Ulcerative Colitis: Inflammatory Bowel Disease

Description

Alternative Names

Complications

Surgical removal of the colon is the only cure for ulcerative colitis, but the disease varies greatly in severity. In one 10-year study, 87% of patients went into complete remission after a single attack and only 8% developed a chronic persistent condition. Mortality rates were approximately the same as in the general population, although they were higher in UC patients with severe initial attacks or extensive disease. Surgical and medical treatments have complications of their own that can be very severe.

Criteria for Severity of Ulcerative Colitis

Ulcerative colitis is considered mild if a patient has the following symptoms:

• Four or less bowel movements a day.
• Only occasional blood in the stool.
• A normal temperature and pulse rate.
• Normal hemoglobin or red blood cell count.
• No abnormalities observed on x-rays of the colon.

Ulcerative colitis is considered serious if the following symptoms are present:

• More than six movements a day.
• Frequent to persistent blood and mucus in the stool (in serious cases, stool is liquid and looks like anchovy sauce).
• Fever.
• A rapid pulse.
• Anemia.
• Abnormal x-rays of the colon.
• Tenderness in the abdomen when pressed, with possible distention.

Complications in the Intestine

Malabsorption and Malnutrition. Malabsorption is the inability of the intestines to absorb nutrients. In IBD, this occurs as a result of bleeding and diarrhea, as a side effect from some of the medications, and as a result of surgery. Malnutrition typically develops rapidly after the condition has been present for some time.

Toxic Megacolon. UC patients have a higher than normal risk, although this is still an uncommon occurrence. A serious complication that can occur if inflammation spreads into the deeper layers of the colon. In such cases, the colon enlarges and becomes paralyzed. In severe cases, it may rupture, which is a life-threatening event and requires emergency surgery. Symptoms include weakness and abdominal pain and bloating; the patient may be disoriented or groggy. X-rays are needed to confirm the diagnosis, but barium enemas and colonoscopies should not be performed. Medications used for pain and diarrhea, such as opiates and drugs that reduce spasms of the colon, may increase the risk of toxic megacolon. Its incidence is decreasing with treatment advances.

Toxic megacolon is characterized by extreme inflammation and distention of the colon. Common symptoms are pain, distention of the abdomen, fever, rapid heart rate, and dehydration. This is a life-threatening complication that requires immediate medical treatment.

Bleeding. Bleeding due to ulcers in the colon is a common complication of UC. It can increase the risk for anemia. In some cases, bleeding can be massive and dangerous and requires surgery.

Intestinal Cancers. UC patients have a higher than normal risk for colon cancer. Estimated to be 5% to 10% after 10 years and 15% to 40% after 30 years. They should consider annual screening for colon cancer with colonoscopy beginning as early as age 25, depending on other risk factors, particularly any evidence of precancerous tissue (dysplasia). New tests for certain genetic markers may help determine increased risk. Note: inflammation can produce changes in tissue that resemble precancerous or cancerous changes, increasing the chance for a false diagnosis of cancer. Inflammatory bowel disease in the rectum and lower (sigmoid) colon does not significantly increase the risk for cancer. [For more information, seeWell-Connected report #55, Colon and Rectal Cancers.]

Click the icon to see an image of the colonoscopy procedure.

Complications Outside the Intestine

Eyes. Inflammation in parts of the eye is a common complication. Retinal disease, including detachment can occur but is rare. People with accompanying arthritic complications may be at higher risk for eye problems.

Joints. Stiffness and arthritic-like symptoms occurs in the joints from inflammation. The back is commonly affected.

Bones. Low body weight and calcium loss from corticosteroids contribute to osteoporosis (bone loss). There has been some concern that the disease itself may promote bone loss, although evidence supporting this is weak. (The risk for bone loss much less in ulcerative colitis than in Crohn's disease.)

Click the icon to see an image of osteoporosis.

Anemia. UC poses a higher than normal risk for anemia.

Liver and Gallbladder Disorders. Patients have a higher than average risk for mild but not severe liver abnormalities. Of note is a higher risk (although rare) for primary sclerosing cholangitis, which is persistent inflammation of the bile duct that can later cause serious obstruction.

Skin Disorders. UC patients have higher risk for skin disorders and may experience ulcer eruptions called pyoderma gangrenosum that heal in the center and spread.

Thromboembolism (Blood Clots). Patients are at higher risk for blood clots, which are most likely to occur in lower extremities and pelvic area.

Click the icon to see an image depicting a thrombus.

Kidney Disorders. Patients have a higher than normal risk for kidney stones.

Click the icon to see an image of kidney stones.

Lung Involvement. Lung involvement may develop but it can progress for years without symptoms.

Mouth Sores. There is a slightly higher than average risk for mouth sores and infections in UC, but they are uncommon and lower than in Crohn's disease.

Delayed Growth and Development in Children. Children with UC are at slightly higher than average risk for delayed growth, but their risk is lower than in Crohn's disease.

Fertility. Fertility rates in women are close to normal, but UC surgery can increase the risk for infertility. Prematurity rates high with both. In one study, almost 40% had ovarian cysts and 18% had a hysterectomy, mostly to relieve pain (study did not differentiate between UC and CD).

Hodgkin's Disease. Patients with UC are at higher risk for Hodgkin's disease, according to a 2000 Italian study. The risk of other cancers was not increased, however.

Menstrual Problems in Women. Menstrual abnormalities are common, including premenstrual disorder, abnormal bleeding, and pain. Pain with intercourse occurs in about half of patients. Sexual function may be impaired, not only because of the emotional impact, but also by treatment side effects and complications of the diseases, such as fistulas.

Emotional Factors. The emotional consequences of UC cannot be overestimated, particularly in children. Eating becomes associated with fear of abdominal pain before the end of the meal. Frequent attacks of diarrhea can cause such a strong sense of humiliation that social isolation and low self-esteem may result. Adolescents with IBD may have added problems that increase emotional distress, including weight gain from steroid treatments and delayed puberty.

Neurologic Factors. Inflammatory bowel disease has been associated with neurologic complications, including a higher risk for dementia, movement disorder, and stroke.

Note on Measles Vaccine, Autism, and Inflammatory Bowel Disease. Most publicity has centered on a possible link between the MMR vaccine, which was introduced in 1988, and a variant of autism that includes inflammatory bowel disease (IBD) and impaired behavioral development. Such findings have been rigorously reviewed and refuted in a number of well-conducted studies. Of special note, a 2002 analysis of vaccination records of children born between 1979 and 1998 found no higher incidence in autism, with or without behavioral problems and gastrointestinal disorders. In the study, there was a link between impaired behavioral development and bowel problems, but they were not related to the vaccine. The popular media has incorrectly reported the possible link between autism and MMR as causing a split in the scientific community, but virtually all experts refute any association.