Ulcerative Colitis

Ulcerative colitis is an inflammatory process that involves the lining of the colon and rectum.  The cause of UC is unknown.  Patients with UC commonly complain of diarrhea and rectal bleeding1.  Some may also have complaints of abdominal pain and anal spasms.  The disease usually starts in the rectum and proceeds toward the beginning of the colon.  Consequently, patients with UC have varying degrees of colonic involvement.  The spectrum ranges from only rectal disease to total colon involvement.  The extent of colonic disease is the most important factor with respect to the patient’s overall disease course and in their response to medical treatments.

There are also manifestations of UC that involve other organ systems.  These include arthritis, skin ulcers, blurred vision and light sensitivity, and liver disease.  Some forms of arthritis, skin ulcers, and visual symptoms may respond to anti-inflammatory medical therapies2. 

The diagnosis of UC is usually confirmed by a colonoscopy.   Typically this will be performed by a colon and rectal surgeon or a gastroenterologist.  Furthermore, care is taken to verify that another disease processes that may cause similar symptoms is not the cause of the patient’s complaints.  Once the diagnosis is confirmed, treatment is begun.

Care for the patient with UC involves controlling the diarrhea with anti-diarrheal medications and making sure that adequate hydration is maintained.  The patient may also be placed on a low-fiber diet.  Next anti-inflammatory medications are begun. 

If the disease can not be controlled medically, surgery may become necessary.  Medical failure is defined as the inability to control the symptoms of UC with anti-inflammatory medication.  Also, some may not tolerate the side effects of the medications used to treat this disease.  In both situations, surgical intervention becomes a consideration.  Finally, patients with long standing UC, greater than 7 years, have an increased risk of developing cancer of the colon and rectum.  If precancerous or cancerous tissue is found on a colon biopsy, surgery is recommended. 

Typically, the entire colon and rectum are removed when a patient undergoes surgery for UC.  The patient will evacuate their digestive contents in one of two ways: through an ileostomy or through a “neo-rectum” constructed from small bowel and reconnected to the anus.

 Each person with UC is unique. The extent of their disease, their symptoms, and their desires must be considered by a team of health-care providers with experience in managing this condition.  The array of medical and surgical interventions must be tailored to the needs of the individual.

Link: NIH site for UC.

References:

1. Current Surgical Therapy 8th ed., Cameron. 2005.