Ulcerative colitis is becoming increasingly more common in
the West, but is still quite a rare disease with only 80 out of 100,000 people
suffering with it. The peak age for diagnosis of colitis is between 20 and 35,
although it can present in youths and older adults.

Symptoms

Symptoms for ulcerative colitis are unpleasant, and include
diarrhoea, weight loss, blood and mucus in the faeces , nausea and fever. Sufferers
may also experience abdominal cramping when having a bowel movement. Where just
the rectum is affected, this is called proctitis. Proctitis
presents itself as blood and mucus in the faeces and does not cause diarrhoea.

Features of colitis ulceration

• Ulceration and inflammation is continuous but superficial


• Rectum always involved


• Granulated, ulcerated mucosa (inner lining of bowel). As you can see in
  the colitis picture above, the lining is white and ulcerated. Healthy bowel
  is pink and shiny, like the inside of your mouth.


• Normal serosa (outer membrane of the bowel)

Diagnosis

• Endoscopy: An endoscope is a long, flexible camera that
  uses fibre optics to relay images back on-screen so that your doctor can view
  the health of your bowel lining. The two main endoscopic techniques used to
  diagnose colitis are the colonoscopy (exam of the entire
  large bowel) and sigmoidoscopy (shallow rectal examination
  that looks at the last part of your colon and your rectum).


• Barium enema X-ray: an enema of barium isotope is administered
  to your bottom, and a series of xrays are taken to determine the extent of
  the disease.


• Blood samples can help determine the severity of the inflammation,
  and show whether the patient suffers from anaemia (low haemoglobin count).
  

Treatment

Treatment is initially medication- based and may include some or all of the
following:

• Corticosteroids such as prednisolone or budesonide.
  These have anti-inflammatory properties and may be taken orally in tablet
  form, intravenously or topically (at the site of the inflammation) by way
  of an enema or suppositories.


• Aminosalicylates as tablets, suppositories or enemas. These
  are anti-inflammatory medications for the treatment of mild to moderate disease.
  They can also be used on-going to prevent flare-ups.


• Immunosuppressants, eg azathioprine, cyclosporin, 6-mercaptopurine,
  methotrexate are used for very severe symptoms that cannot be controlled
  by steroids. Immunosuppressants are not licensed for UC, but they have effect
  in Crohn's disease and therefore can help colitis which is quite similar in how it presents.

In some cases, medication is not effective in controlling symptoms. In these
circumstances, surgery may be required. Surgery involves removing all of the
colon (colectomy) and an ileostomy may be formed. In some cases,
further surgery to make a j-pouch can be performed. When the
colon is removed, ulcerative colitis is cured.

In the case of proctitis, removal of the rectum may be performed, and a colostomy
formed.

Further resources- Interactive Tutors from MedlinePlus:

Ulcerative
colitis |Colostomy
| Colonoscopy
| Sigmoidoscopy