Ulcerative Colitis Spotlight

What is Ulcerative Colitis?

• Ulcerative colitis is a type of inflammatory bowel disease (IBD) causes ongoing inflammation and small sores (ulcers) in the inner lining of the large intestine.
• This inflammation makes the large intestine, or colon, empty frequently, which leads to the most common symptoms of colitis: diarrhea (often bloody) and abdominal cramps and pain.
• The symptoms of ulcerative colitis, as well as possible complications, will vary depending on the extent of inflammation in the rectum and the colon.
• Colitis symptoms can come on gradually or suddenly and vary in severity.

Is Colitis the same as Crohn’s Disease?

• Ulcerative colitis is not the same as another IBD called Crohn’s disease.
• Unlike Crohn’s disease, which can affect any area of the gastrointestinal (GI) tract, ulcerative colitis affects only the colon.
• Colitis inflammation also differs from that of Crohn’s disease in that it starts in the rectum and extends up the colon in a continuous manner. In Crohn’s disease, there may be areas of normal intestine between the areas of diseased intestine.
• Finally, ulcerative colitis affects only the innermost lining of the colon, whereas Crohn’s disease can affect the entire thickness of the bowel wall.

What causes Colitis?

• Doctors don’t yet know exactly what causes ulcerative colitis.
• Researchers suspect that the inflammation may be the result of several factors working together, including a person’s genes, their immune system and something in the environment, such as a bacteria or virus, that may switch on a person’s immune system.
• Because the immune system may not turn off correctly, this causes ongoing inflammation in the large intestine.

What are the risk factors for getting Colitis?

• While the exact cause of colitis is not yet known, certain factors make it more likely a person will develop the disease. These include:
  • Age: While colitis can begin at any age, it usually starts when people are between 15 and 30 years old.
  • Family history: Up to 20 percent of people with colitis have a close relative with ulcerative colitis or Crohn’s disease.
  • Ethnic background: There is a higher incidence of ulcerative colitis in whites than in non-whites, and a higher incidence among Jews than in non-Jews.
  • Where you live: Ulcerative colitis occurs mostly in developed countries, and is found more often in urban areas than rural ones, and in northern regions rather than southern regions.

Which diagnostic tests are available to test for Colitis?

• Diagnosing ulcerative colitis starts with a medical history and a physical exam.
• Doctors often perform a number of tests including blood tests and stool sample analysis to rule out other conditions.
• The most accurate methods of diagnosing ulcerative colitis include colonoscopy and sigmoidoscopy.
  • In these exams, a thin tube equipped with a light and a camera (an endoscope) is inserted into the rectum and the intestine to look for signs of inflammation, bleeding or ulcers, and to possibly take samples of tissue that can be studied under a microscope.

Which treatments are available for Colitis?

• Along with their physicians, patients often decide to use a combination of treatments to relieve symptoms and maintain remission.
• Treatment depends on the severity of symptoms, how often they occur, and how much of the large intestine is inflamed.
• About half of people with colitis have mild symptoms that require little treatment. The rest may have more severe symptoms that require more complex treatment.
• In general, a treatment plan may include:
  • Medications which reduce inflammation and treat the symptoms of ulcerative colitis to prevent them from coming back.
  • The four main categories of medication are aminosalicylates, corticosteroids, immunomodulators and biologic therapies.
  • Surgery may be recommended at some point during the disease.
    • About 25 percent to 40 percent of people with ulcerative colitis eventually have their colon removed.
    • Some opt for surgery after drug therapy fails to control severe and ongoing symptoms.
    • Surgery may also be necessary if a person suffers serious complications from ulcerative colitis.

Will Colitis ever go away?

• There is no cure for colitis, but with the right treatment, the disease can be well-managed.
• Among the best ways of controlling colitis is aggressive treatment in the early stages of the disease so that you maintain remission and your symptoms do not get worse.
• Adherence to your treatment plan and communication with your doctor about your symptoms or treatment side effects are key to living comfortably with the disease.

Will Colitis lead to other health issues?

• Research has shown that ulcerative colitis may make it more likely that a person will develop arthritis, eye inflammation, liver diseases and osteoporosis.
• Scientists do not know how or why colitis influences these other health problems, but they think inflammation triggered by the immune system may play a part.
• In some cases, the conditions that occur outside of the large intestine go away when the colitis is treated.
• About 5 percent of people who have ulcerative colitis develop colon cancer, which is a higher rate than for people without ulcerative colitis.
• The risk of colon cancer increases in each decade after ulcerative colitis is diagnosed.

Do I need to change my diet?

• There is no evidence that either certain foods or stress cause colitis.
• But during flare-ups, both stress and particular foods may make symptoms worse for some people.
• Most doctors recommend that their patients eliminate only foods they are convinced make their colitis symptoms worse based on past experience.
• If you do eliminate a specific food or food group, it’s helpful to meet with a registered dietician to ensure you are still getting proper nutrients.

What are the first signs (or symptoms) of Colitis?

• Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs.
• You may have the following signs and symptoms, depending on which part of the colon is inflamed:
  • Diarrhea, often with blood
  • Abdominal pain and cramping
  • Rectal pain
  • Rectal bleeding — passing small amount of blood with stool
  • Urgency to defecate
  • Inability to defecate despite urgency
  • Weight loss
  • Fatigue
  • Fever
  • In children, failure to grow
• Most people with ulcerative colitis have mild to moderate symptoms.
• The course of ulcerative colitis may vary, with some people having long periods of remission.

Without health insurance, which treatments are available?

• Blood tests. Your doctor may suggest blood tests to check for anemia or to check for signs of infection.
• Stool sample
• Colonoscopy
• Sigmoidoscopy
• X-ray
• CT scan

Are there foundations which provide free treatment for patients with Colitis?

• The CCFA Irwin M. and Suzanne R. Rosenthal IBD Resource Center (IBD Help Center) at info@ccfa.org can assist you in finding the appropriate resources.
• HealthWell Launched a Crohn’s Disease Fund – healthwellfoundation.org
• In some cases, pharmaceutical companies can help with medications.
• Your physician and support staff may be able to help you
• The Chronis and Colitis Foundation can help pay for College – http://www.crohnscolitisfoundation.org

What would you tell someone who is newly-diagnosed with Colitis?

• Know how to talk to your doctor about it.
  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • Do you have abdominal pain?
  • Have you had diarrhea? How often?
  • Have you recently lost any weight unintentionally?
  • Does anything seem to improve your symptoms?
  • Have you ever experienced liver problems, hepatitis or jaundice?
  • Have you recently traveled? If so, where?

What is the risk for patients with Crohn’s Disease developing Colon Cancer?

• There is recognized increased risk for colorectal cancer in patients with ibd, particularly in long-standing and extensive ulcerative colitis.
• There also appears to be an increased rate of intestinal cancer in Crohn’s disease, including both colon and small bowel sites.
• In Crohn’s disease, evidence suggests that detection of colorectal cancer may be delayed with a worse prognosis.

Does stress play a role in causing Colitis (or making the symptoms worse)?

• Studies show a strong connection between ulcerative colitis and stress.
  • Deep breathing.
  • Yoga and stretching.
  • Being organized.
  • Massage and acupuncture.
  • Don’t overdo it.