A chronic , episodic, inflammatory disease of the large intestine and rectum characterized by bloody diarrhea .

Alternative Names

Nonspecific ulcerative colitis

Causes, incidence, and risk factors

The cause is unknown, and it may affect any age group although there are peaks at ages 15 to 30 and then again at ages 50 to 70. The disease usually begins in the rectal area and may eventually extend through the entire large bowel. Repeated episodes of inflammation lead to thickening of the wall of the intestine and rectum with scar tissue. Death of colon tissue or sepsis may occur with severe disease. The symptoms vary in severity and their onset may be gradual or sudden. Attacks may be provoked by many factors, including respiratory infections or stress . Risk factors include a family history of ulcerative colitis or Jewish ancestry. The incidence is 10-15 out of 100,000 people.

Signs and tests

Colonoscopy

with

biopsy

Barium enema

Treatment

The goals of treatment are to control the

acute attacks, prevent recurrent attacks, and promote healing of the colon. Hospitalization is often required for severe attacks. Corticosteroids are prescribed to reduce inflammation. Medical therapy options to decrease the frequency of attacks include 5-aminosalicylates (such as mesalamine) and immunomodulators (azathioprine, 6-mercaptopurine). Surgery may be indicated in refractory disease. Removal of the colon is curative and removes the threat of colon cancer. Patients may have an ostomy or may have a procedure (ileal pouch anal anastomosis) to connect the small intestine to the anus and gain more normal bowel function.

Expectations (prognosis)

The course of the disease varies with remissions and exacerbations over a period of years, or the disorder can present as a fulminant disease. A permanent and complete cure is unusual. The risk of colon cancer increases in each decade after the diagnosis.

Complications

Perforation of the colon

Carcinoma

Massive colonic hemorrhage

Colon stricture

Inflammation of the joints

Ankylosing spondylitis

Lesions in the eye

Mouth ulcers

Liver disease

Impaired growth and sexual development in children

Pyoderma gangrenosum

Complications of corticosteroid therapy

Calling your health care provider

Call your health care provider if persistent abdominal pain , new or increased bleeding, or other symptoms of ulcerative colitis are present. Call your health care provider if ulcerative colitis symptoms worsen or do not improve with treatment, or if new symptoms develop.

Prevention

Because the cause is unknown, prevention is also unknown. In patients with ulcerative colitis, nonsteroidal anti-inflammatory drugs (NSAID's) may exacerbate symptoms. As a prevention strategy for the risk of colon cancer, surveillance colonoscopy is recommended after 8 years of disease.