Sunday, October 17, 2010

>Inflammatory bowel disease(IBD)

Ulcerative Colitis:

If you have had intestinal problems -- diarrhea, abdomen pain, and rectal bleeding -- you may have ulcerative colitis. Learn the symptoms that doctors look for in diagnosing this inflammatory disorder, and treatments to help control it.

Ulcerative Colitis - Cause

The cause of ulcerative colitis is unknown. Studies suggest that this and other inflammatory bowel diseases may result from an abnormal response by the body's immune system to normal intestinal bacteria. Disease-causing bacteria and viruses also may play a role in causing the condition.
Ulcerative colitis can run in families-some people may have a genetic tendency to have it.

Ulcerative Colitis - Symptoms

The symptoms of ulcerative colitis may include:
  • Diarrhea or rectal urgency. Some people may have diarrhea 10 to 20 times a day. The urge to go to the bathroom may wake you up at night.
  • Rectal bleeding. Ulcerative colitis usually causes bloody diarrhea and mucus. You also may have rectal pain and an urgent need to empty your bowels.
  • Abdominal pain, often described as cramping. Your abdomen may be sore when touched.
  • Constipation. This symptom may develop depending on what part of the colon is affected. Constipation is much less common than diarrhea.
  • Loss of appetite.
  • Fever. In severe cases, fever or other symptoms that affect the entire body may develop.
  • Weight loss. Ongoing (chronic) symptoms, such as diarrhea, can lead to weight loss.
  • Too few red blood cells (anemia). Some people develop anemia because of low iron levels caused by bloody stools or intestinal inflammation.
You also may have symptoms and complications outside the digestive tract, such as joint pain, eye problems, skin rash, or liver disease. But some of these problems are generally more common in Crohn's disease, the other major inflammatory bowel disease.
Other conditions with symptoms similar to ulcerative colitis include Crohn's disease, diverticulitis, irritable bowel syndrome (IBS), and colon can

Ulcerative Colitis - What Happens

The course of ulcerative colitis varies greatly from one person to another. Some people may have only mild symptoms, and others may have severe symptoms or complications that, in unusual cases, may be life-threatening.
Ulcerative colitis may be mild, moderate, or severe. It may be described as dependent on corticosteroids, unresponsive to steroids, or not active (in remission).
Ulcerative colitis also may be defined by the part of the large intestine affected: the rectum (proctitis), the left side of the colon (left-sided colitis), or the entire colon (pancolitis).
Most people with ulcerative colitis have periods of remission that may last up to several years. These periods are interrupted by occasional flare-ups of moderate symptoms. About 5 to 10 out of 100 people who have ulcerative colitis have symptoms all the time.
Children may have the same symptoms as adults. Also, children with ulcerative colitis may grow more slowly than normal and go through puberty later than expected.

Complications and long-term effects

  • Inflammation and scarring of the bile ducts (primary sclerosing cholangitis) may occur. A bile duct is a passage that carries fluid produced in the liver to the small intestine.
  • Severe inflammation and ulceration sometimes irritate muscles in the colon, causing colon walls to stretch. The colon may swell to many times its normal size, a condition known as toxic megacolon. This is an emergency that requires immediate treatment, but it is rare.
  • Narrowed areas of the intestine (strictures) may occur in ulcerative colitis, causing difficulty in passing stools. Abnormal connections or openings (fistulas) between parts of the intestine or between the intestine and other organs are rare because ulcerative colitis does not affect the deeper intestinal tissues.
  • Your risk of cancer of the colon and rectum is higher than average if you have had ulcerative colitis for 8 years or longer. With regular screening, some cancers can be detected early and treated successfully.
  • Ulcerative colitis can cause rare complications such as scarring of the pancreas and inflammation of the membrane surrounding the heart (pericarditis).
Some people who have ulcerative colitis also have irritable bowel syndrome (IBS), which is not as serious as ulcerative colitis. IBS causes abdominal pain along with diarrhea or constipation.
Most women who have ulcerative colitis are able to become pregnant and usually have healthy babies. Symptoms may become worse during the first 3 months of  of pregnancy. Some medicines to treat the disease can be used during pregnancy.

Ulcerative Colitis - What Increases Your Risk

You have an increased risk of developing ulcerative colitis if you:
  • Have a family history of ulcerative colitis. Your risk increases if an immediate family member such as a parent, brother, or sister has the disease.
  • Are of Ashkenazi Jewish ancestry. For more information on genetic diseases in this group, see the topic Ashkenazi Jewish Genetic Panel (AJGP)

Ulcerative Colitis - When To Call a Doctor

Call a doctor immediately if you have been diagnosed with ulcerative colitis and you have any of the following:
  • Fever over 101F or shaking chills
  • Lightheadedness, passing out, or rapid heart rate
  • Stools that are almost always bloody
  • Severe dehydration
  • Severe belly pain with or without bloating
  • Pus draining from the area around the anus or pain and swelling in the anal area
  • Repeated vomiting
  • Not passing any stools or gas
If you have any of these symptoms and you have been diagnosed with ulcerative colitis, your disease may have gotten significantly worse. Some of these symptoms also may be signs of toxic megacolon, a condition in which the colon swells to many times its normal size. Toxic megacolon requires emergency treatment. Untreated toxic megacolon can cause the colon to leak or rupture, which can be fatal.
People who have ulcerative colitis usually know their normal pattern of symptoms. Call your doctor if there is a change in your usual symptoms or if:
  • Your symptoms become significantly worse than usual.
  • You have persistent diarrhea for more than 2 weeks.
  • You have lost weight.

Watchful Waiting

Watchful waiting is not appropriate when you have any of the above symptoms. If your symptoms are caused by ulcerative colitis, delaying the diagnosis and treatment may make the disease worse and increase your risk of complications.
Even when the disease is in remission, your doctor will want to see you regularly to check for complications, some of which can be hard to detect. It is always appropriate to call your doctor's office for advice.

Who To See

Health professionals who can diagnose ulcerative colitis include:
  • Family medicine doctor.
  • Internist.
  • Gastroenterologist.
For the treatment and management of ulcerative colitis, you are likely to be referred to a gastroenterologist.
To be evaluated for surgery, you may be referred to a:
  • General surgeon.
  • Colon and rectal surgeon.

Ulcerative Colitis - Exams and Tests

Ulcerative colitis can be relatively easy to diagnose because it normally affects only the colon and rectum and usually causes an obvious change in daily bowel habits, such as frequent stools containing blood or mucus. Your doctor will conduct a medical history and physical exam before doing other tests.
The colon and rectum can be examined with flexible sigmoidoscopy or colonoscopy, tests in which a doctor examines the inside of the large intestine using a small, lighted scope. In general, colonoscopy is the preferred test because it can be used to examine the entire colon. But flexible sigmoidoscopy may be all that is needed to diagnose ulcerative colitis. Both procedures can be used to take a sample (biopsy) of intestinal tissue. The diagnosis of ulcerative colitis is made by ruling out other causes of diarrhea and assessing the results of these tests.
Other exams and tests that may be used to evaluate ulcerative colitis include:
  • Abdominal X-ray, which provides a picture of structures and organs in the abdomen.
  • Barium enema, a test that allows the doctor to examine the large intestine (colon). For a barium enema, a whitish liquid (barium) is inserted through the rectum into the colon and large intestine. The barium outlines the inside of the colon so that it can be more clearly seen on an X-ray.
  • Computed tomography (CT) scan, which uses X-rays to produce detailed pictures of structures inside the body.
  • Magnetic resonance imaging (MRI), which uses a magnetic field and pulses of radio wave energy to provide pictures of organs and structures inside the body.
A stool analysis (including a test for blood in the stool) is often done, depending on symptoms, to look for blood, signs of bacterial infection, parasites, or the presence of white blood cells. This test can be used to distinguish ulcerative colitis from irritable bowel syndrome (IBS), a less serious condition that sometimes has similar symptoms.
The presence of white blood cells in stool indicates inflammation and infection but is not necessarily a sign of ulcerative colitis. But white blood cells in stool mean that you do not have IBS. Stool analysis may be done during a flare-up of ulcerative colitis if there is concern that new symptoms are caused by another problem. You can collect a stool sample, or the doctor may obtain it during sigmoidoscopy or colonoscopy.
  • Standard blood and urine tests may be done to check for anemia, inflammation, or malnutrition. Depending on the symptoms, an erythrocyte sedimentation rate (ESR, or sed rate) or C-reactive protein (CRP) blood test may be done to look for infection or inflammation. C-reactive protein is a substance produced by the liver as a result of inflammation in the body.
  • Biopsy of a sample of tissue from the lining of the intestine may be done. Biopsies are collected during sigmoidoscopy or colonoscopy to confirm the diagnosis of ulcerative colitis. A biopsy also may be done to find out whether a tumor is present. Multiple biopsies for cancer screening are often done in people who have had ulcerative colitis for 8 years or more. Bowel biopsies are painless (other than the potential discomfort of the scope procedure) and remove only a tiny piece of tissue.
In about 10 out of 100 people who have symptoms, neither Crohn's disease nor ulcerative colitis can be diagnosed. These people have a form of inflammatory bowel disease called indeterminate colitis, which doctors believe is a combination of Crohn's disease and ulcerative colitis.

Ulcerative Colitis - Treatment Overview

Treatment for ulcerative colitis depends mainly on the severity of the disease and usually includes medicines to control symptoms, such as diarrhea, and changes in diet. A few people have symptoms that are persistent and severe, in some cases requiring treatment with additional medicines or surgery.
The goals of treatment include:
  • Relieving symptoms and ending sudden (acute) attacks as quickly as possible.
  • Treating complications, such as anemia or infection. Treatment may include taking nutritional supplements to restore normal growth and sexual development in children and teens.
  • Preventing or delaying new attacks.

Initial treatment

If you don't have any symptoms of ulcerative colitis or if your disease is not active (in remission), you may not need treatment. If you do have symptoms, they usually can be managed with medicines to put the disease in remission. It often is easier to keep the disease in remission than to treat a flare-up.
Mild symptoms may respond to antidiarrheal medicines and changes in your diet. Sometimes you may need to use enemas or suppositories. Talk with your doctor before taking antidiarrheals. Prescription medicines may be used to treat mild symptoms and keep the disease in remission. Usually, corticosteroids (such as hydrocortisone or prednisone) are given for a few weeks to control active disease. Aminosalicylates (such as sulfasalazine or mesalamine) will often also be used to reduce or stop symptoms, sometimes at the same time as corticosteroids.
When your symptoms are under control, you may continue to take aminosalicylates to keep the disease in remission. Aminosalicylates relieve inflammation in the intestines.
Moderate to severe symptoms usually require corticosteroids to control inflammation. The required dose of steroids may be higher than that needed to treat mild colitis. When inflammation goes away, you will take aminosalicylates to keep the condition in remission.

Immunomodulator medicines, such as azathioprine (AZA) or 6-mercaptopurine (6-MP), also may be needed for severe cases that cannot be controlled with aminosalicylates alone. These medicines suppress the body's immune system to prevent inflammation. Immunomodulators also may be needed to avoid long-term use of steroids, which can cause side effects such as increased risk of infection and osteoporosis.
For severe ulcerative colitis, when corticosteroids don't work, your doctor may have you try infliximab. Infliximab (Remicade) may work to put you in remission when other medicines don't. Infliximab has also been shown to help heal the lining of the intestine.

Ongoing treatment

The goal of ongoing treatment is to keep ulcerative colitis from causing symptoms (keep it in remission). Most people take aminosalicylates (such as sulfasalazine or mesalamine) to prevent symptoms from recurring. Aminosalicylates relieve inflammation in the intestines. If you do have flare-ups, you may be given corticosteroids (such as hydrocortisone or prednisone) to control the inflammation.

Ulcerative Colitis - Prevention

You cannot prevent ulcerative colitis because the cause is unknown. But you can take steps to reduce the severity of the disease.
  • Medicines taken regularly may reduce acute attacks and keep the disease in remission.
  • Most experts recommend acetaminophen (Tylenol) for pain relief rather than nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. NSAIDs have been linked to flare-ups of inflammatory bowel disease (IBD).
Antibiotics may make ulcerative colitis symptoms worse and should only be used when necessary.

Ulcerative Colitis - Surgery

Ulcerative colitis affects only the large intestine, so surgery that removes the entire large intestine can cure the disease. Some people who have ulcerative colitis in the entire colon (pancolitis) eventually need surgery to remove the colon.
People may need surgery for ulcerative colitis in several situations, such as when other therapy fails to manage symptoms, when holes develop in the large intestine, or if dysplasia is found during colonoscopy or biopsy.


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