Colitis: The Enemy Within

Answer 1

Colitis, or ulcerative colitis, is an Inflammatory Bowel Disease thought to be an abnormal reaction by the immune system. It attacks the mucosal lining of the large intestine, starting at the rectum and spreading through the entire colon. Peak onset of disease activity is between 15-30 years of age, although it can come sooner or later. It affects males or females, with Ashkenazi Jewish descendants at a higher risk than other populations. There is no cure for colitis, only treatment to manage symptoms.

Colitis often starts with bleeding from the rectum, abdominal pain and frequent bowel movements. Fevers and weight loss may occur, making anemia and dehydration a concern. Symptoms range from mild to severe. Manifestations of the disease outside of the colon may include joint pain, skin rashes, mouth ulcers, gallstones, liver disease, eye problems and growth retardation in children.

Diagnosis can be made through colonoscopy, biopsy, X-rays, CT scans and blood or stool testing. Medicines used to treat colitis are sulfasalazine, aminosalicylates, topical corticosteroid creams, prednisone, immunomodulating drugs, and infliximab, which is given intravenously. Surgeries are performed when medicine can no longer control symptoms. 25-35% of all colitis patients eventually need surgery.

Surgery is curative for colitis. 95% of surgeries are elective, 5% are done because of complications or emergencies, such as toxic megacolon (distention of the bowel with air), bowel perforation, or sepsis. Colitis can also lead to cancer. Surgery usually involves removing the rectum and colon, called a proctocolectomy with an ileostomy, which means bringing the small intestine through the abdominal wall to empty into a pouch worn on the body. The intestine may also be shaped into a pouch, called a J pouch, and attached to the anus to preserve normal bowel function.

Diet modification can help with symptoms, but doesn’t improve the inflammation. Individuals differ in their sensitivities, so each person will have to experiment to see what foods bother them. A good rule of thumb is to avoid anything known to aggravate diarrhea. Eating a healthy diet is important for good nutrition, because individuals can become malnourished and need supplements. Regular exercise is good, but it can make symptoms worse during severe illness.