Ulcerative colitis (UC) (sometimes called colitis ulcerative) 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 bleeding(1)1. 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, light sensitivity and liver disease. Some forms of arthritis, skin ulcers and visual symptoms may respond to anti-inflammatory medical therapies(2).
The diagnosis of UC is usually confirmed by a colonoscopy procedure. 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. The most commonly prescribed drugs are:
- Various forms of sulfa drugs – Dipentum, Asacol
- Cotricosteroids, such as Prednisone and Methylprednisolone
- Various immunosuppresive agents like 6-Mercaptopurine and Azathioprine
- Metronidazole antibiotic with immune system effects, frequently helpful in anal disease.
- Biologic agents (Humira, Remicaid, others)
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 seven 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 healthcare 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.
- Current Surgical Therapy 8th ed., Cameron. 2005.
- Current Therapy in Colon and Rectal Surgery 2nd ed., Fazio, Church, Delaney. 2005.
For advanced, specialized care, visit Dayton Colon & Rectal Center. Our colitis ulcerative patients come to us from the area of Miami Valley, in the greater Dayton area and in the greater Springfield area, including: Dayton, Huber Heights, Centerville, Englewood and Kettering in Montgomery County, OH; Springfield in Clark County, OH; and Beavercreek and Xenia in Green County, OH. Call us at 937.435.8663 or fill out our online Request an Appointment form to schedule a consultation with one of our colorectal specialists.