Complications:

Complications in the Intestine

Malabsorption and Malnutrition. Malabsorption is the inability of the intestines to absorb nutrients. In IBD, this occurs as a result of bleeding and diarrhea, as a side effect from some of the medications, and as a result of surgery. Malnutrition may occur in ulcerative colitis, but it tends to be less severe than with Crohnâ ' s disease.

Toxic Megacolon. Toxic megacolon is a serious complication that can occur if inflammation spreads into the deeper layers of the colon. In such cases, the colon enlarges and becomes paralyzed. In severe cases, it may rupture, which is a life-threatening event needing emergency surgery. Symptoms include weakness and abdominal pain and bloating.

Toxic megacolon is characterized by extreme inflammation and distention of the colon. Common symptoms are pain, distention of the abdomen, fever, rapid heart rate, and dehydration. This is a life-threatening complication that requires immediate medical treatment.

Bleeding. Bleeding due to ulcers in the colon is a common complication of UC. It can increase the risk for anemia. In some cases, bleeding can be massive and dangerous, requiring surgery.

Intestinal Infections. Inflammatory bowel disease can increase patientsâ ' susceptibility to Clostridium difficile, a species of intestinal bacteria that causes severe diarrhea. It is usually acquired in a hospital. However, several recent studies indicate that C. difficile is increasing among patients with inflammatory bowel disease and that many patients acquire this infection outside of the hospital setting. Patients with ulcerative colitis are at particularly high risk.

Colorectal Cancers. Patients with ulcerative colitis have a higher than normal risk for cancers of the colon and rectum. About 5 - 8% of patients with ulcerative colitis will develop colorectal cancer within 20 years of their ulcerative colitis diagnosis. The risk of colorectal cancer increases with the duration of the disease, severity of disease, and how much of the colon is involved. (The risk is highest for patients with pancolitis, which involves the entire large intestine.) Cancer risk increases significantly after 8 - 10 years with pancolitis and after 12 - 15 years for left-sided colitis. The American Cancer Society recommends that patients with inflammatory bowel disease at these stages receive colonoscopies (screening tests for colorectal cancer) every 1 - 2 years with biopsies to test for dysplasia (precancerous changes in cells). [For more information, see In-Depth Report #55: Colon and rectal cancers.]

Complications outside the Intestine

Eyes. Inflammation in the pigmented part of the eye, a condition called uveitis, is a common complication.

Joints. There is a fairly strong association with seronegative spondyloarthropathies (psoriatic arthritis, ankylosing spondylities, and other disorders). Arthritis involves joints of the limbs and the spine.

Bones. Ulcerative colitis, and the corticosteroid and other immune-suppressing drugs used to treat it, can cause osteopenia (low bone density) and osteoporosis (bone loss).

Liver and Gallbladder Disorders. People have a higher than average risk for mild but not severe liver abnormalities. There is a higher risk (although rare) for primary sclerosing cholangitis, which is persistent inflammation of the bile duct that can later cause serious obstruction.

Skin Disorders. Patients with ulcerative colitis have a higher risk for skin disorders and may experience ulcer eruptions called pyoderma gangrenosum that heal in the center and spread. Patients may also have mouth sores.

Thromboembolism (Blood Clots). People with inflammatory bowel disease are at higher risk for blood clots, especially deep venous thrombosis where blood clots form in the legs. They are also at risk for pulmonary embolism, when a blood clot travels from the legs to the lungs.

Kidney Stones. People with ulcerative colitis have a higher than normal risk for kidney stones.

Delayed Growth and Development in Children. Children with ulcerative colitis are at slightly higher than average risk for delayed growth, but their risk is lower than with Crohn's disease.

Emotional Factors. The emotional consequences of ulcerative colitis cannot be overestimated. Eating becomes associated with fear of abdominal pain before the end of the meal. Frequent attacks of diarrhea can cause such a strong sense of humiliation that social isolation and low self-esteem may result. Ulcerative colitis takes a serious toll on work, family, and social activities. According to a one survey, 40% of patients report incapacitating symptoms at least 180 days per year. Adolescents with IBD may have added problems that increase emotional distress, including weight gain from steroid treatments and delayed puberty.