Ulcerative Colitis (cont.)
How is the Diagnosis of Ulcerative
Colitis Made?
The diagnosis of
ulcerative colitis is suggested by the symptoms of abdominal pain, rectal
bleeding, and diarrhea. Stool specimens are collected for analysis to exclude
infection and parasites, since these conditions can cause colitis that mimics
ulcerative colitis. Blood tests may show anemia and an
elevated white blood cell count or
sedimentation rate (commonly referred to as sed
rate). An elevated white blood cell count and sed rate both reflect ongoing
inflammation in the colon. Confirmation of ulcerative colitis requires a test to
visualize the large intestine. Flexible tubes inserted through the rectum
(sigmoidoscopes and colonoscopes) permit direct visualization of the inside of the colon to
establish the diagnosis and to measure the extent of the colitis. Small tissue
samples
(biopsies) can be obtained during the procedure to determine
the severity
of the colitis.
Knowledge of the extent and severity of the
colitis is
important in choosing among treatment options. A barium enema
x-ray may also indicate the diagnosis of ulcerative colitis. During a barium
enema, a chalky substance is administered into the rectum and injected into the
colon. Barium is radiopaque and can outline the colon on x-ray pictures. A barium
enema is less accurate and useful than direct visualization techniques in the
diagnosis of ulcerative colitis.
What are the Complications of Ulcerative
Colitis?
Patients with ulcerative colitis limited to the rectum (proctitis) or colitis limited to the end of the left colon (proctosigmoiditis) usually do quite well. Brief periodic treatments using oral medications or enemas may be sufficient. Serious complications are rare in these patients. In those with more extensive disease, blood loss from the inflamed intestines can lead to anemia and may require treatment with iron supplements or even
blood transfusions. Rarely, the colon can acutely dilate to a large size when the inflammation becomes very severe. This condition is called toxic megacolon. Patients with toxic megacolon are extremely ill with fever, abdominal pain and distention, dehydration, and malnutrition. Unless the patient improves rapidly with medication, surgery usually is necessary to prevent colon rupture.
Colon cancer is a recognized complication of chronic ulcerative colitis. The risk for cancer begins to rise after eight to ten years of colitis. Patients with only ulcerative proctitis probably do not have increased risk of colon cancer compared to the general population. Among patients with active pancolitis (involving the entire colon) for 10 years or longer, the risk of colon cancer is increased compared to the general population. In patients with colitis limited to the left side of the colon, the risk of colon cancer is increased but not as high as in patients with chronic pancolitis.
The current estimates for the cumulative incidence of colon cancer associated with ulcerative colitis are 2.5% at 10 years, 7.6% at 30 years, and 10.8% at 50 years. Patients at higher risk of cancer are patients with positive family histories of colon cancer, long durations of colitis, extensive colon involvement, and primary sclerosing cholangitis (PSC), another complication of ulcerative colitis.
Since these cancers have a more favorable outcome when diagnosed and treated at an earlier stage, yearly colon examinations may be recommended after eight years of known extensive disease. During these examinations, samples of tissue (biopsies) can be taken to search for precancerous changes in the lining cells of the colon. When precancerous changes are found, removal of the colon may be necessary to prevent colon cancer.
Complications of ulcerative colitis can involve other parts of the body. Ten percent of the patients can develop inflammation of the joints (arthritis). Some patients have
low back pain due to arthritis of the sacroiliac joints. Rarely, patients may develop painful, red, skin nodules (erythema nodosum). Yet others can have painful, red eyes (uveitis, episcleritis). Because these particular complications can risk permanent vision impairment, eye pain or redness are symptoms that require a physician's evaluation. Diseases of the liver and bile ducts may also be associated with ulcerative colitis. For example, in rare patients with a condition called sclerosing cholangitis, repeated infections and inflammation in the bile ducts can lead to recurrent fever, yellowing of skin (jaundice),
cirrhosis, and the need for a liver transplant.
Next: What are the treatments for ulcerative colitis? »
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