ulcerative colitis - canadian digestive health foundation

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  • Understanding ULCERATIVE COLITIS

    What is ulcerative colitis?

    Ulcerative colitis is a chronic disorder affecting the large

    intestine (colon). The digestive system (including the

    stomach, small and large intestines) converts food into

    nutrients and absorbs them into the bloodstream to fuel

    our bodies. The colons main role is to absorb water and

    salts from undigested food waste. This action helps to

    thicken and solidify the stool, which is then expelled from

    the body through the anus.

    Ulcerative colitis causes inflammation (redness and

    swelling) and ulceration (sores) along the lining of the

    colon which can lead to abdominal pain, cramps, bleeding

    and diarrhea. The disease usually begins in the rectal

    area, which holds stool until you go to the bathroom, and

    may involve the entire colon over time. Ulcerative colitis

    is classified as an inflammatory bowel disease (IBD), due

    to the inflammation that occurs in the intestines. Another

    common form of IBD is called Crohns disease. Although

    the symptoms of ulcerative colitis are similar to Crohns

    disease, the conditions are different in several ways.

    While both ulcerative colitis and Crohns disease are

    types of IBD, they should not be confused with Irritable

    Bowel Syndrome (IBS), a disorder that affects the muscle

    contractions and the sensitivity of the colon. Unlike

    ulcerative colitis and Crohns disease, IBS does not cause

    intestinal inflammation nor damage the bowel.

    FEATURE ULCERATIVE COLITIS CROHNS DISEASELocation of inflammation Limited to the large intestine (colon and

    rectum)

    Anywhere in the GI tract (from the

    gums to the bum)

    Pattern of inflammation Inflamed areas are continuous with no

    patchiness

    Patches of inflammation can be found

    between healthy sections of bowel

    Appearance of inflammation Ulcers penetrate the inner lining of the

    intestine only

    Ulcers can penetrate the entire thickness

    (several layers) of the intestinal lining

    Location of pain Typically in the lower left abdomen Typically in the lower right abdomen

    Bleeding Common during bowel movements Uncommon

    Ulcerative colitis Crohns disease

  • ULCERATIVE COLITIS

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    Canada has one of the highest rates of IBD in the world. It

    is estimated that more than 230,000 Canadians suffer from

    IBD with over 4,500 new cases of ulcerative colitis and 5,700

    new cases of Crohns disease being diagnosed every year.

    The number of people with IBD has been rising, particularly

    since 2001, and significantly so in children under the age of

    10. An estimated 5,900 Canadian children have IBD and 20-

    30% of people diagnosed with IBD develop the condition

    before the age of 20.

    In Canada, the economic and health-care related costs of

    IBD are estimated to be $2.8 billion annually. Direct medical

    costs (medications, hospitalizations, physician visits) total

    in excess of $1.2 billion per year. Causing frequent work

    and school absenteeism, IBD can significantly erode an

    individuals productivity and quality of life. Many people

    develop IBD during the peak years of productivity and

    family life.

    What are the symptoms of ulcerative colitis?

    The most common symptoms of ulcerative colitis are

    abdominal pain, diarrhea, blood in the stool and false urges

    to have a bowel movement.

    Abdominal pain (cramping): Ulcerative colitis pain

    can be felt anywhere throughout the abdomen, but it is

    typically located in the lower left side.

    Diarrhea: Diarrhea (frequent, loose or watery stools)

    can range from mild to severe and, in some cases, may

    involve as many as 20 or more trips to the bathroom a

    day.

    Blood and/or mucus in the stool: Ulcers may form

    where inflammation has damaged the intestinal lining.

    These areas bleed and produce pus and mucus, which

    may appear in the stool.

    False urges to have a bowel movement: The urge

    to have a bowel movement may arise frequently, even

    though there is little stool to pass. This urge is caused by

    inflammation of the rectum.

    Other symptoms of ulcerative colitis may include:

    Weight loss Anemia

    Fatigue Nausea

    Fever Vomiting

    Ulcerative colitis may also cause inflammation problems

    outside of the gut, leading to joint pain, eye irritation, skin

    rashes, kidney stones, liver disease, and poor growth in

    children.

    The symptoms of ulcerative colitis vary, depending on the

    extent of inflammation. At times, the pain and discomfort

    of ulcerative colitis may be severe and debilitating, and

    at other times, symptoms may improve or even disappear

    completely.

    What causes ulcerative colitis?

    The exact cause of ulcerative colitis is unknown. However, it

    is believed to be due to a combination of factors, including

    a persons genes (inherited traits) and triggers in the

    environment. This interaction of genetic and environmental

    factors activates an abnormal response of the bodys

    immune system.

    Normally, the immune system protects the body from

    infection. In people with ulcerative colitis, however, the

    immune system can mistake microbes (such as bacteria

    that are normally found in the intestines), food, and other

    material in the intestines, as invading substances. When

    this happens, the body

    launches an attack,

    sending white blood

    cells into the lining of the

    intestines where they

    cause inflammation

    and ulcerations.

    Illustration of normal intestine (left) and intestine with ulcerative colitis (right)

    Normally, the immune system protects the body from infection. With IBD, the immune system can cause serious damage.

  • Colonoscopy

    ULCERATIVE COLITIS

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    o Flexible sigmoidoscopy:

    A slim, flexible tube

    (sigmoidoscope) equipped

    with a light and a tiny

    camera is guided through

    the rectum into the colon.

    The sigmoidoscope allows

    your doctor to examine

    the lining of the lower part

    of the colon only.

    o Colonoscopy: In a procedure similar to a flexible

    sigmoidoscopy, a flexible scope allows your doctor

    to view the lining of

    both the upper and

    lower parts of the colon.

    o Barium enema: A small tube is placed in the rectum and filled with barium liquid and air. Barium

    coats the lining of the colon and rectum so they can

    be seen on an X-ray, allowing your doctor to see

    areas of damage or inflammation.

    o CT (computerized tomography) scan: A CT scan produces cross-sectional X-ray images of the

    abdomen and pelvis to help diagnose ulcerative

    colitis and rule out other possible disorders and

    conditions.

    o MRI (magnetic resonance imaging) scan: An MRI is similar to a CT scan, but it does not use X-rays

    to capture an image. An MRI uses magnetism, radio

    waves, and a computer to produce highly-detailed

    images of the body. It offers an extremely accurate

    method of detecting inflammation and disease in

    the colon and throughout the body.

    Sigmoidoscopy

    Risk Factors

    Age: Ulcerative colitis may affect any age group,

    although there are peaks at ages 15 to 30 years, and

    again at ages 50 to 70 years.

    Race/ethnic background: Ulcerative colitis is more

    common among whites than non-whites and in people of

    Ashkenazi Jewish descent.

    Family history: People with a first-degree relative

    (parent or sibling) with ulcerative colitis are at greater

    risk of developing the condition.

    How do I know if I have ulcerative colitis?

    Often, symptoms alone can provide doctors with the

    information they need to diagnose ulcerative colitis. Your

    doctor will perform a physical examination and take a

    complete medical history that includes a careful review of

    your symptoms. For this reason, it is important to be candid

    and specific with your doctor about the problems you are

    having.

    There is no one specific laboratory test, X-ray or scope to

    diagnose ulcerative colitis, however, to help confirm the

    condition and rule out other problems, your doctor may

    send you to have one or more of the following tests:

    Blood tests: Blood tests can help to identify anemia (low

    blood count), infection and inflammation.

    Stool sample tests: A stool analysis can detect blood in

    the stool and rule out infection, malabsorption, parasites

    and other digestive problems.

    Imaging tests: Your doctor may order tests to see your

    lower digestive organs. These safe tests can help to

    diagnose ulcerative colitis or Crohns disease and identify

    other problems such as ulcers, polyps (growths on the

    lining of the intestines) and

    colon cancer. A sample of

    the lining of the intestine

    (biopsy) may be taken to

    examine under a microscope.

    It is important to

    be candid and specific with your doctor.

  • ULCERATIVE COLITIS

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    How is ulcerative colitis treated?

    There is no cure for ulcerative colitis at the present time, however, there are effective treatments available that may control your disease and even place it into remission. Remission means that your symptoms disappear completely. Y

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