Ulcerative Colitis
Shallow and widespread bleeding ulcers are typical
of ulcerative colitis. The inflammation usually occurs
in the rectum and lower part of the colon, but may affect
the entire colon. Constant healing and scarring may
lead to the formation of inflammatory polyps. In some
cases, cancerous cell changes are associated with ulcerative
colitis. It is sometimes difficult to differentiate
between ulcerative colitis and Crohn's disease. Both
cause recurrent bouts of colon inflammation, damage
the digestive tract and can be associated with cancerous
cell changes and complication in the other parts of
the body. However, there are also significant differences.
For example, ulcerative colitis usually occurs only
in the colon, while Crohn's disease can affect any part
of the digestive tract; ulcerative colitis affects the
lining of the colon, while all layers of the intestine
are involved in Crohn's disease; and the inflammation
of the bowel is patchy in Crohn's disease, while it
is continuous in ulcerative colitis. Ulcerative colitis
is slightly more common than Crohn's disease in the
United States.
The first episode of ulcerative colitis often occurs
in late adolescence and maybe severe. Remission is possible,
but it can continue throughout an individual's life.
The exact cause of the disease remains unknown. However,
doctors believe that an agent, such as a virus or bacterium,
alters the body's immune system, triggering inflammation
of the intestinal wall. Other contributing factors may
include genetic predisposition, diet and stress. Ulcerative
colitis may have an autoimmune component, suggested
by the fact that complications of the disease occur
in parts of the body other than the intestine. These
include sacrolitis (inflammation of the sacroiliac joint
at the base of the back), spondylitis (a painful type
of arthritis that affects the joints of vertebrae in
the back), erythema nodosum (a skin condition in which
red areas of swelling appear on the legs), and iritis
(inflammation of the iris in the eye). When the symptoms
of colitis subside, these conditions also generally
improve.
Treatment
Anti-inflammatory drugs are the main treatment for
ulcerative colitis. The goal of both aspirin-based anti-inflammatory
drugs, such as sulfasalazine and corticosteroids, such
as prednisone, is to suppress the inflammatory response
so the body can heal itself. Powerful corticosteroids
more successfully control stubborn cases of inflammation,
but they also have many unwanted side effects. They
include bloating, weight gain, brittle bones, nervousness,
and insomnia. In selected cases, anti-inflammatory drugs
may be administered as enemas to deliver the medication
to the site of the inflammation and reduce side affects.
Other drugs that may be prescribed to manage colitis
include immunosuppressant and antibiotics. Severe attacks
of colitis generally require hospitalization and intravenous
administration of medication. If a great deal of blood
has been lost, a transfusion may be required.
In some cases, surgical removal of all or part of
the colon (a colectomy) becomes necessary. When possible
only part of the colon is removed, the healthy remaining
sections are joined together. This maintains a passageway
for stool. When this is not possible, an opening called
a stoma is made in the abdominal wall to allow discharge
of feces into a bag attached to the skin.
Source: AMA Complete Medical Encyclopedia,
Copyright 2003, American Medical Association
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