Tuesday, July 17, 2012

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Ulcerative Colitis






Ulcerative colitis is a type of inflammatory bowel disease (IBD) that affects the lining of the large intestine, colon and rectum.  Ulcerative colitis symptoms, the symptoms vary in severity and may start slowly or suddenly.  About half of people only have mild symptoms; others have more severe attacks that occur more often.  Many factors can lead to attacks including respiratory infections or physical stress.  Symptoms include abdominal pain and cramping, blood and pus in the stools, diarrhea from very few episodes to very often, weight loss.

Inflammatory bowel disease is a disease of long lasting or chronic inflammation of the gastrointestinal tract.  Inflammation is the result of activation of the immune system and it generally includes five signs of active inflammation, warmth, redness, pain, swelling and loss of function.  In inflammatory bowel disease these symptoms happen in the gastrointestinal tract and cause symptoms in your belly.  We will refer to inflammatory bowel disease as a chronic inflammatory disease because the immune system is abnormally activated and stays activated for months or years.  The inflammation can quiet down or become quiescent for a while, but weeks, months or years later, the inflammation can come back with a big flare of activity and symptoms.  It is also chronic because the damage or distortion of the intestinal lining is left behind when the intestine heals after a flare and can still be seen under a microscope.  Ulcerative colitis causes inflammation in the inner most layer of the colon, the mucosa.  Only when ulcerative colitis becomes very severe or toxic, does it affect all of the layers of the colon.  Unlike Crohn’s disease, ulcerative colitis only effects the colon and is continuous meaning that the colon is effected from the rectum, the last part of the colon and continuously upstream.  Ulcerative colitis can affect just the short segment of the rectum, further up the sigmoid or left colon or be more extensive.  If ulcerative colitis affects the whole colon, it is often called pancolitis.  The symptoms that usually have the most impact on the patients with ulcerative colitis are frequent bloody bowel movements with mucus, the urgent need to have a bowel movement, abdominal pain, tiredness, gas, weight loss.  The bloody bowel movements usually get people to go to a doctor and generally lead to a diagnosis more quickly an ulcerative colitis compared to Crohn’s disease.  About 10% of inflammatory bowel disease patients are diagnosed with indeterminate colitis.  Indeterminate means that we just cant figure out what kind it is.  This is a condition that clearly a chronic and inflammatory disease of the colon, but there is something that suggests that this might be Crohn’s other than just ulcerative colitis.  Sometimes that could be segmental inflammation or especially deep ulcers which can both suggest Crohn’s disease.  It can be hard to sure about the diagnosis of Crohn’s disease and less it affects the small intestine or goes all the way through the intestinal line.  Two other diagnoses that are not inflammatory bowel disease are important to know about.  One is acute infectious colitis or acute enteritis.  These are due to inflammation of the colon or small intestine that last a short time days or weeks and then goes away.  These are generally due to infections and do not leave any chronic damage behind afterwards they can be seen under microscope.  Some times people with the acute infections of the GI tract are thought to have inflammatory bowel disease, but turn out to have just had a bad infection of part of the GI tract.  Another diagnosis that is not inflammatory bowel disease is IBS or irritable bowel syndrome.  IBS can cause symptoms of pain, diarrhea, or constipation that can look like inflammatory bowel disease, but they are no chronic inflammation and damage to the lining of the intestine.  However the abnormalities in IBS and inflammation in the inflammatory bowel disease are treated very differently.


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