About colitis, ulcerative

What is colitis, ulcerative?

Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.

Ulcerative colitis can be debilitating and can sometimes lead to life-threatening complications. While it has no known cure, treatment can greatly reduce signs and symptoms of the disease and bring about long-term remission.



What are the symptoms for colitis, ulcerative?

Diarrhoea symptom was found in the colitis, ulcerative condition

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.

Types

Doctors often classify ulcerative colitis according to its location. Types of ulcerative colitis include:

  • Ulcerative proctitis. Inflammation is confined to the area closest to the anus (rectum), and Rectal bleeding may be the only sign of the disease.
  • Proctosigmoiditis. Inflammation involves the rectum and sigmoid colon — the lower end of the colon. Signs and symptoms include bloody diarrhea, Abdominal cramps and pain, and an inability to move the bowels in spite of the urge to do so (tenesmus).
  • Left-sided colitis. Inflammation extends from the rectum up through the sigmoid and descending colon. Signs and symptoms include bloody diarrhea, abdominal cramping and Pain on the left side, and urgency to defecate.
  • Pancolitis. This type often affects the entire colon and causes bouts of Bloody diarrhea that may be severe, Abdominal cramps and pain, fatigue, and significant weight loss.



What are the causes for colitis, ulcerative?

The exact cause of ulcerative colitis remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate but don't cause ulcerative colitis.

One possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too.

Heredity also seems to play a role in that ulcerative colitis is more common in people who have family members with the disease. However, most people with ulcerative colitis don't have this family history.



What are the treatments for colitis, ulcerative?

Ulcerative colitis treatment usually involves either drug therapy or surgery.

Several categories of drugs may be effective in treating ulcerative colitis. The type you take will depend on the severity of your condition. The drugs that work well for some people may not work for others, so it may take time to find a medication that helps you.

In addition, because some drugs have serious side effects, you'll need to weigh the benefits and risks of any treatment.

Anti-inflammatory drugs

Anti-inflammatory drugs are often the first step in the treatment of ulcerative colitis and are appropriate for the majority of people with this condition. These drugs include:

  • 5-aminosalicylates. Examples of this type of medication include sulfasalazine (Azulfidine), mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum). Which one you take, and whether it is taken by mouth or as an enema or suppository, depends on the area of your colon that's affected.
  • Corticosteroids. These drugs, which include prednisone and budesonide, are generally reserved for moderate to severe ulcerative colitis that doesn't respond to other treatments. Due to the side effects, they are not usually given long term.

Immune system suppressors

These drugs also reduce inflammation, but they do so by suppressing the immune system response that starts the process of inflammation. For some people, a combination of these drugs works better than one drug alone.

Immunosuppressant drugs include:

  • Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These are the most widely used immunosuppressants for the treatment of inflammatory bowel disease. Taking them requires that you follow up closely with your doctor and have your blood checked regularly to look for side effects, including effects on the liver and pancreas.
  • Cyclosporine (Gengraf, Neoral, Sandimmune). This drug is normally reserved for people who haven't responded well to other medications. Cyclosporine has the potential for serious side effects and is not for long-term use.
  • Tofacitinib (Xeljanz). This is called a "small molecule" and works by stopping the process of inflammation. Tofacitinib is effective when other therapies don't work. Main side effects include the increased risk of shingles infection and blood clots.

    The U.S. Food and Drug Administration (FDA) recently issued a warning about tofacitinib, stating that preliminary studies show an increased risk of serious heart-related problems and cancer from taking this drug. If you're taking tofacitinib for ulcerative colitis, don't stop taking the medication without first talking with your doctor.

Biologics

This class of therapies targets proteins made by the immune system. Types of biologics used to treat ulcerative colitis include:

  • Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi). These drugs, called tumor necrosis factor (TNF) inhibitors, or biologics, work by neutralizing a protein produced by your immune system. They are for people with severe ulcerative colitis who don't respond to or can't tolerate other treatments.
  • Vedolizumab (Entyvio). This medication is approved for treatment of ulcerative colitis for people who don't respond to or can't tolerate other treatments. It works by blocking inflammatory cells from getting to the site of inflammation.
  • Ustekinumab (Stelara). This medication is approved for treatment of ulcerative colitis for people who don't respond to or can't tolerate other treatments. It works by blocking a different protein that causes inflammation.

Other medications

You may need additional medications to manage specific symptoms of ulcerative colitis. Always talk with your doctor before using over-the-counter medications. He or she may recommend one or more of the following.

  • Anti-diarrheal medications. For severe diarrhea, loperamide (Imodium A-D) may be effective. Use anti-diarrheal medications with great caution and after talking with your doctor, because they may increase the risk of an enlarged colon (toxic megacolon).
  • Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others) — but not ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) and diclofenac sodium, which can worsen symptoms and increase the severity of disease.
  • Antispasmodics. Sometimes doctors will prescribe antispasmodic therapies to help with cramps.
  • Iron supplements. If you have chronic intestinal bleeding, you may develop iron deficiency anemia and be given iron supplements.

Surgery

Surgery can eliminate ulcerative colitis and involves removing your entire colon and rectum (proctocolectomy).

In most cases, this involves a procedure called ileoanal anastomosis (J-pouch) surgery. This procedure eliminates the need to wear a bag to collect stool. Your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus, allowing you to expel waste relatively normally.

In some cases a pouch is not possible. Instead, surgeons create a permanent opening in your abdomen (ileal stoma) through which stool is passed for collection in an attached bag.

Cancer surveillance

You will need more-frequent screening for colon cancer because of your increased risk. The recommended schedule will depend on the location of your disease and how long you have had it. People with proctitis are not at increased risk of colon cancer.

If your disease involves more than your rectum, you will require a surveillance colonoscopy every one to two years, beginning as soon as eight years after diagnosis if the majority of your colon is involved, or 15 years if only the left side of your colon is involved.



What are the risk factors for colitis, ulcerative?

Ulcerative colitis affects about the same number of women and men. Risk factors may include:

  • Age. Ulcerative colitis usually begins before the age of 30. But it can occur at any age, and some people may not develop the disease until after age 60.
  • Race or ethnicity. Although whites have the highest risk of the disease, it can occur in any race. If you're of Ashkenazi Jewish descent, your risk is even higher.
  • Family history. You're at higher risk if you have a close relative, such as a parent, sibling or child, with the disease.



Is there a cure/medications for colitis, ulcerative?

Even though there is no cure, there are various promising treatment options available to treat the symptoms, including,

  • Medications – Medications are used to suppress the inflammation of the colon and heal the tissues over time. It also effectively reduces and controls the symptoms of diarrhea, bleeding, and abdominal pain.
  • Combinational Therapy – An additional therapy combined with initial therapy to increase the effectiveness of the treatment.
  • Surgery – Surgery is only suggested when the medical therapy is not successful or when it results in further complications, preventing symptoms. Patients with ulcerative colitis undergo surgery, to remove the colon through colectomy or both their colon and rectum through proctocolectomy.
  • Biosimilars – Biosimilars are biological therapies that use natural proteins to target specific areas of the immune system to control the inflammation caused by ulcerative colitis. It can be taken through injection or intravenous infusion.
  • JAK Inhibitors – JAK inhibitors are a recent treatment, where the small molecule compounds are absorbed by the bloodstream. These inhibitors will reach the immune system and prevent the messaging pathways of immune cells, easing the symptoms.
  • Diet and Nutrition – A healthy and balanced diet will reduce the symptoms, replace missing nutrients, and enhance healing.



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