habits or if you have signs and symptoms such as:

*Abdominal pain

*Blood in your stool

*Ongoing diarrhea that doesn't respond to nonprescription medications

*Diarrhea that awakens you from sleep

*An unexplained fever lasting more than a day or two

Although ulcerative colitis usually isn't fatal, it's a serious disease. In some cases, ulcerative colitis may cause life-threatening complications.

Causes

The exact cause of ulcerative colitis remains unknown. Previously, diet and stress were suspected. However, researchers now know that these factors may aggravate but don't cause ulcerative colitis.

One possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacterium, an irregular immune response causes the immune system to attack the cells in the digestive tract, too.

Heredity also seems to play a role in that ulcerative colitis is more common in people who have family members with the disease. However, most people with ulcerative colitis don't have this family history.

Risk factors

Ulcerative colitis affects about the same number of women and men. Risk factors may include:

*Age. Ulcerative colitis usually begins before the age of 30, but it can occur at any age. Some people may not develop the disease until after age 60.

*Race or ethnicity. Although white people have the highest risk of the disease, it can occur in any race. If you're of Ashkenazi Jewish descent, your risk is even higher.

*Family history. You're at higher risk if you have a close relative, such as a parent, sibling or child, with the disease.

Complications

Possible complications of ulcerative colitis include:

*Severe bleeding

*Severe dehydration

*A rapidly swelling colon, also called a toxic megacolon

*A hole in the colon, also called a perforated colon

*Increased risk of blood clots in veins and arteries

*Inflammation of the skin, joints and eyes

*An increased risk of colon cancer

*Bone loss, also called osteoporosis

Diagnosis

Endoscopic procedures with tissue biopsy are the only way to definitively diagnose ulcerative colitis. Other types of tests can help rule out complications or other forms of inflammatory bowel disease, such as Crohn's disease.

To help confirm a diagnosis of ulcerative colitis, you may have one or more of the following tests and procedures:

Lab tests

*Blood tests. Your provider may suggest blood tests to check for anemia — a condition in which there aren't enough red blood cells to carry adequate oxygen to your tissues — or to check for signs of infection or inflammation.

*Stool studies. White blood cells or certain proteins in your stool can indicate ulcerative colitis. A stool sample also can help rule out other disorders, such as infections caused by bacteria, viruses and parasites.

Endoscopic procedures

*Colonoscopy. This exam allows your provider to view your entire colon using a thin, flexible, lighted tube with a camera on the end. During the procedure, tissue samples are taken for laboratory analysis. This is known as a tissue biopsy. A tissue sample is necessary to make the diagnosis.

*Flexible sigmoidoscopy. Your provider uses a slender, flexible, lighted tube to examine the rectum and sigmoid colon — the lower end of your colon. If your colon is severely inflamed, this test may be preferred instead of a full colonoscopy.

Imaging procedures

*X-ray. If you have severe symptoms, your provider may use a standard X-ray of your abdominal area to rule out serious complications, such as a megacolon or a perforated colon.

*CT scan. A CT scan of your abdomen or pelvis may be performed if a complication from ulcerative colitis is suspected. A CT scan may also reveal how much of the colon is inflamed.

*Computerized tomography (CT) enterography and magnetic resonance (MR) enterography. These types of noninvasive tests may be recommended to exclude any inflammation in the small intestine. These tests are more sensitive for finding inflammation in the bowel than are conventional imaging tests. MR enterography is a radiation-free alternative.

Treatment

Ulcerative colitis treatment usually involves either medication therapy or surgery.

Several categories of medications may be effective in treating ulcerative colitis. The type you take will depend on the severity of your condition. The medications that work well for some people may not work for others. It may take time to find a medication that helps you.

In addition, because some medications have serious side effects, you'll need to weigh the benefits and risks of any treatment.

Anti-inflammatory medications

Anti-inflammatory medications are often the first step in the treatment of ulcerative colitis and are appropriate for most people with this condition. These include:

*5-aminosalicylates. Examples of this type of medication include sulfasalazine (Azulfidine), mesalamine (Delzicol, Rowasa, others), balsalazide (Colazal) and olsalazine (Dipentum). Which medication you take and how you take it — by mouth or as an enema or suppository — depends on the area of your colon that's affected.

*Corticosteroids. These medications, which include prednisone and budesonide, are generally reserved for moderate to severe ulcerative colitis that doesn't respond to other treatments. Corticosteroids suppress the immune system. Due to the side effects, they are not usually given long term.

Immune system suppressors

These medications also reduce inflammation, but they do so by suppressing the immune system response that starts the process of inflammation. For some people, a combination of these medications works better than one medication alone.

Immunosuppressant medications include:

*Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These are commonly used immunosuppressants for the treatment of inflammatory bowel disease. They are often used in combination with medications known as biologics. Taking them requires that you follow up closely with your provider and have your blood checked regularly to look for side effects, including effects on the liver and pancreas.

*Cyclosporine (Gengraf, Neoral, Sandimmune). This medication is typically reserved for people who haven't responded well to other medications. Cyclosporine has the potential for serious side effects and is not for long-term use.

*"Small molecule" medications. More recently, orally delivered agents, also known as "small molecules," have become available for IBD treatment. These include tofacitinib (Xeljanz), upadacitinib (Rinvoq) and ozanimod (Zeposia). These medications may be effective when other therapies don't work. Main side effects include the increased risk of shingles infection and blood clots.

The U.S. Food and Drug Administration (FDA) recently issued a warning about tofacitinib, stating that preliminary studies show an increased risk of serious heart-related problems and cancer from taking this medication. If you're taking tofacitinib for ulcerative colitis, don't stop taking it without first talking with your health care provider.

Biologics

This class of therapies targets proteins made by the immune system. Types of biologics used to treat ulcerative colitis include:

*Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). These medications, called tumor necrosis factor (TNF) inhibitors, work by neutralizing a protein produced by your immune system. They are for people with severe ulcerative colitis who don't respond to or can't tolerate other treatments. TNF inhibitors are also called biologics.

*Vedolizumab (Entyvio). This medication is approved for treatment of ulcerative colitis for people who don't respond to or can't tolerate other treatments. It works by blocking inflammatory cells from getting to the site of inflammation.

*Ustekinumab (Stelara). This medication is approved for treatment of ulcerative colitis for people who don't respond to or can't tolerate other treatments. It works by blocking a different protein that causes inflammation.

TYPE OF DOCTOR AND DEPARTMENT: Gastroenterology and Hepatology SPECIALIST CAN DIAGNOSE THIS DISEASE.