Ulcerative Colitis

Ulcerative colitis is an inflammatory disease condition that causes diarrhoea (frequent, loose stools) and ulcers in the lining of the colon and rectum. It can occur at any age and is more common among people of the age group between 15 and 30 years. It has a tendency to run in families. The most common symptoms of ulcerative colitis are pain in the abdomen and blood stained diarrhoea. There may also be symptoms such as anaemia, tiredness, loss of appetite, rectal bleeding, sores on skin, and pain in the joints. Growth failure may occur in children with this disease. In most of the cases, the symptoms of ulcerative colitis are very mild, but when it is severe it causes frequent fever, nausea and painful cramps in the abdomen.

The exact cause of ulcerative colitis is not known. Immune system abnormality is common in patients with ulcerative colitis, but whether it causes the disease or occurs as a result of the disease is not clearly understood. It is believed that the body’s immune system may react in an abnormal way to the microbial flora in the digestive tract. Your physician may order few diagnostic tests after routine physical examination.

• Blood tests: Blood tests are done to check anaemia which suggests bleeding in the colon or rectum. An increased white blood cell count indicates inflammation in the body.
• Stool sample: A stool sample may be examined to detect presence of blood and also to reveal white blood cells, bacteria or viruses.
• Colonoscopy or sigmoidoscopy: These endoscopic tests are the most accurate methods to diagnose ulcerative colitis and rule out other conditions. Your doctor inserts an endoscope (long, flexible tube with a light and camera at one end which is connected to computer and a TV monitor) into the anus to see for any bleeding, inflammation or ulcer on the colon wall and at the same time, a tissue sample may be taken from the colon wall. This biopsy tissue is further examined under a microscope.
• Barium enema or CT scans: These tests are also used to diagnose ulcerative colitis and its complications.

Treatment

Drug Therapy

The goal of drug therapy is to alleviate symptoms and improve the quality of life. Medications such as anti-inflammatory drugs, corticosteroids, and immunomodulators are used to reduce inflammation. Pain relievers and anti-diarrhoea medications may also be prescribed to relieve symptoms. In patients with severe bleeding and severe diarrhoea that causes dehydration, replenishment of lost blood and fluids is done through intravenous administration.

Surgery

Surgical removal of the colon will be recommended if the medical treatment is unable to cure or in conditions such as massive bleeding, rupture of the colon, or risk of colon cancer. Surgical procedure to remove the colon and rectum is known as proctocolectomy and is performed by either an ileostomy or ileoanal anastomosis technique.

• Ileostomy: In this technique, surgeon makes a small opening or stoma in the abdomen and attaches the ileum (end portion of the small intestine) to it. Waste products will be excreted through this stoma. A pouch which collects waste is worn over the stoma.
• Ileoanal anastomosis: In this technique, the colon and the inner part of the rectum are removed, leaving behind the outer muscles of the rectum. Then the ileum is attached to the inside of the rectum and anus to create a pouch where waste is stored until it is excreted through anus in a normal way.