Ulcerative Colitis (UC) is one of two main diseases, along with Crohn’s Disease (Crohn’s), in a group of diseases known as Inflammatory Bowel Disease. UC is a disease characterized by inflammation of the lining of the colon (also known as the large intestine). Crohn’s can affect any area of the GI tract and UC only affects the colon. UC is a chronic disorder that continues to affect the patient off and on throughout the patient’s life. Both Crohn’s and UC are autoimmune conditions, where the body’s immune system acts wrongly by attacking normal cells that are supposed to be in the body. UC is believed to occur when the immune system attacks the “good” bacteria that reside in the GI tract of a healthy human. The immune system’s attack brings white blood cells into the lining of the intestines causing inflammation. The chronic inflammation caused by these immune system cells lead to injury to the GI tract and to ulcerations, which causes the patient to have symptoms. Crohn’s and UC have symptoms that are very similar. One difference between the two diseases is the fact that Crohn’s can happen at any point in the GI tract, while UC only affects the colon. Another difference between UC and Crohn’s is the way the disease affects the diseased tissue. In UC, only the surface layers (the innermost cells) of the colon are affected by the disease, and the damage and inflammation to cells is evenly spread without any areas of normal tissue. On the other hand, Crohn’s may involve cells at any layer of the GI tract, and there are sometimes areas of normal, healthy tissue in between the damaged cells.
About 1.4 million people in the US have Inflammatory Bowel Disease, with UC and Crohn’s each representing about half of those cases. There are many factors that correlate with increased incidence of Inflammatory Bowel Disease, and not all of these are fully understood. Some factors include genetics, race/ethnicity and environment. There is also some evidence that there may be a link between bacterial or viral infection in the colon and the immune system causing a reaction that leads to development of UC.
Symptoms of UC
About half of patients that have UC experience mild symptoms like bowel movements that become more urgent and loose, blood frequently appearing in the stool, cramping abdominal pain, and continual diarrhea with pain and bloody stool. UC also frequently causes weight loss and loss of appetite. Also, UC is a disease that flares up, with the patient experiencing symptoms more severely for a period of time, and then the disease goes into remission with the patient experiencing few or no UC symptoms. Since the periods of remission between UC flare-ups can be fairly long, it can be hard to tell whether or not treatment is effective or to predict when the disease symptoms will return. With management, most patients with UC are able to live normal and productive lives. Sometimes a percentage of UC patients experience more severe symptoms of UC. Severe manifestations of UC may include fever, severe diarrhea leading to dehydration, and other symptoms that impact areas of the body outside of the colon.
Treatment of UC
Since UC is a chronic illness (a person experiences it throughout his/her life and there is not a cure), the goal of treatment is to decrease the amount of time a UC patient experiences symptoms. Treatment focuses on regulating the patient’s immune system so symptoms are brought under control and subside for a time. Treatment is also used to maintain remission, decrease the severity of UC symptoms, and improve the patient’s quality of life. Several classes of drugs are often used in treatment of UC:
- Aminosalicylates (5-ASA): A class of anti-inflammatory drugs, these are used to treat mild UC symptoms. Examples are oral sulfasalazine (brand names Asacol, Colazal, Pentasa, Dipentum) and rectal 5-ASA (brand names Rowasa and Canasa). The preferred drug for treatment of mild to moderate UC is mesalamine (Asacol), which is applied rectally. 5-ASA drugs act locally to treat symptoms, are used to cause remission if UC is mild, and can also be used to prevent relapses of UC.
- Corticosteroids: This class is used to treat UC that is active and moderate to severe. These drugs work by generally suppressing the immune system (not targeting a specific part of the immune system that causes inflammation) and thereby decreasing inflammation and symptoms. Corticosteroids should not be used as maintenance drugs due to their many short term and long term side effects. Also, they are not shown to maintain remission. Examples include prednisone and methylprednisolone. Budesonide (Uceris) is a strong glucocorticoid that is not very well absorbed by the stomach or small intestine, so it’s a good choice to reduce inflammation in the large intestine.
- Immune Modifiers: These medications are used to maintain remission of UC and to decrease the dosage patients need of corticosteroids. Immune modifiers work by suppressing the body’s immune system (not specifically the part that causes bowel inflammation in UC) and are used mainly in patients that have not gotten their disease under control with corticosteroids and aminosalicylates. Examples are azathioprine (Imuran), 6-MP (Purinethol), cyclosporine (Neoral), and tacrolimus (Prograf).
- Antibiotics: These are used to treat infection related to UC such as abscesses or fistulas. They may also be used to treat colitis symptoms to avoid the patient developing a life-threatening infection. Metronidazole (Flagyl), ciprofloxacin (Cipro) and others have a role in preventing and eliminating infection in UC patients.
- Biologic Therapies: These medications are used for UC patients with moderate to severe disease who do not respond to other therapies by going into remission. Biologic medications are genetically engineered from living organisms (like genes and proteins). They reduce inflammation and decrease UC symptoms by acting on a specific part of the immune system that is attacking cells in error and blocking its attack on these cells. Examples of biologics are golimumab (Simponi), infliximab (Remicade), and adalimumab (Humira).
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