Ulcerative Colitis
Ulcerative Colitis is a disease of the inner lining of the large
intestine (colon and rectum). Other parts of the gastrointestinal
tract (oesophagus, stomach and small intestine) are not affected.
(Figure 1). On occasion, some distant organs may be involved
by inflammation. This inflammation sometimes causes problems
with joints (arthritis), with the eye (iritis), or with the liver
(cholangitis). Skin infections are also a problem from time to
time.
Figure 1 - Severe Ulcerative Colitis of the whole large intestine.
The removal of this diseased organ restored the patient to health.
The Cause of Ulcerative Colitis
The cause is not known, there are many theories, but none of
them explain all the facts about Ulcerative Colitis.
The Symptoms
These are both generalised due
to anaemia and the loss of fluids. The patient feels weak and
listless. The localised symptoms
are:
- Diarrhoea – up to 20 stools per day
with a passage of mucous blood and pus.
- Urgency of Defecation – that
is, having to run to open ones bowels.
- Abdominal Cramps
- Weight Loss
- Fever
These symptoms are variable, as the disease
waxes and wanes with exacerbations and remissions. This variation
may go on for many years.
The Diagnosis
As a result of the story and the
clinical examination, the patient’s
doctor will order a few tests, such as blood count and examination
of the stools. The most important test however is a Colonoscopy
(Figure 2) with biopsies. The Colonoscopist takes samples of
the bowel lining for Pathological analysis. The appearance
of normal bowel is shown in Figure 3.
Figure 2 - Moderate Ulcerative Colitis as seen with the colonoscope.
In this case the patient could be treated with medicines causing remissions lasting
many years.
Figure 3 - Normal bowel for comparison.
The lining of the colon is smooth and fine blood vessels deep to the lining can
be seen.
Treatment
Fortunately the medical
treatment, although not curative, is usually effective in keeping
the patient well and at work. The
basic drug is called Salazopyrin. There are several good substitutes
for this drug, should the patient fail to tolerate it (e.g.
Mesasal). Other medicines help to keep the patient well. Imuran
(azathioprine)
is an immune suppressant. Iron for iron deficiency and anti-diarrheal
drugs may also be useful. Prednisolone (Cortisone) for short
periods in the form of tablets or enemas can be important.
Complications
The patient’s General Practitioner, in conjunction with
the Specialist, must always be on the alert for possible complications.
These could be due to the drugs prescribed or due to the severity
of the disease, or alternatively, due to the duration of the
disease. Cancer of the bowel can ensue after many years. Generally
speaking, cancer does not result from the disease until it has
been present for 10 to 15 years. The possibility of cancer can
be monitored by regular Colonoscopies and biopsies. When the
lining of the bowel shows “dysplasia”, as assessed
by the Pathologist under the microscope, the possibility of surgery
to remove the colon must be considered. A permanent ileostomy
(bag) used to be necessary after this operation. Fortunately,
this can now be avoided by modern techniques. Other complications
requiring surgery are possible during severe exacerbations, which
include bleeding and perforation of the bowel, as well as infection.
Fortunately, most of the serious complications of Ulcerative
Colitis, which require surgery, are rare.
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