UCUC

Ulcerative Colitis ( UC )Ulcerative Colitis ( UC )

Ulcerative colitis is an inflammatory bowel Ulcerative colitis is an inflammatory bowel

disease (IBD) that causes chronic inflammation disease (IBD) that causes chronic inflammation of of

the digestive tractthe digestive tract

It is characterized by abdominal pain and It is characterized by abdominal pain and diarrhea. diarrhea.

Like Crohn's disease, another common IBD, Like Crohn's disease, another common IBD,

ulcerative colitis can be debilitating and ulcerative colitis can be debilitating and sometimes sometimes

can lead to life-threatening complications.can lead to life-threatening complications.

Ulcerative colitis usually affects only the Ulcerative colitis usually affects only the innermost innermost

lining of the large intestine (colon) and lining of the large intestine (colon) and rectum.rectum.

It occurs only through continuous stretches of It occurs only through continuous stretches of the the

colon, unlike Crohn's disease, which occurs in colon, unlike Crohn's disease, which occurs in

patches anywhere in the digestive tract and patches anywhere in the digestive tract and often often

spreads deep into the layers of affected tissuesspreads deep into the layers of affected tissues

Etiology of UC:Etiology of UC:

Unknown, unclearUnknown, unclear

- Heredity - Heredity

- autoimmune reaction - autoimmune reaction

- Inflammatory reaction- Inflammatory reaction

- Stress ( precipitates symptoms rather - Stress ( precipitates symptoms rather than causes than causes

UC )UC )

Diagnosis of UC Diagnosis of UC - Clinical manifestations- Clinical manifestations Abdominal pain, diarrhea, bloody Abdominal pain, diarrhea, bloody

diarrheadiarrhea- Endoscopy, biopsy- Endoscopy, biopsyComplications of UCComplications of UC- Toxic megacolon - Toxic megacolon The most serious acute complication of The most serious acute complication of

ulcerative ulcerative colitis that occurs when the colon becomes colitis that occurs when the colon becomes paralyzed, resulting in no bowel movement or paralyzed, resulting in no bowel movement or passing gas passing gas

Signs and symptoms of toxic megacolon Signs and symptoms of toxic megacolon include include

fever, abdominal pain and swelling, weakness fever, abdominal pain and swelling, weakness and and

disorientationdisorientationIf toxic megacolon isn't treated, the colon may If toxic megacolon isn't treated, the colon may rupture, causing peritonitis, a life-threatening rupture, causing peritonitis, a life-threatening condition requiring emergency surgery. condition requiring emergency surgery. Other complications to UC include:Other complications to UC include:- Perforated colon, severe dehydration - Perforated colon, severe dehydration - Liver disease - Liver disease - Inflammation of the skin, joints and eyes- Inflammation of the skin, joints and eyes- Colon cancer - Colon cancer

Treatment of UC:Treatment of UC:There's no known cure for ulcerative colitis, but There's no known cure for ulcerative colitis, but therapies are available that may dramatically therapies are available that may dramatically

reduce reduce the signs and symptoms of ulcerative colitis and the signs and symptoms of ulcerative colitis and

even even bring about a long-term remission bring about a long-term remission Ulcerative colitis treatment usually involves Ulcerative colitis treatment usually involves

either either drug therapy or surgerydrug therapy or surgeryThe goal of medical treatment is to reduce the The goal of medical treatment is to reduce the inflammation that triggers the signs and inflammation that triggers the signs and

symptoms symptoms

A. Anti-inflammatory drugs A. Anti-inflammatory drugs Anti-inflammatory drugs are often the first Anti-inflammatory drugs are often the first step in the treatment of IBD. They include:step in the treatment of IBD. They include:

- - SulfasalazineSulfasalazine It is a sulfa drug, in the gut is converted to It is a sulfa drug, in the gut is converted to

sulfapyridine and 5-ASA ( 5-amino sulfapyridine and 5-ASA ( 5-amino salicylates )salicylates )

Sulfapyridine has no antiinlammatory Sulfapyridine has no antiinlammatory effect, absorbed to systemic circulation and effect, absorbed to systemic circulation and responsible for most of the side effects to responsible for most of the side effects to sulfasalazine including allergysulfasalazine including allergy

5-ASA remains in the colon and has good 5-ASA remains in the colon and has good antiinflammatory effectantiinflammatory effect

--

- Mesalamine and olsalazine - Mesalamine and olsalazine

These medications tend to have fewer These medications tend to have fewer side effects than sulfasalazine has. side effects than sulfasalazine has.

- Balsalazide - Balsalazide

This drug is similar to sulfasalazine, This drug is similar to sulfasalazine, but produces fewer side effectsbut produces fewer side effects

- - CorticosteroidsCorticosteroids Corticosteroids can help reduce Corticosteroids can help reduce

inflammation, but they have numerous inflammation, but they have numerous side effects, including a puffy face, side effects, including a puffy face, excessive facial hair, night sweats, excessive facial hair, night sweats, insomnia and hyperactivity, high blood insomnia and hyperactivity, high blood pressure, type II diabetes, osteoporosis, pressure, type II diabetes, osteoporosis, bone fractures, cataracts and an bone fractures, cataracts and an increased susceptibility to infections. increased susceptibility to infections.

Long-term use of steroid drugs is not Long-term use of steroid drugs is not advisedadvised

Use corticosteroids only in cases of moderate Use corticosteroids only in cases of moderate to to

severe inflammatory bowel diseases that don't severe inflammatory bowel diseases that don't respond to other treatmentsrespond to other treatmentsSteroids may be used in conjunction with other Steroids may be used in conjunction with other medications as means to induce remissionmedications as means to induce remissionFor example, steroids may be used with an For example, steroids may be used with an

immune immune system suppressor — the steroids can induce system suppressor — the steroids can induce remission, while the immune system remission, while the immune system

suppressors can suppressors can help maintain remissionhelp maintain remission

B. Immune system suppressors B. Immune system suppressors These drugs also reduce inflammation, but These drugs also reduce inflammation, but they target the immune system rather than they target the immune system rather than treating inflammation itself. treating inflammation itself. Immunosuppressant drugs include:Immunosuppressant drugs include:

- - Azathioprine Azathioprine and Mercaptopurine and Mercaptopurine These drugs have been recently approved to These drugs have been recently approved to

treat treat UC UC Because azathioprine and mercaptopurine Because azathioprine and mercaptopurine

act slowly,act slowly,they are sometimes initially combined with a they are sometimes initially combined with a corticosteroidscorticosteroids

- - CyclosporineCyclosporine It is a potent drug which is normally reserved for It is a potent drug which is normally reserved for people who don't respond well to other people who don't respond well to other

medicationsmedications- - Infliximab Infliximab This drug is a monoclonal antibody effective in This drug is a monoclonal antibody effective in patients with moderate to severe UC who don't patients with moderate to severe UC who don't respond to or can't tolerate other treatments respond to or can't tolerate other treatments It works by neutralizing a protein produced by It works by neutralizing a protein produced by

your your immune system known as tumor necrosis factor immune system known as tumor necrosis factor (TNF) (TNF)

Nicotine skin patches Nicotine skin patches These skin patches - the same These skin patches - the same kind smokers use - seem to kind smokers use - seem to provide short-term relief from provide short-term relief from flare-ups of ulcerative colitis for flare-ups of ulcerative colitis for some people, especially people some people, especially people who formerly smokedwho formerly smoked

Other medications Other medications In addition to controlling inflammation, In addition to controlling inflammation,

some some medications may help relieve UC signs and medications may help relieve UC signs and

symptoms. symptoms. - Anti-diarrheals - Anti-diarrheals - Pain relievers. For mild pain e.g - Pain relievers. For mild pain e.g

headache use acetaminophen . NSAIDs headache use acetaminophen . NSAIDs are contraindicated because they lead to are contraindicated because they lead to diarrheadiarrhea

- Iron supplements. If patients have - Iron supplements. If patients have chronic intestinal bleeding, they may chronic intestinal bleeding, they may develop iron deficiency anemia develop iron deficiency anemia

SurgerySurgery If diet and lifestyle changes, drug If diet and lifestyle changes, drug therapy or other treatments don't therapy or other treatments don't relieve signs and symptoms of UC, relieve signs and symptoms of UC, surgery is recommendsurgery is recommend