ulcerative colitis and treatments

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Ulcerative colitis

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What is Ulcerative Colitis?

• Ulcerative colitis(UC) is a chronic inflammatory
  condition that affects the large bowel and
  rectum. It may also be associated with conditions
  of the skin, eyes, joints and liver. The cause of
  this condition is unknown. It can occur at any
  age but tends to occur between the second and
  forth decades of life with a second peak
  incidence of onset in the seventies. The
  occurrence in the population is 5 per 100,000.

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How it Starts?

• The inflammation commonly begins in the rectum
  (proctitis) and extends a variable distance
  towards the start of the large bowel (colitis).
  The classical symptoms include diarrhea, the
  passage of blood and mucus, urgency to defecate,
  and crampy lower abdominal pain. It can also
  result in weight loss, anaemia, and electrolyte
  deficiencies due to malnutrition and chronic
  blood loss. It may present in a mild form with
  minimal symptoms or be very severe with a life
  threatening illness secondary to toxic colitis.
  UC may also run a remitting and relapsing course
  requiring admissions to hospital for medical
  treatment and life long medication. UC increases
  the risk of bowel cancer and this risk increases
  with the duration of the disease (10 at 20 yrs.).

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Diagnosis

• The diagnosis is based on symptoms, colonoscopy
  findings of diffuse confluent ulceration of the
  inner lining of the large bowel associated with
  pseudo polyps, and biopsy results. Histological
  evaluation of biopsies classically demonstrates
  inflammation restricted to the inner superficial
  layers of the bowel. Of note, there are no blood
  tests that are diagnostic, but are usually used
  to support making the diagnosis.

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Treatments

• Some patients with ulcerative colitis require
  surgery by colorectal surgeon. Most patients are
  treated medically, with anti-inflammatory
  medication (NSAID type drugs/steroids) or
  immunosuppressants (salazopyrine/azothiaprine)
  usually being the first choice of therapy. Some
  progress to corticosteroids or newer
  anti-inflammatory drugs.
• If surgery is required it usually involves
  complete removal of the large bowel and rectum
  with either formation of an ileostomy (end of the
  small bowel is brought out onto the abdominal
  wall) or restoration of intestinal continuity by
  formation of a new rectum with the small bowel
  (ileal pouch) which can them be joined to the
  anus. Patients with an ileal pouch will usually
  experience 4-6 loose bowel motions per day. This
  procedure is usually done in two or three stages
  and can be done either by an open or laparoscopic
  approach, depending on the clinical state of the
  patient.

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