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WHAT IS THE CAUSE OF ULCERATIVE COLITIS?

Despite extensive and continuing research, the cause is still unknown. However, there are a number of predisposing factors which may play a part in the development of the disease.

1. Genetics and heredity
There is a slightly increased risk of developing ulcerative colitis if a near relative has the disease. Twin studies have shown that ther is a higher incidence of ulcerative colitis amongst identical twins than in non-identical twins, suggesting a genetic link.

2. Infection
Some cases of ulcerative colitis start after an episode of gastroenteritis.

3. Psychological factors
Persons affected are often ‘high achievers.’ Although stress is not a proven cause of the disease, it can make it worse.

4. Immunological factors
It is possible that the body’s own defence system (immune system) is acting against the bowel lining and many drugs used to treat ulcerative colitis affect the immune system.

However, it is likely that immunological changes are produced after the disease started, rather than causing it themselves.

WHAT ARE THE SYMPTOMS OF ULCERATIVE COLITIS?

The symptoms of ulcerative colitis vary according to the extent and severity of the inflammation.

Mild disease
Inflammation is usually limited to the rectum or recto-sigmoid area, and causes diarrhoea, rectal bleeding or both. Mild ulcerative colitis can be mistaken for haemorrhoids.

Moderate disease
Symptoms become more severe:

1. Diarrhoea is a major feature with frequent loose stools containing blood.

2. Crampy abdominal pain which may be relieved by passing a motion.

3. Increased inflammation leads to general symptoms of mild fever, tiredness,fatigue, poor appetite and weight loss.

4. Symptoms may arise elsewhere in the body, e.g. arthritis, inflammation of the eye or skin.
Severe or fulminant disease

The onset is sudden with severe symptoms including:

1. Profuse diarrhoea with constant rectal bleeding.

2. High fever.

3. Tenesmus (a constant desire to have the bowels opened).

4. Loss of appetite and weight.

5. Fatigue and weakness.

6. Distended (swollen) abdomen.

7. Abdominal cramps and tenderness over the colon.

 

TREATMENT OF ULCERATIVE COLITIS

The aim of treatment is to control inflammation, maintain remission and prevent complications, thereby improving quality of life.

Treatments include:

Medical Treatment

1. Anti inflammatory drugs
e.g. Sulphasalazine (Salazopyrin)
– Mesalazine – Pentasa
– Asacol
– Olsalazine – Dipentum

These are all 5-Aminosalicylic Acid related drugs in various forms which are released at various sites within the large bowel. (Pentasa is a slow release form of mesalazine and is also effective in the small bowel).
They can be given as either a tablet or enema or suppository.

2. Corticosteroids
Steroid preparations given by mouth, injection, suppository or enema
e.g. – Prednisolone
– Hydrocortisone
– Predsol
– Predfoam,

3. Antibiotics
Inflamed areas may become infected and require antibiotics such as:
– Metronidozole (Flagyl)
– Ciprofloxacillin

4. Bulking agents
Rectal or left-sided colitis may be aggravated by right-sided (proximal) constipation. The following preparations may be helpful in providing bulk in the colon which stimulates a bowel motion as they absorb fluid and cause pressure on the bowel wall.
– Normacol
– Fybogel
– Methylcellulose (Celevac)

5. Correction of dehydration
Water and salts can very quickly be lost from the body due to continued watery or bloody diarrhoea. Oral rehydration solutions, such as dioralyte, may help initially but on admission to hospital for fluids into the vein may be necessary in severe disease.

6. Diet
There is no evidence that diet has any effect on the treatment of ulcerative colitis but avoiding certain foods may help some people, e.g. milk products may make the diarrhoea and wind worse if you are intolerant to the milk sugar, lactose. Some people believe that it makes the mucus worse also. If you find that this is true for you, then avoid these foods but you should not avoid anything unnecessarily.

You may also find that coarse fibre is a problem, (e.g. granary bread and some cereals), particularly when the rectum is sore and inflamed. Constipation is often associated with distal colitis and may aggravate the condition. In this situation a bulk laxative is advised instead, e.g. methylcellulose, Fybogel or Normacol, with an increased fluid intake to soften and regulate the motions.

A high calorie, high protein diet can help replace lost nutrients and regain energy.

7. Supplements
In active inflammation certain vitamins and minerals may be lost from the body. Low levels of iron may also result from continued loss of blood in the motions. Supplements of multivitamins and iron tablets may help.

8. Rest
Frequent diarrhoea can be very tiring and it is important to conserve energy and allow healing to take place. Avoid situations which you know are going t cause stress as this may make the inflammation worse.

SURGICAL TREATMENT

The vast majority of patients with ulcerative colitis never require surgery.

However, if the disease is severe and does not respond to medical treatment, it may be advised.

Surgical treatment of ulcerative colitis involves removal of the colon, curing the disease completely.

Two main operations are carried out:

1. Following removal of the colon, the remaining small bowel is joined to the anus. In this operation, a pouch is formed from loops of small bowel (ileum) and allows the continued passage of stools via the anus. This operation is called an ileo-anal anastamosis or a Park’s pouch, after Sir Alan Park who invented it.

2. If the above operation cannot be performed, the end portion of the small bowel is brought out onto the abdominal wall to form a stoma over which a bag is placed to collect waste material (ileostomy). The anus no longer works.

COMPLICATIONS OF ULCERATIVE COLITIS

If treatment is not carefully followed and occasionally in very severe cases, complications may occur:

These include:
1. Haemorrhage
This is bleeding from the bowel and may require blood transfusions or an operation.

2. Perforation
This is a hole in the bowel caused by thinning of the lining due to inflammation. It may cause leaking of the contents into the abdomen (peritonitis) and may require an operation.

3. Stricture formation
Strictures are areas of narrowing in the bowel caused by inflammation and scarring. This leads to obstruction and may require surgical removal.

4. Abscess formation
Pockets of pus usually occurring close to the anus and may require surgical drainage.

5. Anorectal disease
e.g. fissures. These are painful cracks in the lining causing bleeding on defaecation (passage of a bowel motion). Very occasionally they may lead to a fistula.

6. Dysplasia and carcinoma
Patients with long-standing (over 10 years) and extensive colitis have an increased risk of bowel cancer.

Dysplasia is a change in the appearance under the microscope of the mucosa which may alert the doctors to the risk of cancer developing.

7. Arthritis
May affect any joints, but especially those in the legs. Inflammation in the bottom of the spine is called sacroileitis.

THE FUTURE

The cause of ulcerative colitis is still unknown. The Department of Gastroenterology at Addenbrooke’s Hospital has been active in the research into this disease since it was founded in 1980, and an extensive research programme continues.

We are often approached by pharmaceutical companies and requested to recruit patients for clinical trials of new drugs and treatments.

Patients attending the hospital have the advantage of being offered new products at an early stage and you may be asked if you wish to take part in research or trials to improve our knowledge and treatment of ulcerative colitis.

PREVENTING A ‘FLARE-UP’ OF ULCERATIVE COLITIS

Listed below are a few points to help you prevent a flare-up of your disease. Some flare-ups are unavoidable but if advice is followed, they will occur less often.

1. Follow treatment – take medications as directed by the doctor. Do not stop because you feel well. The doctor will advise you when it is safe to stop.

2. Seek prompt treatment/advice as soon as symptoms begin in order to prevent a more severe relapse.
– always ensure that you have an adequate supply of medications. Keeping a stock of enemas may be useful so that treatment can commence as soon as possible. 5-ASA, (e.g. Pentasa, Asacol) are better than steroid enemas although they should only be used if blood is seen. These will only be effective for distal colitis. Oral steroids may be necessary for more extensive colitis.

3. Avoid – situations which you know trigger attacks, e.g:
certain foods. There is no evidence that colitis is upset by food, but ifyou find certain foods upset you, then you should avoid them. stressful situations: Take time to practice relaxation at certain periods throughout the day.

4. Avoid constipation: flare-ups of left-sided colitis are frequently triggered by proximal constipation.

5. Gastrointestinal infections may trigger a flare-up and so you should avoid situations which may lead to this occurring, e.g:
– avoid travelling to countries with poor sanitation
– be stringent with hygiene when preparing and cooking food
– avoid cafés and restaurants with poor reputations

6. Avoid taking non-steroidal anti-inflammatory drugs (e.g. Volterol, Brufen, Naproxen) as these have been associated with flare-ups of the disease. If you need to take painkillers, try paracetamol or Co-proxamol instead.

7. Keep yourself fit – ensure that a healthy, balanced diet is taken, with vitamin and mineral supplements as necessary. Take regular excercise.

8. Ensure that you get adequate rest and sleep.

This information is taken from www.crohns.org.uk

 

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