Ulcerative Colitis
Ulcerative colitis is a chronic inflammation of the large intestine (colon). 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. In patients with ulcerative colitis, ulcers and inflammation of
the inner lining of the colon lead to symptoms of abdominal pain, diarrhea, and rectal
bleeding.
Symptoms of ulcerative colitis
anemia
fatigue
weight loss
loss of appetite
rectal bleeding
loss of body fluids and nutrients
skin lesions
joint pain
growth failure (specifically in children)
Bloody diarrhea
Diagnostic test
A physical exam and medical history are usually the first step.
Blood tests may be done to check for anemia, which could indicate bleeding in the colon or
rectum, or they may uncover a high white blood cell count, which is a sign of inflammation
somewhere in the body.
A stool sample can also reveal white blood cells, whose presence indicates ulcerative colitis
or inflammatory disease.
A colonoscopy or sigmoidoscopy are the most accurate methods for making a diagnosis of
ulcerative colitis and ruling-out other possible conditions, such as Crohn’s disease,
diverticular disease, or cancer.
Treatment for ulcerative colitis
Aminosalicylates, drugs that contain 5-aminosalicyclic acid (5-ASA), help control
inflammation. Sulfasalazine is a combination of sulfapyridine and 5-ASA. The sulfapyridine
component carries the anti-inflammatory 5-ASA to the intestine.
Corticosteroids such as prednisone, methylprednisone, and hydrocortisone also reduce
inflammation. They may be used by people who have moderate to severe ulcerative colitis
or who do not respond to 5-ASA drugs.
Immunomodulators such as azathioprine and 6-mercapto-purine (6-MP) reduce
inflammation by affecting the immune system. These drugs are used for patients who have
not responded to 5-ASAs or corticosteroids or who are dependent on corticosteroids.
Surgery
Ileostomy, in which the surgeon creates a small opening in the abdomen, called a stoma,
and attaches the end of the small intestine, called the ileum, to it. Waste will travel
through the small intestine and exit the body through the stoma.
Ileoanal anastomosis, or pull-through operation, which allows the patient to have normal
bowel movements because it preserves part of the anus. In this operation, the surgeon
removes the colon and the inside of the rectum, leaving the outer muscles of the rectum.
vel through the small intestine and exit the body through the stoma.
Pathophysiology
Ulcerative colitis (UC) usually begins in the rectum. It may remain localized to the rectum
(ulcerative proctitis) or extend proximally, sometimes involving the entire colon. Rarely, it
involves most of the large bowel at once.
The inflammation caused by UC affects the mucosa and submucosa, and there is a sharp
border between normal and affected tissue. Only in severe disease is the muscularis
involved. In early cases, the mucous membrane is erythematous, finely granular, and
friable, with loss of the normal vascular pattern and often with scattered hemorrhagic
areas. Large mucosal ulcers with copious purulent exudate characterize severe disease.
Islands of relatively normal or hyperplastic inflammatory mucosa (pseudopolyps) project
above areas of ulcerated mucosa. Fistulas and abscesses do not occur.
