ULCERATIVE COLITIS

BACKGROUND

Ulcerative colitis is a condition that causes diarrhea, belly pain, and bloody bowel movements. These symptoms happen because the large intestine becomes inflamed and gets sores, called "ulcers." The large intestine is also called the colon.

DISEASE OCCURRENCE IN POPULATION:

Ulcerative colitis is more common in the Western and Northern hemispheres; the incidence is low in Asia and the Far East.

In Pakistan true prevalence of this disease is unknown. In a large referral centre the incidence of ulcerative colitis in patients presenting with rectal bleeding was reported to be as high as 25%.

RISK FACTORS:

Ulcerative colitis affects about the same number of women and men. Risk factors may include:

• Age: Ulcerative colitis usually begins before the age of 30. But, it can occur at any age, and some people may not develop the disease until after age 60.
• Race or ethnicity: Although whites have the highest risk of the disease, it can occur in any race.
• Family history: You're at higher risk if you have a close relative, such as a parent, sibling or child, with the disease.
• Isotretinoin use: Isotretinoin is a medication sometimes used to treat scarring cystic acne or acne. Some studies suggest it is a risk factor for Irritable bowel syndrome (IBD), but a clear association between ulcerative colitis and isotretinoin has not been established.

SIGN AND SYMPTOMS:

Symptoms can be mild or severe. They might happen just once. Or they might go away and come back over and over again. Possible symptoms include:

• Diarrhea that might happen 10 or more times a day
• Bloody bowel movements
• Bleeding from the anus
• Mucus coming out of the anus
• Belly cramps
• Fever
• Weight loss
• Swelling and pain in the hips and knees
• Redness and pain in the eyes
• Skin rash
• Ulcers or sores in your mouth

DIAGNOSTIC TEST:

There are a few tests that can help doctors diagnose ulcerative colitis. Doctors usually use a test called a "sigmoidoscopy" or a similar test called a "colonoscopy". For these tests, the doctor puts a thin tube into your rectum (the lower part of the large intestine) and threads it up into your colon. The tube has a camera attached to it, so the doctor can look inside your colon. The tube also has tools attached, so the doctor can take samples of tissue to look at under the microscope. Other tests might include X-rays or scans.

TREATMENT OPTIONS:

Depending on your symptoms, your doctor might prescribe:

• Medicines that you put directly into your rectum. These reduce swelling in mild cases. It takes about 3 to 4 weeks before they start working.
• Medicines that you take in a pill. A common one is called "5-ASA (5-aminosalicylic acid)."
• A brief course of medicines called steroids to reduce swelling. (These are not the same steroids that athletes use to build muscle.)
• Stronger medicines for severe cases. These medicines work on your immune system to protect your colon from damage. Common ones are "6-mercaptopurine," "azathioprine," and anti-tumor necrosis factor (anti-TNF) medicines such as "infliximab" and "adalimumab."

For most people, symptoms go away after just a few weeks of treatment.

PRECAUTIONS:

Your symptoms might improve if you:

• Cut down on foods that make your symptoms worse
• Avoid pain medicines such as ibuprofen and naproxen. If you need a pain medicine, acetaminophen is OK to use.

If you start cutting foods out of your diet, your doctor might suggest that you take a multivitamin and a folic acid supplement. If you stop eating dairy, you should take calcium and vitamin D. These supplements will make up for nutrients you might be missing.

REFERENCES:

• Jafri, W. Inflammatory bowel disease: an important cause of rectal bleeding - a review of 100 rectal bleeders. Gut., 1989;30:1466(Abs).
• http://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/basics/risk-factors/CON-20043763
• https://www.uptodate.com/contents/ulcerative-colitis-in-adults-the-basics?source=search_result&search=ulcerative%20colitis%20patient%20info&selectedTitle=1~150