Ulcerative Colitis

Ulcerative Colitis is an inflammatory bowel disease whose cause is unknown.  It tends to occur in teenagers and young adults, but also affects those over age 55.  The presenting symptoms are usually bloody diarrhea, mucoid stools, abdominal cramping and occasionally fever and weight loss.

Most cases are mild to moderate, and up to 30% of cases will resolve completely for many years or forever.  Others however, will have symptoms that come and go, while 20-25% may have chronic symptoms.

There are many medications that are used to treat this disease.  Mild to moderate disease may require suppositories or enemas to treat the lower colon (i.e. Canasa, Rowasa, Cortenema).  Oral medications (i.e. Asacol, Azulfidine, Colazal, Pentasa) are often helpful.  Sometimes antibiotics like Flagyl or Cipro are useful.  For more severe or chronic disease, we may employ immune modulators like Imuran, Azasan, 6-MP or Prednisone.  Remicade has been used in refractory cases.

If none of the above regimens can put the patient in remission, and the quality of life is poor, then surgery is warranted.  Most of the time, a patient will be able to have the diseased colon removed completely, and a connection made between the small bowel and the anus, known as an ileo-anal anastomosis.  They may then live quite normally, as they did before they contracted ulcerative colitis.

The most important part to remember about this disease is that it is not the same for each person.  The severity varies greatly between people, as does their response to treatment.  One must be willing to try many regimens sometimes before the right one is found for you.

Another important pearl that we learned through reviewing our experience over the past 15 years is that it is rare for ulcerative colitis to develop into cancer, even after 20-30 years or more of having the disease.  Dysplasia is also quite rare, in our collective experience.