Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
The most common symptoms of ulcerative colitis are abdominal pain and bloody
diarrhea. Patients also may experience
anemia
fatigue
weight loss
loss of appetite
rectal bleeding
loss of body fluids and nutrients
skin lesions
joint pain
growth failure (specifically in children)
About half of the people diagnosed with ulcerative colitis have mild
symptoms. Others suffer frequent fevers, bloody diarrhea, nausea, and severe
abdominal cramps. Ulcerative colitis may also cause problems such as arthritis,
inflammation of the eye, liver disease, and osteoporosis. It is not known why
these problems occur outside the colon. Scientists think these complications may
be the result of inflammation triggered by the immune system. Some of these
problems go away when the colitis is treated.
SOURCE: National Digestive Diseases Information Clearinghouse. Ulcerative
Colitis.
What is Ulcerative Colitis?
Ulcerative colitis is a chronic inflammation of the large intestine (colon). The colon is the part of
the digestive system where waste material is stored. The rectum is the end of
the colon adjacent to the anus. In patients with ulcerative colitis, ulcers and
inflammation of the inner lining of the colon lead to symptoms of
abdominal
pain, diarrhea, and
rectal
bleeding.
Ulcerative colitis is closely
related to another condition of inflammation of the intestines called Crohn's
disease. Together, they are frequently referred to
as inflammatory bowel disease (IBD).
Ulcerative
colitis and Crohn's diseases are chronic conditions that can last
years to decades. They affect approximately 500,000 to 2 million people In the
United States. Men and women are affected equally. They most commonly begin
during adolescence and early adulthood, but they also can begin during childhood
and later in life.
It is found worldwide, but is most common in the United States, England, and
northern Europe. It is especially common in people of Jewish descent. Ulcerative
colitis is rarely seen in Eastern Europe, Asia, and South America, and is rare
in the black population. For unknown reasons, an increased frequency of this
condition has been recently observed in developing nations.
First degree relatives of people with ulcerative colitis have an increased
lifetime risk of developing the disease, but the overall risk remains small.
What Causes Ulcerative Colitis?
The causes of ulcerative colitis is not known. To date,
there has been no convincing evidence that it is caused by infection or is contagious.
Ulcerative colitis likely involves abnormal activation of the immune system in the
intestines. The immune system is composed of immune cells and the proteins that
these cells produce. These cells and proteins serve to defend the body against
harmful bacteria, viruses, fungi, and other foreign invaders. Activation of the
immune system causes inflammation within the tissues where the activation
occurs. (Inflammation is, in fact, an important mechanism of defense used by the
immune system.) Normally, the immune system is activated only when the body is
exposed to harmful invaders. In patients ulcerative
colitis, however, the immune system is abnormally and chronically activated in
the absence of any known invader. The continued abnormal activation of the
immune systems causes chronic inflammation and ulceration. The susceptibility to abnormal activation of the immune system is
genetically inherited. First degree relatives (brothers, sisters, children, and
parents) of patients with IBD are thus more likely to develop these diseases.
In the last 1 to 2 years, there have been multiple studies using genome wide association scans investigating genetic susceptibility in ulcerative colitis. These studies have found there to be approximately 30 genes that might increase susceptibility to ulcerative colitis including immunoglobulin receptor gene FCGR2A, 5p15, 2p16, ORMDL3, ECM1, as well as regions on chromosomes 1p36, 12q15, 7q22, 22q13, and IL23R. At this early point in the research, it is still unclear how these genetic associations will be applied to treating the disease, but they might have future implications for understanding pathogenesis and creating new treatments.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Rectal bleeding may be moderate to severe and most bleeding comes from the colon, rectum, or anus. Common causes include anal fissures, hemorrhoids, diverticulitis, and more.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Pink eye, also called conjunctivitis, is redness or irritation of the conjunctivae, the membranes on the inner part of the eyelids and the membranes covering the whites of the eyes. These membranes react to a wide range of bacteria, viruses, allergy-provoking agents, irritants, and toxic agents.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.
Colon cancer is a malignancy that arises from the inner lining of the colon. Most, if not all, of these cancers develop from colonic polyps. Removal of these precancerous polyps can prevent colon cancer.
Clostridium difficile (C. difficile) is a bacterium, and is one of the most common causes of infection of the colon. C. difficile spores are found frequently in hospitals, nursing homes, extended care facilities, and nurseries for newborn infants. They can be found on bedpans, furniture, toilet seats, linens, telephones, stethoscopes, fingernails, rings, floors, infants' rooms, and diaper pails. They even can be carried by pets. Antibiotic-associated (C. difficile) colitis is an infection of the colon caused by C. difficile that occurs primarily among individuals who have been using antibiotics. Treatment for C. difficile colitis hydration, replenishment of electrolyte deficiencies, discontinuing the antibiotic that caused the colitis, and using antibiotics to eradicate the C. difficile bacterium.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Dyspepsia (indigestion) is a functional disease in which the gastrointestinal organs, primarily the stomach and first part of the small intestine, function abnormally. It is a chronic disease in which the symptoms fluctuate infrequency and intensity. Symptoms of dyspepsia include upper abdominal pain, belching, nausea, vomiting, abdominal bloating, early satiety, and abdominal distention (swelling). These symptoms are most often provoked by eating.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
Inflammation of the inner lining of the colon is referred to as colitis. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, Ulcerative colitis, or microscopic colitis). Treatment depends on the cause of the colitis.
The inflammatory bowel diseases (IBD) are Crohn's disease (CD) and ulcerative colitis (UC). The intestinal complications of Crohn's disease and ulcerative colitis differ because of the characteristically dissimilar behaviors of the intestinal inflammation in these two diseases.
Erythema nodosum is a skin inflammation that results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees. Erythema nodosum can resolve on its own in 3 to 6 weeks, leaving a bruised area. Treatments include anti-inflammatory medications and cortisone by mouth or injection.
Corticosteroid drugs such as prednisone and prednisolone are commonly used to treat asthma, allergic reactions, RA, and IBD. Steroids such as these do have serious drawbacks such as steroid withdrawal symptoms such as: fatigue, weakness, decreased appetite, weight loss, nausea, vomiting, abdominal pain, and diarrhea. Speak with your healthcare provider prior to tapering off steroid medications.
Bronchiectasis is a condition in which the bronchial tubes of the lung become damaged. Inflammation from infection or other causes destroys the smooth muscles of the bronchial tubes. Bronchiectasis is a form of COPD (which includes emphysema and chronic bronchitis). There are three primary types of bronchiectasis: 1) cylindrical bronchiectasis; 2) saccular bronchiectasis; and 3) cystic bronchiectasis. Bronchiectasis may also be acquired or congenital. The most common symptoms of bronchiectasis are recurrent cough and sputum production. There is no cure for bronchiectasis. Treatment is often geared toward controlling the symptoms of bronchiectasis.
Primary sclerosing cholangitis (PSC) is a chronic, progressive disease of the bile ducts that channel bile from the liver into the intestines. There is an association between primary sclerosing cholangitis and ulcerative colitis and Crohn's disease. Symptoms of primary sclerosing cholangitis include abnormal liver blood tests, itching, fatigue, and jaundice. Primary sclerosing cholangitis is treated with medications and in some cases, liver transplant.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Biologic rhythms, or biorhythms, are how our bodies respond to the regular phases of the sun, moon, and seasons. A medical chronobiologist studies how the "body clock" or biorhythms affect diseases and how the body clock responds to treatment of diseases and conditions at different times of the day.
Flexible sigmoidoscopy is a procedure that allows your doctor to examine the rectum and the lower (sigmoid) colon. The flexible sigmoidoscope is a flexible tube 60 cm long and about the thickness of your little finger. It is inserted gently into the anus and advanced slowly into the rectum and the lower colon. It is an accurate and simple method of investigating the cause of rectal bleeding, change in bowel habit, and rectal symptoms such as pain and diarrhea. Flexible sigmoidoscopy also is a part of colon screening and surveillance for colon cancer.
What is the preparation for flexible sigmoidoscopy?
In order to obtain accurate results, the rectum and the lower colon must be completely clean of stool. Your doctor will give you detailed instructions on how to cleanse your colon. In general, this requires the use of one or two enemas prior to the procedure and may also call for a laxative and some dietar...
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