Get answers to your Ulcerative Colitis questions.
Ulcerative colitis is a common condition of the colon that affects approximately 600,000 people in the United States. Ulcerative colitis usually affects young adults (patients in their 20’s and 30’s) but can affect children and older adults as well. The cause of ulcerative colitis is not known; however, most experts agree that genetics (traits passed on from your parents), the environment, and the patient’s immune system (cells that fight off infection) play an important role in the disease. Common symptoms of ulcerative colitis include:
No medicines will cure a patient; therefore patients must deal with the illness for their entire lifetime unless the colon is removed. Patients typically will have periods of active symptoms ("flares") followed by symptom-free periods ("remission"). The symptoms can have a negative impact on quality of life for patients. However, most patients continue to work and have productive lives.
Many different tests are used to diagnosis patients with ulcerative colitis. Although blood tests are usually ordered, these alone cannot diagnosis ulcerative colitis without further testing. Blood tests often reveal that inflammation is present in the body. Frequently, patients can have low blood counts (“anemia”) because of bleeding from ulcerative colitis. Some special blood tests are now offered that can help make an accurate diagnosis. A colonoscopy is required to confirm the diagnosis of ulcerative colitis.
A colonoscopy is a procedure performed when the patient is sedated that allows the doctor to view the entire colon and a portion of the small bowel called the ileum. All patients with ulcerative colitis will have abnormalities in the lining of the colon that can be seen during colonoscopy. Biopsies of the abnormal areas confirm the diagnosis of ulcerative colitis. Other tests used to exclude disorders that cause symptoms similar to ulcerative colitis include: upper endoscopy (EGD), upper GI series and small bowel follow through (X-ray test of intestines), CT (CAT) scan, barium enema, MRI, and capsule endoscopy.
Current therapies to treat patients with ulcerative colitis include aminosalicylates (“5-ASA”), steroids, immune suppressants, and biologic therapy (medications that block specific inflammatory molecules important in ulcerative colitis). For some of these drugs, treatments are available in pill form, enemas, injections under the skin, and intravenous infusions. Although medical treatment can be effective in controlling the symptoms of ulcerative colitis, patients must take medications continuously to prevent the symptoms from returning.
Patients typically receive drugs based on a pyramid or “Step up” approach. For example, if patients have mild symptoms, they receive less powerful therapies lower in the pyramid with fewer side effects. However, as symptoms worsen or if patients are sicker when diagnosed, they receive more aggressive therapies higher in the pyramid. Despite medical therapy, 20-30% of patients will have a colectomy (removal of the colon) during their lifetime. A colectomy relieves the colitis symptoms and is curative.
Although patients usually require a colostomy (bag attached to the belly wall that collects fecal waste) after colectomy, another surgical procedure can be performed in many patients later to reverse the ostomy called a restorative proctocolectomy or J pouch. This procedure allows patients to have bowel movements without an ostomy. There have been many advances in surgery for ulcerative colitis. The most significant are development of restorative proctocolectomy and use of minimally invasive surgery (laparoscopy).
Most gastroenterologists and surgeons can provide care for patients with ulcerative colitis. However, the University of Maryland Inflammatory Bowel Disease Program has several unique aspects that set it apart from other providers caring for patients with Crohn’s disease: