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.

Diagnosis

Colonoscopy - in this procedure a doctor uses a long, flexible tube equipped with a camera and light to visualize the entire length of the colon by inserting the tube through the rectum.

Sigmoidoscopy - this is similar to colonoscopy but the visualization is limited to the lower part of the colon
Both procedures will reveal the presence of ulcerations and inflammation as well as the extent of intestinal involvement.

Biopsy - this procedure may be performed along with colonoscopy and may be able to confirm the presence or absence of cancer cells; a regular biopsy is advised for patients with ulcerative colitis to monitor for the growth of abnormal and cancerous cells.

Stool exam - reveals blood and mucus in the stool.

Blood tests - in some patients there may be an elevation in white blood cell count which is an indication of infection.

Symptoms

Ulcerative colitis may present with symptoms similar to Crohn's disease and other bowel problems. The most common manifestations of the disorder are:

Change in bowel habits (diarrhea or constipation)
Abdominal pain often felt in the lower left side of the abdomen
Fever
Weight loss and anorexia
Fatigue
Blood in the stool
Bleeding rectum
Joint pains

Treatment

The main goal in the treatment of ulcerative colitis is the prevention of symptom flare-ups and reduction of inflammation. Anti-inflammatory drugs like aminosalicylates like Mesalazine and Sulfasalazine are often used to prevent or reduce inflammation. Side-effects include nausea and vomiting, reduced sperm count and damage to some organs like the liver and the kidneys. When anti-inflammatory drugs cannot do the job alone, corticosteroids are often included in the treatment regimen.

Steroids like cortisone, hydrocortisone and methylprednisone can also prevent inflammation, although they also come with side effects like "Cushing�s syndrome", which manifests itself as temporary facial swelling termed or puffy face and immunosupression, which leads to an increased susceptibility to infections.

Immunosuppressive drugs like Mercatopurine, Azxathioprine and Methotrexate are also used to prevent immune system reactions. The patient should be monitored when these drugs are given because they can make the patient more susceptible to infections.

Surgery is often the last resort in ulcerative colitis, especially in the case of hemorrhage, formation of holes in the colon or the presence of cancerous cells. It is also the procedure of choice in the event of complications like toxic megacolon and severe colitis.

This entails the removal of the disease portion of the intestine followed by an anastomosis or the creation of a stoma. If hemorrhage has developed patients are often given blood replacements and IV therapy to prevent fluid and electrolyte imbalance. Dietary modification is also an important part of treatment.

Patients are advised to reduce intake of high fat foods, foods that contain high levels off simple sugars, salts, and preservatives. Salty foods should be avoided since they promote dehydration. Gas-forming vegetables like cauliflower cabbages and broccoli should also be avoided.

Patients are advised to maintain an adequate intake of water to prevent dehydration, which is often the result of diarrhea. And because diarrhea can lead to vitamin and mineral deficiencies, patients are often advised to supplement their diet with vitamin and mineral capsules.

Prognosis

Prognosis often depends on the extent of the ulceration. Those with ulcerative colitis in the left side of the colon often show the most promise for recovery while those individuals who have extensive colitis affecting a majority of the colon have a poorer prognosis.

Patients with mild cases of ulcerative colitis are often able to fully return to normal functioning with the help of anti-inflammatory medications. Surgery is rare, except in patients with complications like toxic megacolon, gangrene and intestinal perforation.