Ulcerative Colitis (cont.)
Surgery
Surgery for ulcerative colitis
usually involves removing the entire colon and the rectum. Removal of the colon
and rectum is the only permanent cure for ulcerative colitis. This procedure
also eliminates the risk of developing colon cancer. Surgery in ulcerative
colitis is reserved for the following patients:
- Patients with fulminant colitis and toxic megacolon who are not responding
readily to medications.
- Patients with long standing pancolitis or left-sided colitis who are at
risk of developing colon cancers. Removal of the colon is important when
precancerous changes are detected in the colon lining.
- Patients who have had years of severe colitis which has responded poorly to
medications.
Standard surgery involves the removal of the entire colon,
including the rectum. A small opening is made in the abdominal wall. and the
end of the small intestine is attached to the skin of the abdomen to form an ileostomy. Stool collects
in a bag that is attached over the ileostomy. Recent improvements in
the construction of ileostomies have allowed for continent ileostomies. A
continent ileostomy is a pouch created from the intestine. The
pouch serves as a reservoir similar to a rectum, and is emptied on a regular
basis with a small tube. Patients with continent ileostomies do not need to wear
collecting bags.
More recently, a
surgery has been developed which allows stool to be passed normally through the anus. In an
ileo-anal anastomosis, the large
intestine is
removed and the small intestine is attached
just above the anus. Only the diseased lining of the anus is
removed and
the muscles of the anus remain intact. In this "pull-through"
procedure, the normal route of stool elimination is
maintained.
What research is being done regarding ulcerative colitis?
Infliximab (Remicade) is an antibody that attaches to a protein called tumor
necrosis factor-alpha (TNF-alpha). TNF-alpha is one fo the proteins produced by
immune cells that promote inflammation. By attaching to TNF-alpha, infliximab
blocks its activity and in so doing decreases inflammation.
Infliximab has been used successfully in treating severe Crohn's disease
patients who are not responding adequately to steroids and immunomodulators such
as 6-MP/azathioprine. But for many years doctors thought infliximab would not be
beneficial in treating ulcerative colitis.
Recent studies involving small numbers of patients with severe ulcerative
colitis who are not responding to high dose steroids indicated infliximab may be
beneficial in controlling disease and in decreasing the need for urgent removal
of the colon. Placebo controlled studies involving larger number of
patients will be conducted to determine the efficacy and safety of
infliximab in ulcerative colitis.
Active research is also ongoing to find other anti-TNF agents that are
potentially more effective with less side effects in treating ulcerative
colitis.
Research in ulcerative colitis is very active, and
many questions remain to be answered. The cause, mechanism of inflammation, and
optimal treatments have yet to be defined. Researchers have recently identified
genetic differences among patients which may allow them to select certain
subgroups of patients with ulcerative colitis who may respond differently to
medications. Newer and safer medications are being developed. Improvements in
surgical procedures to make them safer and more effective continue to emerge.
- Ulcerative colitis is an inflammation of the large
intestine (colon).
- The cause of ulcerative colitis is unknown.
- Intermittent rectal bleeding, crampy abdominal pain
and diarrhea often are symptoms of ulcerative colitis.
- The diagnosis of ulcerative colitis can be made with a barium
enema, but direct visualization (sigmoidoscopy or colonoscopy) is the most
accurate means of diagnosis.
- Long-standing
ulcerative colitis is a risk factor for
colon cancer.
- Treatment of ulcerative colitis may involve both
medications and surgery.
- Ulcerative colitis also can cause inflammation in joints,
spine,
skin, eyes, and the liver and its bile ducts.
Last Editorial Review: 8/27/2007
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