Ulcerative colitis is a disease that causes inflammation and sores, called ulcers, in the lining of the rectum and colon. Ulcers form where inflammation has killed the cells that usually line the colon, then bleed and produce pus. Inflammation in the colon also causes the colon to empty frequently, causing diarrhea.

When the inflammation occurs in the rectum and lower part of the colon it is called ulcerative proctitis. If the entire colon is affected it is called pancolitis. If only the left side of the colon is affected it is called limited or distal colitis.

Ulcerative colitis is an inflammatory bowel disease (IBD), the general name for diseases that cause inflammation in the small intestine and colon. It can be difficult to diagnose because its symptoms are similar to other intestinal disorders and to another type of IBD called Crohn's disease. Crohn's disease differs because it causes inflammation deeper within the intestinal wall and can occur in other parts of the digestive system including the small intestine, mouth, esophagus, and stomach.

Ulcerative colitis can occur in people of any age, but it usually starts between the ages of 15 and 30, and less frequently between 50 and 70 years of age. It affects men and women equally and appears to run in families, with reports of up to 20 percent of people with ulcerative colitis having a family member or relative with ulcerative colitis or Crohn's disease. A higher incidence of ulcerative colitis is seen in Whites and people of Jewish descent.

The most common symptoms of ulcerative colitis are abdominal pain and bloody diarrhea. Patients also may experience:

anemia
fatigue
weight loss
loss of appetite
rectal bleeding
loss of body fluids and nutrients
skin lesions
joint pain
growth failure (specifically in children)

About half of the people diagnosed with ulcerative colitis have mild symptoms. Others suffer frequent fevers, bloody diarrhea, nausea, and severe abdominal cramps. Ulcerative colitis may also cause problems such as arthritis, inflammation of the eye, liver disease, and osteoporosis. It is not known why these problems occur outside the colon. Scientists think these complications may be the result of inflammation triggered by the immune system. Some of these problems go away when the colitis is treated.

Many theories exist about what causes ulcerative colitis. People with ulcerative colitis have abnormalities of the immune system, but doctors do not know whether these abnormalities are a cause or a result of the disease. The body's immune system is believed to react abnormally to the bacteria in the digestive tract.

Ulcerative colitis is not caused by emotional distress or sensitivity to certain foods or food products, but these factors may trigger symptoms in some people. The stress of living with ulcerative colitis may also contribute to a worsening of symptoms.

Ulcerative colitis is an inflammatory, chronic disease which affects the mucosa and submucosa of the colon. The disease starts from the rectum and sigmoid colon and can progress up into the entire colon when left untreated. It rarely affects the small intestine, except for the terminal ileum.

The severity of ulcerative colitis ranges from a mild, localized disorder to a fulminant disease that may cause a perforated colon, which can progress to peritonitis or inflammation of the abdominal wall and toxemia. The escape of potentially harmful waste substances into the abdominal wall could lead to its passage into the bloodstream, leading to toxemia or poisoning.

Causes and Risk Factors

The cause of ulcerative colitis is unknown. Risk factors include:

Family history of the disease
Bacterial infection
Allergic reaction to food, milk and other substances that release inflammatory substances into the bowel
Overproduction of enzymes that break down mucous membranes
Emotional stress
Autoimmune disorders like rheumatoid arthritis, hemolytic anemia, erythema nodosum and uveitis

Signs and Symptoms

Recurrent bloody diarrhea and symptom-free remissions are the hallmark characteristics of ulcerative colitis. The stool typically contains pus and mucus. Other signs and symptoms include:

Spastic rectum and anus
Abdominal pain
Irritability
Weight loss
Weakness
Anorexia
Nausea and bleeding
Fever
Occasional constipation, especially in elderly patients

Diagnostic Tests

Sigmoidoscopy - this procedure can show increased mucosal friability, decreased mucosal detail, and thick, inflammatory exudates. A biopsy during sigmoidoscopy will confirm the diagnosis.

Colonscopy - can help determine the extent of the disease and evaluate strictured areas and pseudopolyps.

Barium enema - this can help examine the severity and extent of the disease as well as indicate complications like strictures and malignant growth.

Stool sample - will often contain the presence of white blood cells, parasites and parasite eggs.

Erythrocyte sedimentation rate - usually shows increased levels according to the severity of the disease.

Electrolytes and proteins - decreased serum levels of potassium, magnesium, albumin and hemoglobin, as well as an increase in white blood cell count and prothrombin time will support the diagnosis.

Treatment

The main goal in the treatment of the disease is to control the inflammation, replace nutritional loses and blood lost and prevent complications from occurring. Supportive treatments include bed rest, IV therapy to replace the lost fluids and a clear, liquid diet.

To correct anemia iron supplements are often given. Corticosteroids like prednisone, hydrocortisone and budesonide are often given to control the inflammation. In some cases where the disease is restricted to the left side of the colon, topical melasamine suppositories or enemas may also be given.

If infection is present sulfasalazine, which is both an anti-inflammatory and antimicrobial drug, may also be used. Surgery is the last resort in most severe cases, especially in patients with toxic megacolon, patients who fail to respond to drug therapy, or those who finds the symptoms unbearable.