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Ulcerative Colitis FAQs

Reviewed by Jay W. Marks, MD

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Q:Is the large intestine the same as the colon?

A:Yes.

Ulcerative colitis is a gastrointestinal disease with chronic inflammation of the large intestine (colon) and the development of intestinal sores, called ulcers. The colon is the part of the digestive system where waste material is stored. The rectum is the end of the colon adjacent to the anus.

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Q:What condition is similar to ulcerative colitis?

A:Ulcerative colitis is related to another inflammatory intestinal condition called Crohn's disease, which can cause chronic inflammation in any part of the gastrointestinal tract.

Together, they are frequently referred to as inflammatory bowel disease, or IBD. Ulcerative colitis and Crohn's disease are conditions that can last years to decades. They most commonly begin during adolescence and early adulthood, but they also can begin during childhood and later in life.

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Q:What are symptoms of ulcerative colitis?

A:Rectal bleeding, cramping abdominal pain, and diarrhea often are symptoms of ulcerative colitis.

Patients also may experience fever, anemia, fatigue, weight loss, loss of appetite, loss of body fluids and nutrients, skin lesions, joint pain, and failure to grow. The latter is specifically seen in children.

About half of the people diagnosed with ulcerative colitis have mild symptoms. Others suffer frequent fevers, bloody diarrhea, and severe abdominal cramps. The symptoms of ulcerative colitis do tend to come and go, with fairly long periods in between flare-ups in which patients may experience no distress at all.

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Q:Worldwide, where is ulcerative colitis most common?

A:Ulcerative colitis is found worldwide, but is most common in the United States, England, and northern Europe.

It is especially common in people of Jewish descent. Ulcerative colitis is rarely seen in Eastern Europe, Asia, and South America, and is rare in the black population. For unknown reasons, an increased frequency of this condition has been recently observed in developing nations.

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Q:Is a person with ulcerative colitis at risk for colon cancer?

A:Yes. Long-standing ulcerative colitis is a risk factor for colon cancer.

More specifically, a person who has had a condition that causes inflammation of the colon (such as ulcerative colitis or Crohn's disease) for many years is at increased risk of developing colorectal cancer. The risk for cancer begins to rise after 8 to 10 years of colitis.

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Q:Ulcerative colitis can be cured with antibiotics. True or False?

A:False. There is no medication that can cure ulcerative colitis.

In terms of treating ulcerative colitis, both medications and surgery have been used to treat the condition. However, surgery is reserved for those with severe inflammation and life-threatening complications. Patients with ulcerative colitis will typically experience periods of relapse (worsening of inflammation), followed by periods of remission (resolution of inflammation). The remission and relapse cycle can last from months to years.

During relapses, symptoms of abdominal pain, diarrhea, and rectal bleeding worsen. During remissions, these symptoms subside. Remissions usually occur because of treatment with medications or surgery, but occasionally they occur spontaneously, that is, without any treatment.

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Q:Smokers are more likely to develop ulcerative colitis. True or False?

A:False.

It has long been observed that the risk of ulcerative colitis appears to be higher in nonsmokers and in ex-smokers. In certain circumstances, patients improve when treated with nicotine.

One must also keep in mind that although smoking may be slightly beneficial for ulcerative colitis, it increases the risk of lung and cardiovascular disease for both the individuals who smoke and are exposed to secondhand smoke.

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Q:What causes ulcerative colitis?

A:The cause of ulcerative colitis is unknown.

Doctors and scientists believe that ulcerative colitis likely involves the abnormal activation of the immune system in the intestines. Normally, the immune system is activated only when the body is exposed to harmful invaders such as bacteria, viruses, and fungi. In patients with ulcerative colitis, however, the immune system is abnormally and chronically activated in the absence of any known invader. This continued abnormal activation of the immune systems causes chronic inflammation and ulceration.

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Q:Complications of ulcerative colitis are limited to the intestines. True or False?

A:False.

Beyond affecting the intestines, complications of ulcerative colitis often involve bleeding from deep ulcerations, rupture of the bowel, severe abdominal bloating, or failure of the patient to respond to the usual medical treatments. Still, complications of ulcerative colitis are not limited to the intestines or the abdomen, as complications of ulcerative colitis can involve other parts of the body. For example:
- 10% of the patients can develop inflammation of the joints (arthritis).
- Some patients have low back pain due to arthritis of the sacroiliac joints.
- Patients with ulcerative colitis also might have an increased tendency to form blood clots.

Moreover, ulcerative colitis can affect a person's life in many ways. Some people avoid going out in public for fear of having pain, gas, or diarrhea. Also, the disease and its treatment can make it difficult to have a pleasurable sex life.

Living with a chronic disease like ulcerative colitis can also lead to depression. With support and a doctor's help, people with ulcerative colitis can learn to cope with the emotional and physical effects of this condition.

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Q:People with ulcerative colitis should avoid gluten to prevent flare-ups. True or False?

A:False.

Although it seems reasonable that a specialized diet might benefit patients with ulcerative colitis, there is actually no evidence to support treatment with dietary modification. Therefore, during flare-ups, patients should continue to eat what they can tolerate.

Despite extensive research, no diet has been found to slow progression of the disease, or to treat or cure the disease. It is recommended that patients stay on a balanced, healthy diet rich in fruits, vegetables, grains, lean meats, beans, fish, eggs, and nuts.

The Crohn's and Colitis Foundation of America recommends a bland diet with soft food during a flare including hot cereals, boiled eggs, mashed potatoes, steamed vegetables, and canned or cooked vegetables to minimize discomfort.

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