Ulcerative Colitis

Ulcerative colitis is an inflammatory bowel disease that affects the rectum and colon. While the exact cause was not known, it was thought to be related to over-reaction of the immune system triggered by certain environmental factors such as intestinal bacteria. Genetics may also play a role. The immune system attacks own body’s cells, causing inflammation and ulcers in the lining (mucosa) of the large intestine. The disease starts in the rectum and spread in a continuous manner and may involve part of or the entire length of colon as well. It is a chronic condition that may flare up at times, go into remission and come back later. Patients with ulcerative colitis are at higher risk of developing colon or rectal cancer.

Symptoms and diagnosis of ulcerative colitis

Common symptoms of ulcerative colitis include cramping pain in lower abdomen, sensation that you need to empty your bowel frequently, loose stool with mucus and sometimes blood. During acute flare (when inflammation is more severe), you may have multiple bloody loose stool, fever, weakness, weight loss. Diagnosis is made based on symptoms and colonoscopic exam findings. Direct visualization of the extent and severity of the inflammation of colon and rectum, along with microscopic exam of biopsy taken during colonoscopy help establish the diagnosis. Additionally blood test and sometimes CT scan or MRI may be needed to differentiate ulcerative colitis from other disease process such as Crohn's disease.

Treatment of ulcerative colitis

Medications with anti-inflammatory and immune-supressing actions are the first line of treatment and is often managed by a gastroenterologist. Medication cannot cure ulcerative colitis but can control symptoms so patient can function and live a normal life. Surgery may be needed in the following circumstances:

When medication is no longer effective and side effects of medication outweigh its benefits
When cancer or pre-cancerous lesion develop in the colon or rectum
When severe bleeding, inflammation or infection (toxic colitis or perforation) is not controlled by medication and is potentially life threatening

In emergency situation (severe bleeding or infection), surgery typically involves removal of the colon only and creation of an ileostomy, since patient is anticipated to have wound healing difficulty due to being severely ill and on maximum dose of immune-supressing medications. Once fully recovered from the acute illness, patient will undergo a second stage surgery to remove the rectum. In non-emergent situation, surgery typically involves removal of the entire colon and rectum, with creation of an ileal pouch (the new rectum) using the terminal ileum (the last part of small intestine). The ileal pouch is anastomosed/connected to the top of the anal canal, and a temporary ileostomy is created to divert stool from going through the ileal pouch-anal anastomosis until the connection has healed well. In certain patients, creation of a permanant ileostomy may be a better choice. The necessity, timing and approach of surgery is indivdualized and is determined after a thorough assessment by Dr Choi and discussion with the patient.

While the surgery may be radical, removing the entire colon and rectum provides permanent cure. Patient will have permanent changes of bowel habit due to loss of the colon and rectum. If an ileal pouch-anal anastomosis is created, frequent and less formed bowel movements up to 6-8 times during the day and at least 1-2 times at night is expected. Some patients may experience inflammation / infection of the pouch and needs treatment and close follow up.