Ulcerative colitis

Ulcerative colitis is an inflammatory disease of the bowel, that usually affects the distal end of the large intestine and rectum. It has no known cause, although there is a genetic component to susceptibility.

Ulcerative colitis is similar to Crohn's disease, but there are characteristic differences: ulcerative colitis is usually confined to the mucosa and submucosa, and affects whole areas of intestine. (Crohn's disease tends to be patchy, and affect more layers of intestine.)

Features

• Chronic (> 6 months) of bloody diarrhea.
• No infective cause of diarrhea found.
• Inflammatory changes are mainly left sided or in the distal large bowel.
• Disease variable in severity from patient to patient and time to time.
• Significant risk of carcinoma after 10 years, which may in some cases require frequent surveillance biopsies or even prophylactic bowel removal.
• Patients may have other auto-immune features.
• Prevalent in former smokers. Stopping smoking can cause a reduction in the protective mucus lining the colon. When this protective mucus is reduced, the bacteria in the colon can attack the colon lining causing the immune system to become active and fight the bacteria. For unknown reasons, this causes damage to the lining (ulcers) of the colon walls in one or more places. Resumption of nicotine either through patches or smoking can extend remission time although the benefits versus the other health risks of smoking are questionable.

Cause

The cause of ulcerative colitis is unknown, although infective agents have been suspected, and there is a genetic component to susceptibility.

Diagnosis

A long-standing history of bloody diarrhea, with no sign of infection, is consistent with ulcerative colitis. A biopsy can help confirm the diagnosis. Ulcerative colitis mainly affects the left side of the colon.

Course

People with ulcerative colitis will initially have bloody diarrhea (the severity of which is variable from time to time).

Because of destruction of the nerves in the bowel, movement may be impaired, and the intestine may dilate. This results in an extreme diarrheal disease, toxic megacolon.

Eventually the inflamed mucosa develops a risk of malignancy, requiring biopsy every few months. Sometimes the risk of malignancy is such that bowel resection is offered.

Treatment

Anti-diarrheal drugs (such as loperamide) should be avoided unless under specific doctors orders, as they can worsen the disease.

Anti-inflammatory drugs (such as sulfasalazine or mesalamine) can be used, and in severe cases steroids may be given.

See also

• Aphthous stomatitis
• Cholangiocarcinoma
• Crohn's disease
• Inflammatory bowel disease
• Primary sclerosing cholangitis

Health science - Medicine - Gastroenterology

Diseases of the esophagus - stomach

Halitosis - Nausea - Vomiting - GERD - Achalasia - Esophageal cancer - Esophageal varices - Peptic ulcer - Abdominal pain - Stomach cancer - liver - pancreas - gallbladder - biliary tree

Hepatitis - Cirrhosis - NASH - Budd-Chiari syndrome - Hepatocellular carcinoma - Pancreatitis - Pancreatic cancer - Gallstones - Cholecystitis

Diseases of the small intestine

Peptic ulcer - Malabsorption (e.g. celiac disease, lactose intolerance, fructose malabsorption, Whipple's disease) - Lymphoma

Diseases of the colon

Diarrhea - Appendicitis - Diverticulitis - Diverticulosis - IBD (Crohn's disease and Ulcerative colitis) - Irritable bowel syndrome - Constipation - Colorectal cancer - Hirschsprung's disease - Pseudomembranous colitis