Ulcerative Colitis

In this Article

• 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?
• 5-ASA compounds (Azulfidine, Asacol, Pentasa, Dipentum)
• Systemic corticosteroids (including side effects)
• What are immunomodulator medications?
• Summary of medication treatment
• Surgery
• What research is being done regarding ulcerative colitis?
• Ulcerative Colitis At A Glance
• Pictures of Digestive Disease Myths - Slideshow
• Patient Discussions: Ulcerative Colitis - Symptoms Experienced

Surgery

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:

1. Patients with fulminant colitis and toxic megacolon who are not responding readily to medications.

2. Patients with long standing pancolitis or left-sided colitis who are at risk of developing colon cancers. Removal of the colon is important when precancerous changes are detected in the colon lining.

3. 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.

What research is being done regarding ulcerative colitis?

Infliximab (Remicade) is an antibody that attaches to a protein called tumor necrosis factor-alpha (TNF-alpha). TNF-alpha is one fo the proteins produced by immune cells that promote inflammation. By attaching to TNF-alpha, infliximab blocks its activity and in so doing decreases inflammation.

Infliximab has been used successfully in treating severe Crohn's disease patients who are not responding adequately to steroids and immunomodulators such as 6-MP/azathioprine. But for many years doctors thought infliximab would not be beneficial in treating ulcerative colitis.

Recent studies involving small numbers of patients with severe ulcerative colitis who are not responding to high dose steroids indicated infliximab may be beneficial in controlling disease and in decreasing the need for urgent removal of the colon. Placebo controlled studies involving larger number of patients will be conducted to determine the efficacy and safety of infliximab in ulcerative colitis.

Active research is also ongoing to find other anti-TNF agents that are potentially more effective with less side effects in treating ulcerative colitis.

Research in ulcerative colitis is very active, and many questions remain to be answered. The cause, mechanism of inflammation, and optimal treatments have yet to be defined. Researchers have recently identified genetic differences among patients which may allow them to select certain subgroups of patients with ulcerative colitis who may respond differently to medications. Newer and safer medications are being developed. Improvements in surgical procedures to make them safer and more effective continue to emerge.

Ulcerative Colitis At A Glance

• Ulcerative colitis is an inflammation of the large intestine (colon).
  
  
• The cause of ulcerative colitis is unknown.
  
  
• Intermittent rectal bleeding, crampy abdominal pain and diarrhea often are symptoms of ulcerative colitis.
  
  
• The diagnosis of ulcerative colitis can be made with a barium enema, but direct visualization (sigmoidoscopy or colonoscopy) is the most accurate means of diagnosis.
  
  
• Long-standing ulcerative colitis is a risk factor for colon cancer.
  
  
• Treatment of ulcerative colitis may involve both medications and surgery.
  
  
• Ulcerative colitis also can cause inflammation in joints, spine, skin, eyes, and the liver and its bile ducts.

Ulcerative Colitis - Symptoms Experienced

The MedicineNet physician editors ask:

For ulcerative colitis, what were the symptoms and signs you experienced?

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