Ulcerative Colitis

Inflammatory Bowel Disease (IBD) is a broad term that describes conditions with recurring immune response and chronic inflammation of the gastrointestinal tract. The two most common IBDs are ulcerative colitis and Crohn’s disease. Neither ulcerative colitis nor Crohn’s disease should be confused with irritable bowel syndrome (IBS), a disorder that affects the motility (muscle contractions) of the colon. IBS is not characterized by intestinal inflammation and is therefore much less serious than ulcerative colitis or Crohn’s disease.

IBD is one of the most prevalent digestive diseases in the United States with an overall healthcare cost exceeding $1.7 billion. IBD is without a medical cure and commonly requires a lifetime of care. Each year, IBD accounts for more than 700,000 physician visits, 100,000 hospitalizations, and disability in 119,000 patients.

Both illnesses have one strong feature in common. Normally, the immune cells protect the body from infection. In people with IBD, however, the immune system mistakes food, bacteria, and other materials in the intestine for foreign substances, attacking the intestinal lining. The body then sends white blood cells into the lining of the intestines where they produce chronic inflammation. When this happens, the patient experiences the symptoms of IBD.

Symptoms & Diagnosis

Ulcerative colitis is a chronic gastrointestinal disorder that affects the large intestine in an even and continuous distribution. The disease usually begins in the rectum or sigmoid colon and spreads partially or completely through the large intestine.

Complications of ulcerative colitis are less frequent than in Crohn’s disease and can include severe abdominal bloating, bleeding from deep ulcerations, rupture of the bowel, or failure of the patient to respond to the usual medical treatments. Patients with ulcerative colitis are at increased risk of colon cancer.

A definitive diagnosis can be made by direct examination of the colon by sigmoidoscopy (examination of the lower portion only) or colonoscopy (examination of the entire colon, the preferred approach). Both procedures can be used to take a biopsy of intestinal tissue, which can reveal important information about the extent and degree of inflammation. A barium enema x-ray of the colon may also be required at some point in the course of ulcerative colitis to determine the extent of involvement.

Medical Treatment

Conventional treatments for IBD depend on disease location, severity, complications, and response to prior treatments. Medical therapy may include drugs, surgery, or a combination of both. An early diagnosis is associated with less-aggressive drug regimens and thus a less oppressive burden of side effects. The major groups of drugs for Crohn’s disease are aminosalicylates, steroids, immune modifiers, and antibiotics – each with highly undesirable long-term side effects. Unless significant lifestyle modifications occur, up to 75% of patients with Crohn’s disease and 25% of those with ulcerative colitis will require surgery.

The major classes of medication used to treat ulcerative colitis are aminosalicylates, steroids, immune modifiers, and antibiotics. In one-third of patients with ulcerative colitis, medical therapy is not completely successful or further complications arise. Under these circumstances, surgery may then be recommended. This operation involves the removal of the colon (colectomy). Unlike Crohn’s disease, which can recur after surgery, ulcerative colitis is considered “cured” once the colon is removed. Considering that 80% of the immune system resides in the GI tract, one must consider the consequences of future immune challenges. Unfortunately, this reality is often never discussed.