Ulcerative Colitis (cont.)
Jay W. Marks, MD
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
In this Article
- Ulcerative colitis facts
- What is ulcerative colitis?
- What causes ulcerative colitis?
- What are the symptoms of ulcerative colitis?
- How is the diagnosis of ulcerative colitis made?
- What are the complications of ulcerative colitis?
- What are the treatments for ulcerative colitis?
- What are ulcerative colitis medications?
- 5-ASA Compounds
- Systemic corticosteroids (including side effects)
- Golimumab (Simponi)
- What are immunomodulator medications?
- Summary of medication treatment
- Surgery for ulcerative colitis
- Treatment by disease severity and location (based on ACG Practice Guidelines)
- Are there any special dietary requirements for persons with ulcerative colitis?
- What research is being done regarding ulcerative colitis?
- Find a local Gastroenterologist in your town
Surgery for ulcerative colitis
Surgery for ulcerative colitis usually involves removing the entire colon and the rectum. Removal of the colon and rectum is the only permanent cure for ulcerative colitis. This procedure also eliminates the risk of developing colon cancer. Surgery in ulcerative colitis is reserved for the following patients:
- Patients with fulminant colitis and toxic megacolon who are not responding readily to medications.
- Patients with long standing pancolitis or left-sided colitis who are at risk of developing colon cancers. Removal of the colon is important when changes are detected in the colon lining.
- Patients who have had years of severe colitis which has responded poorly to medications.
Standard surgery involves the removal of the entire colon, including the rectum. A small opening is made in the abdominal wall and the end of the small intestine is attached to the skin of the abdomen to form an ileostomy. Stool collects in a bag that is attached over the ileostomy. Recent improvements in the construction of ileostomies have allowed for continent ileostomies. A continent ileostomy is a pouch created from the intestine. The pouch serves as a reservoir similar to a rectum, and is emptied on a regular basis with a small tube. Patients with continent ileostomies do not need to wear collecting bags.
More recently, a surgery has been developed which allows stool to be passed normally through the anus. In an ileo-anal anastomosis, the large intestine is removed and the small intestine is attached just above the anus. Only the diseased lining of the anus is removed and the muscles of the anus remain intact. In this "pull-through" procedure, the normal route of stool elimination is maintained. This procedure has a relatively good success rate, although pouchitis (inflammation of the distal ileum now acting as the rectum) is a well known complication (that should be confirmed by endoscopy) that is manifested by increased diarrhea, urgency, bleeding, and pain.
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