Ulcerative colitis is an idiopathic chronic inflammatory disease involving the colon and the rectum. It is different from the other major category of inflammatory bowel disease, Crohn's disease (regional ileitis). Symptoms of ulcerative colitis (UC) are bloody diarrhea and abdominal pain. Evaluation of the colon with either flexible sigmoidoscopy or colonoscopy is mandatory for establishing the diagnosis as well as the extent of disease. Different degrees of involvement of the colon are important in selecting treatment.
Patients may have universal colitis (involvement of the entire colon), left sided colitis or procto-sigmoiditis. Based upon this information, and the severity of symptoms, an appropriate regimen can be selected by your physician.
Barium enemas may be useful in evaluating patients with ulcerative colitis. This study has limited use because of complications associated with this procedure during an acute episode of ulcerative colitis. Therefore, sigmoidoscopy or anoscopy may be preferable to barium enema for patients with an acute flare of ulcerative colitis or who have bloody diarrhea of undetermined etiology.
Medical therapy of ulcerative colitis is similar to that of Crohn's disease. Both diseases are treated with amino salicylates. The active ingredient in amino salicylates is Mesalamine.
The oldest drug in this category is sulfasalazine, also known as Azulfidine. This compound is made of two amino salicylate portions joined by a sulfur bond. When the compound reaches the colon, the sulfur bond is broken by the colonic bacteria. This releases the amino salicylate portions to become effective in the colon. The usual dose for this disease is 500 mg twice a day. Patients may then be advanced to a standard dose of 2 500 mg tablets by mouth twice a day.
Side effects associated with Azulfidine include headaches, vomiting, abdominal pain, diarrhea, nausea, hair loss and skin rashes. Patients may develop liver function test abnormality as well as bone marrow abnormalities. Folic acid should be utilized in all patients taking Azulfidine. In addition, as reversible sensitivity of sperm counts in men using Azulfidine has been identified.
Other preparations of this medication include Asacol and Pentasa.
Olsalazine is also utilized. However, it has a higher incidence of diarrhea. For this reason Olsalazine is less commonly used to treat patients with ulcerative colitis. Another major treatment for ulcerative colitis is glucocorticoids. Glucocorticoids are immune suppressive medications, which allow rapid reduction of the inflammatory process involved in ulcerative colitis. Patients with refractory left sided colitis or universal colitis are usually treated with these emdications. Prednisone treatment is usually 2-4 months in duration. Initial treatment ranges between 20 and 60 mg per day for the first several weeks. Afterwards, as the symptoms improve, the Prednisone is tapered over 2-3 months. Amino salicylates, as described above, are then utilized to provide maintenance therapy for patients.
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Other Gastrointestinal Diseases:
- Celiac Sprue |
Crohn's Disease |
Colon Cancer |
Colon Polyps |
Colorectal Cancer Screening Guidelines for 2001 |
Constipation |
Diarrhea |
Diverticulosis |
Esophageal Strictures |
Fecal Incontenence |
Gastrointestinal Bleeding |
GERD Treatment Guidelines Summary |
Helicobacter Pylori |
Hemorrhoids |
Irritable Bowel Syndrome |
Lactose Intolerance |
Malabsorption Syndromes |
Pancreatic Cancer |
Pancreatitis |
Pilonidal Cysts |
Puritis Ani |
Rectal Abscess |
Rectal Prolapse |
Treatment of Anal Fissures |
Ulcerative Colitis |
Whipple's Disease
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