Ulcerative colitis is a chronic inflammatory disease that affects the lining of the large intestine (colon) and rectum. People with this condition have tiny ulcers and small abscesses in their colon and rectum that flare up periodically and cause bloody stools and diarrhea.
Crosscut of colon and rectum with ulcerative colitis.
Ulcerative colitis is characterized by alternating periods of flare-ups and remission in which the disease appears to have disappeared. The periods of remission can last from weeks to years.
The inflammation usually begins in the rectum and then spreads to other segments of the colon. How much of the colon is affected varies from person to person. If the inflammation is limited to the rectum, the disease may be called ulcerative proctitis. Ulcerative colitis, unlike Crohn's disease, does not affect the esophagus, stomach or small intestine.
When grouped together, ulcerative colitis and Crohn's disease are referred to as inflammatory bowel disease because they cause inflammation of the bowel.
Ulcerative colitis can be inherited. Up to 25 percent of people with inflammatory bowel disease have a first-degree relative (mother, father, brother, sister) with the disease.
The main symptom of ulcerative colitis is diarrhea that often becomes bloody. Occasionally, the symptoms of ulcerative colitis include severe bloody diarrhea, dehydration, abdominal pain, and fever. Other symptoms may include painful, urgent bowel movements or pus or blood in the stool. Ulcerative colitis may be associated with weight loss, joint pain, anemia (a deficiency in red blood cells), or skin lesions (sores).
The cause of ulcerative colitis remains unknown, but it is likely caused by an abnormal response of the immune system in the gastrointestinal tract to something in the gut – food or bacteria in the intestines, or even the lining of the bowel – that causes uncontrolled inflammation.
A variety of diagnostic procedures and laboratory tests are used to distinguish ulcerative colitis from other conditions. First, your doctor will review your medical history and perform a complete physical examination. One or more of the following tests may be ordered:
Treatment can include drug therapy, dietary modifications and/or surgery. Though treatments cannot cure ulcerative colitis, they can help most people lead normal lives.
It is important for you to seek treatment as soon as you start having symptoms. If you have severe diarrhea and bleeding, hospitalization may be necessary to prevent or treat dehydration, reduce your symptoms and ensure that you receive proper nutrition.
Several medications, including 5-aminosalicylic drugs, corticosteroids, immunosuppressive agents and antibiotics, are used to reduce inflammation of the bowel tissue, allowing it to heal and relieve symptoms.
For mild to moderate ulcerative colitis, your doctor or dietitian may recommend a diet high in protein and calories and low in fiber.
Surgery, in which the entire colon is removed, may be necessary when medications are not effective or if you have severe complications of the disease.
Surgery to remove the entire large intestine (colectomy),or both the colon and rectum (proctocolectomy) removes the threat of colon cancer.
If the entire colon is removed, the operation may create an opening, or stoma, in the abdominal wall, to which a bag is attached (ileostomy). The tip of the lower small intestine is brought through the stoma. Stools pass through this opening and collect in an external pouch, which is attached to the stoma and must be worn at all times.
The pelvic pouch, or ileal pouch-anal anastomosis (IPAA), is a procedure that does not require a permanent stoma. In this procedure, the colon and rectum are removed, and the small intestine is used to form an internal pouch or reservoir that will serve as a new rectum. This pouch is connected to the anus. The reservoir is called a J-pouch. This procedure is frequently done in two to three operations and requires a temporary ileostomy in between.
The continent ileostomy (Kock pouch) is an option for people who would like their old-style ileostomy converted to an internal pouch and for people who don't qualify for the IPAA procedures. In this procedure, there is a stoma but no bag. The colon and rectum are removed, and an internal reservoir is created from the small intestine. An opening is made in the abdominal wall, and the reservoir is then joined to the skin with a nipple valve. To drain the pouch, you insert a catheter through the valve into the internal reservoir.
If you have been told you need surgery to treat ulcerative colitis, you may want to seek a second opinion to ensure the treatment prescribed is the most appropriate. Make sure your diagnosis is confirmed by experts at an institution experienced in identifying and treating digestive disorders.
Call your doctor immediately if:
We recommend that patients with ulcerative colitis undergo a colonoscopy every one to three years. During these procedures, biopsy samples should be taken every 10 cm along the length of the colon; and if any of these samples reveals dysplasia, a total proctocolectomy should be considered.
People with inflammatory bowel disease have a lifetime risk of colorectal cancer at least three times as high as in the general population. Moreover, they tend to develop colorectal cancer much earlier in their lives than do people with sporadic colon cancer. The longer the person has had inflammatory bowel disease and the more extensive it is, the greater the risk. However, proctitis (swelling of the anus and rectum) poses no increase in risk for rectal cancer.
Since the risk of dysplasia or cancer increases with the duration of ulcerative colitis, testing should be done more frequently as duration of disease increases. One method calls for testing every three years for the first 15 years of disease, every two years for the next 10 years, and every year thereafter. Such an approach provides for at least 20 examinations in 40 years of disease. Most of the evaluations would be performed in the later years when the risk is the highest.
A history of primary sclerosing cholangitis, a liver disease associated with ulcerative colitis, adds significantly to the already high risk of dysplasia and colorectal cancer in patients with ulcerative colitis. Therefore, at the same duration of disease, patients with primary sclerosing cholangitis should be tested more often, perhaps every year. For these patients, prophylactic colectomy may offer the best alternative in terms of life expectancy.
Because dysplasia can be present focally (in one spot) as well as diffusely (all over), biopsies must be taken throughout the colon. The sensitivity of testing for detecting dysplasia is increased with a greater number of biopsies taken. At least 32 biopsies should be taken of flat mucosa and of raised lesions.
Any biopsy that is positive for dysplasia poses an inordinately high risk of colorectal cancer; the risk of concurrent cancer has been reported to be as high as 19 percent in patients with low-grade dysplasia and 42 percent in patients with high-grade dysplasia. A total proctocolectomy is usually recommended for all patients with low-grade dysplasia, high-grade dysplasia, or cancers found at colonoscopy.
Research is ongoing to determine whether alternative markers of malignancy or improved visualization of the colon with chromoendoscopy, narrow band imaging, or autofluorescence can significantly improve the sensitivity of the present surveillance techniques to detect dysplasia.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 03/20/2016