Ulcerative colitis treatment
What is ulcerative colitis?
Ulcerative colitis is the more common type of the two Inflammatory Bowel Diseases (IBD). The other is Crohn’s disease. Unlike Crohn's disease which can affect the whole of the gut, ulcerative colitis can only affect the colon or large intestine. The lining of these becomes inflamed and ulcers can develop. It can affect different lengths of the colon and it tends to present with bloody diarrhoea. There are a lot of treatment options, and whilst they will not cure ulcerative colitis, they can help to control it and prevent the symptoms from happening altogether.
What are the symptoms?
The majority of people with ulcerative colitis will have bloody diarrhoea and cramping abdominal pain from the start. In the more severe cases, the patient may lose weight, may have mouth ulcers and feel unwell, and may be anaemic. In the less severe cases, the patients may either have the disease on the left side of the colon, which is the bottom third of the colon, or just in the back passage. They may have fewer symptoms or their symptoms will be slightly different in that they may not always have diarrhoea but they may have blood and urgency. Urgency is a big problem in inflammatory bowel disease.
What are the causes?
Nobody knows what causes ulcerative colitis, but it is thought to be the result of a problem with the immune system. Some research has suggested that the immune systems of people with the condition mistakes “friendly bacteria” in the colon, intended to help the digestion process, as a harmful infection leading to the colon and rectum becoming inflamed.
An alternative theory held by some doctors is that a viral or bacterial infection triggers the immune system, but for an unknown reason it doesn't “turn off" once the infection has passed and the inflammation continues. Some health professionals subscribe yet to another theory which suggests no infection takes place and the immune system may simply malfunction by itself, or that there is a lack of balance between bad and good bacteria in the bowel.
Who gets ulcerative colitis?
Patients with ulcerative colitis tend to be in their teens and twenties, but there are also those that will get it at a later age. Research has suggested that inherited genes may be a factor in developing ulcerative colitis, with studies finding that at least one in four people with the disease having a family history of the condition.
What are the different types of treatment available?
One of the important things with ulcerative colitis is to map the disease, in other words, find out how extensive it is. If the condition begins as ulcerative proctitis, which is where there is inflammation only in the back passage, then the treatment will be most likely to be either suppositories, either anti-inflammatory or steroid suppositories, or foam enemas, which also take the form of anti-inflammatory or steroid drugs.
The patient may not need anything other than these treatments, or they may need oral gut-specific anti-inflammatories like mesalazine in order to bring it under control. If the condition has got rather more extensive but not yet total colitis, then the patient will definitely need drugs like mesalazine and may need a short course of steroids to bring it under control.
If it is total colitis and the patient is noticeably unwell, they may need to be admitted to hospital as an emergency to have intravenous steroids. That is rare but it can happen. If the patient is not as ill as needing urgent hospital treatment, then they may need prednisolone, and subsequently mesalazine and drugs like azathioprine in the long run.
What are the benefits of treatment?
The treatment is aimed at trying to reduce the number of times the patient is opening their bowels and to prevent the bleeding from continuing. Treatment can also reduce the patient’s cancer risk in the future because there is a slightly increased risk of cancer in both the inflammatory bowel diseases, so by managing the disease through treatment the risk of cancer is thereby reduced.
What are the possible side effects of treatment?
There are not many side effects from any of the medications, but steroids, such as mesalazine, have been known to have caused skin rashes. Steroids are only mainly used in the short-term in order to minimize the side effects, which can also include rarer consequences such as bone thinning, diabetes, and cataracts. Azathioprine is a well-recognized drug and the side effects include a reduction in the white blood cells, which is monitored through regular blood tests and an abnormal liver function test.
Of course, if none of these steroids work, there are newer forms of treatment called biologic therapy which are given to try and turn off the inflammation. However, there is still a minority of people who need emergency surgery if the steroids or biologic therapy does not go as planned.
Who administers the treatment?
Most of the treatment will be supervised by a gastroenterologist unless the patient has a very limited disease. If the patient has anything more than a very limited disease, a gastroenterologist would supervise the treatment and make sure that the patient had screening colonoscopies after 8 to 10 years to pick up any signs of cancer.
What can patients do to manage the condition in addition to receiving treatment?
The most important thing is to have a healthy lifestyle, by eating a nutritious and balanced diet to maintain weight and strength, and to drink plenty of fluids to prevent dehydration. It is important to monitor what types of foods may be triggering the symptoms and creating flare-ups. People with ulcerative colitis should also regulate their stress and anxiety.
While stress is not a cause of the condition, it can exacerbate symptoms. Regular exercise can be a good way to tackle stress. Not only is exercise important for overall health, but it can help relieve some of the symptoms of ulcerative colitis, such as fatigue, and strengthen the bones and muscles. Patients should also avoid certain types of medications like ordinary anti-inflammatories, such as naproxen and indomethacin, which can worsen the condition.
What are the long-term challenges of living with ulcerative colitis?
It is a disorder which, until it is under control, can impact significantly because there is a degree of urgency for the patient to open their bowels, so they are always concerned about incontinence.
Abdominal pain and bloating can happen in ulcerative colitis as well. There is also the difficulty about having a chronic disorder, in other words one that there is not a cure for. Patients are usually young and feel very aggrieved about having something that is going to significantly affect their life. They may find it useful to join a local IBD group for support. There are around 50 Crohn’s and Colitis UK Groups located across the UK.
Are there any cures or preventative measures that a person can take in order to avoid developing ulcerative colitis?
There is nothing that a person can do to avoid ulcerative colitis. In terms of a cure, there is only the option of removing the whole of the colon and rectum with surgery. This is a very big operation and is usually always kept for either people whose lives are in danger from their colitis, which rarely happens, or those who have symptoms that are interfering so much with their lives and conventional therapies are not going to help.