Ulcerative colitis is a long-standing inflammatory disease of the lining of the large intestine. It has episodes of remissions (periods of disappearance of the disease) and relapses, or it may occasionally be a continuous disease. Ulcerative colitis (UC) and Crohn’s disease (CD), which are chronic inflammatory diseases of the GI tract of unknown etiology, are commonly referred as Inflammatory bowel disease (IBD).
How does it occur?
The exact cause is unknown, but it is believed to be an auto-immune disorder, i.e. the patient’s immune system reacts with the inner lining of the covering of the large intestine (colon). In that sense it is akin to many auto-immune joint diseases in which the immune system reacts with joints causing swelling of the joints, pain and deformity. The disease may be associated with stress and certain skin rashes.
What are the symptoms?
The symptoms include bloody diarrhoea associated with pain and cramps in the abdomen. Fever and weight loss are also present. Stools may be foul-smelling and defecation could be painful. In India, the disease is often diagnosed late being mistaken initially for dysentery due to bacteria or amoebae.
How is it diagnosed?
Diagnosis depends on the symptoms and physical examination by the doctor. Certain tests like sigmoidoscopy or colonoscopy (looking inside the large intestine with a flexible lighted tube), rectal biopsy and barium enema are helpful.
What is the treatment?
The mainstay of the treatment are drugs which suppress immune reaction. Milder cases can be treated by drugs like 5-amino salicylic acid or sulphasalazine, more severe cases by drugs like corticosteroids, either oral, enemas or in severe cases by injections. After an acute attack is treated by these drugs, 5-amino salicylic acid or sulphasalazine should be given for many years. Severe and relapsive cases of the disease may be treated by more powerful immunosuppressants or more effectively by surgery. Since surgery removes the colon against which the immune system reacts, it is the only definitive cure of the disease.
The surgery involves total removal of the large intestine, followed by an operation called a permanent ileostomy. The ileum (the lower part of the small intestine) is brought through a cut in the abdominal wall and formed into an opening. This allows the stool to collect in a bag attached to the skin. In many cases the ileum can eventually be joined with the anal canal thus restoring the normal passage of stools.
How long will the effects last?
Episodes of colitis come and go over many years. Complete and permanent cure with medication alone is unusual. Ulcerative colitis can usually be controlled with proper treatment, but surgery is often necessary for a cure.
How can one care for oneself?
For diarrhoea, rest the bowel by drinking only clear liquids such as water, juice and tea. It is important to drink often to avoid dehydration. Sucking on ice cubes may help in cases of nausea. Avoid solids as they can cause cramps.
Chronic ulcerative colitis may be associated with cancer of the intestine. Therefore, regular checkups by the doctor are important when the disease continues beyond ten years. The doctor may do a colonoscopy and a biopsy of the colon once in two years. This will exclude the possibility of pre-cancerous changes or early cancer so that early surgery and lasting cure can be achieved.
How can ulcerative colitis be prevented from recurring?
The only way is to suppress the disease activity is by using drugs like 5-amino salicylic acid or sulphasalazine for many years or by surgery.