What is ulcerative colitis?
Ulcerative colitis is an inflammatory bowel disease in which the inner lining of the large intestine (colon or bowel) and rectum become inflamed. Inflammation usually begins in the rectum and lower (sigmoid) intestine and spreads upward to the entire colon. Ulcerative colitis rarely affects the small intestine except for the lower section, the ileum.

The inflammation causes diarrhea, or frequent emptying of the colon. As cells on the surface of the lining of the colon die and slough off, ulcers (open sores) form, causing pus, mucus, and bleeding.

Although children and older people sometimes develop ulcerative colitis, it most often affects people ages 15 to 40. It affects males and females equally and appears to run in some families.

Ulcerative colitis requires long-term medical care. There may be remissions -- periods when the symptoms go away -- that last for months or even years. However, usually symptoms eventually return.

Only in rare cases, when complications occur, is the disease fatal. If only the rectum and lower colon are involved, the risk of cancer is not higher than normal. However, the risk of colon cancer is greater than normal in patients with widespread ulcerative colitis.

What are the symptoms of ulcerative colitis?
The following are the most common symptoms for ulcerative colitis, however, each individual may experience symptoms differently. Symptoms may include:

• abdominal pain
• bloody diarrhea
• fatigue
• weight loss
• loss of appetite
• rectal bleeding
• loss of body fluids and nutrients
• anemia caused by severe bleeding

Inflammatory bowel diseases (IBD) include a group of chronic disorders that cause inflammation or ulceration in the small and large intestines. Most often IBD is classified as:

• ulcerative colitis - causes ulceration and inflammation of the inner lining of the colon and rectum.

• Crohn's disease - an inflammation that extends into the deeper layers of the intestinal wall, and also may affect other parts of the digestive tract, including the mouth, esophagus, stomach, and small intestine.

Ulcerative colitis and Crohn's disease cause similar symptoms that often resemble other conditions, such as irritable bowel syndrome. The correct diagnosis may take some time.

Inflammatory bowel disease may also be referred to as colitis, enteritis, ileitis, and proctitis.

• skin lesions
• joint pain
• inflammation of the eyes
• liver disorders
• osteoporosis
• rashes
• anemia
• kidney stones

The symptoms of ulcerative colitis may resemble other conditions or medical problems. Consult your physician for a diagnosis.

What causes ulcerative colitis?
Although many theories about what causes ulcerative colitis exist, none has been proven. The cause of ulcerative colitis is unknown, and currently there is no cure, except through surgical removal of the colon. A theory suggests that some agent, possibly a virus or an atypical bacterium, interacts with the body's immune system to trigger an inflammatory reaction in the intestinal wall.

Although much scientific evidence shows that people with ulcerative colitis have abnormalities of the immune system, physicians do not know whether these abnormalities are a cause or result of the disease.

There is little proof that ulcerative colitis is caused by emotional distress or sensitivity to certain foods or food products, or is the result of an unhappy childhood.

How is ulcerative colitis diagnosed?
A thorough physical exam, including blood tests to determine whether an anemic condition exists, or if the white blood cell count is elevated (a sign of inflammation), is part of the diagnostic process. Symptoms that suggest ulcerative colitis may also be evaluated by:

• stool sample to check for bleeding or infection

• colonoscopy to look inside the colon

• biopsy - removal of a sample of tissue from the lining of the colon to examine under the microscope

• barium enema x-ray of the colon - used to determine the nature and extent of disease: barium shows up white on x-ray film, revealing growths and other abnormalities in the colon

Treatment for ulcerative colitis:
Specific treatment will be determined by your physician(s) based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

While there is no special diet for ulcerative colitis, patients may be able to control mild symptoms simply by avoiding foods that seem to upset their intestines.

When treatment is necessary, it must be tailored for each case, because what may help one patient may not help another. Patients are also given needed emotional and psychological support. Treatment may include:

• medication
  Abdominal cramps and diarrhea may be helped by medications to lessen inflammation in the colon. More serious cases may require steroid drugs, antibiotics, or drugs that affect the body's immune system.

• hospitalization
  Patients with ulcerative colitis occasionally have symptoms severe enough to require hospitalization to correct malnutrition and to stop diarrhea and loss of blood, fluids, and mineral salts. The patient may need a special diet, feeding through a vein, medications, or, sometimes, surgery.

• surgery
  Most people with ulcerative colitis do not need surgery. However, about 20 to 40 percent of ulcerative colitis patients eventually require surgery for removal of the colon because of massive bleeding, chronic debilitating illness, perforation of the colon, or risk of cancer. Sometimes removing the colon is suggested when medical treatment fails or the side effects of steroids or other drugs threaten the patient's health.

There are several surgical options:

• proctocolectomy
  The most common surgery is the proctocolectomy (removal of the entire colon and rectum) with ileostomy (creation of a small opening in the abdominal wall where the tip of the lower small intestine, the ileum, is brought to the skin's surface to allow drainage of waste).

• ileoanal anastomosis
  Sometimes ileoanal anastomosis ("pull-through operation"), an operation that avoids the use of a pouch, can be performed. The diseased portion of the colon is removed and the outer muscles of the rectum are preserved. The ileum is attached inside the rectum, forming a pouch, or reservoir, that holds the waste. This allows the patient to pass stool through the anus in a normal manner, although the bowel movements may be more frequent and watery than usual.

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