Colitis Explained

One of my friends, Britney, was just diagnosed with colitis. She had been having severe abdominal pain, frequent diarrhea and first thought it might be food poisoning or a lactose intolerance. After many tests, she was diagnosed with colitis. 

Colitis occurs when an overactive immune system launches an attack on healthy tissue in the gut and causes inflammation of the large intestine. This attack leads to Ulcerative Colitis (UC) when ulcers (open sores) develop in the large intestine, also known as your colon. It is one of a few conditions that is grouped under the heading of inflammatory bowel disease (IBD).  

The inflammation in ulcerative colitis often starts in the rectum, and then spreads upward in the body. Different terms identify the area of inflammation. It is called ulcerative proctitis, when the inflammation occurs in the rectum and lower part of the colon, pancolitis if the entire colon is affected, and distal colitis if only the left side of the colon is affected. 

Each person’s case of UC is different as is the amount of inflammation, areas affected, and the amount of discomfort caused. You could have severe inflammation in a small area or mild inflammation in a large area, such as your entire colon. 

Like many autoimmune illnesses, UC follows a pattern of active flare-ups followed by remission where symptoms calm down. About 50% of those diagnosed with ulcerative colitis will have mild symptoms. But for others, ulcerative colitis symptoms often get worse over time.

Symptoms

Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs. Signs and symptoms may include:

• Diarrhea, often with blood or pus
• Abdominal pain and cramping
• Rectal pain
• Rectal bleeding — passing small amount of blood with stool
• Urgency to defecate
• Inability to defecate despite urgency
• Weight loss
• Fatigue
• Fever
• Failure to grow (children)
• Anemia (reduced number of red blood cells)

Who Gets Ulcerative Colitis?

Ulcerative colitis is not a rare condition. Along with Crohn’s disease, also a type of inflammatory bowel disease, it affects up to 1 in 250 people in North America and Europe.

Ulcerative colitis can occur at any age, but it usually starts between the ages 15 and 30, about 20% of patients are diagnosed before they are 20 years old. Another, but less frequently affected age group is 50- to 70-year-olds. Men and women are equally at risk. 

Your chance of getting it is slightly higher if you:

• Have a close relative with inflammatory bowel disease (IBD)
• Are between 15 and 30 years old, or older than 60
• Are Jewish
• Eat a high-fat diet
• Use frequent nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen (Advil® or Motrin®)

Ulcerative Colitis Diagnosis and Testing

Getting a diagnosis for a chronic illness such as colitis can take time and involve several steps and procedures. Educating yourself and asking questions of your practitioners is going to relieve stress and get you the best care possible. It is helpful to write down your symptoms and questions and bring your list to your appointments. 

Here are the basic first steps involved:

• Your health care provider will conduct a physical exam, get a family history, ask diet and life style questions, and have you report all the symptoms you are having. 
• Your health care provider will probably recommend laboratory tests of your blood and fecal matter. This will rule out the possibilities that bacteria, a virus, or a parasite is the cause of symptoms. 
• Blood tests can also identify anemia, which could indicate bleeding in your colon or rectum.
• X-rays may be taken in order to get a clearer and detailed picture of your gastro-intestinal tract. 

Taking a Look Inside

Additional procedures will probably be needed to see what is going on throughout your digestive system:

Endoscopy 

• An endoscopy allows doctors to examine the inside of your colon and rectum with a lighted tube inserted through your anus. There are two types of endoscopies used during ulcerative colitis testing:

• A sigmoidoscopy allows your healthcare professional to examine the extent of the inflammation in your lower colon and rectum.
• A total colonoscopy is a similar to the sigmoidoscopy, but this procedure allows your doctor to examine your entire colon.

Chromoendoscopy

• This technique during a colonoscopy to look for polyps or precancerous changes. During a chromoendoscopy, a blue liquid dye is sprayed into the colon to highlight and detect slight changes in the lining of your intestine. Polyps can then be removed and/or biopsied. It is common to have blue bowel movements following this procedure.  

Biopsy

• During your endoscopy a small piece of tissue from the intestine is removed so it can be analyzed and screened for disease. 

Ulcerative Colitis Treatment 

The goal of treatment and therapies is to put colitis into remission and keep it there as long as possible. Here are the primary kinds of drug treatment per the Mayo Clinic:

Medication

• 5-aminosalicylates. Examples of this type of medication include sulfasalazine (Azulfidine), mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum). Which one you take, and whether it is taken by mouth or as an enema or suppository, depends on the area of your colon that’s affected.
• Corticosteroids. These drugs, which include prednisone and budesonide, are generally reserved for moderate to severe ulcerative colitis that doesn’t respond to other treatments. Due to the side effects, they are not usually given long term.

Immune system suppressors

These drugs also reduce inflammation, but they do so by suppressing the immune system response that starts the process of inflammation. For some people, a combination of these drugs works better than one drug alone.

Immunosuppressant drugs include:

• Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). These are the most widely used immunosuppressants for the treatment of inflammatory bowel disease. Taking them requires that you follow up closely with your doctor and have your blood checked regularly to look for side effects, including effects on the liver and pancreas.
• Cyclosporine (Gengraf, Neoral, Sandimmune). This drug is normally reserved for people who haven’t responded well to other medications. Cyclosporine has the potential for serious side effects and is not for long-term use.
• Tofacitinib (Xeljanz). This is called a “small molecule” and works by stopping the process of inflammation. Tofacitinib is effective when other therapies don’t work. Main side effects include the increased risk of shingles infection and blood clots.

The U.S. Food and Drug Administration (FDA) recently issued a warning about tofacitinib, stating that preliminary studies show an increased risk of serious heart-related problems and cancer from taking this drug. If you’re taking tofacitinib for ulcerative colitis, don’t stop taking the medication without first talking with your doctor.

Diet, Nutrition, and Exercise 

It is important to eat a balanced and nutritious diet while emphasizing foods that do not irritate your digestive tract further. Symptoms such as diarrhea can not only be dehydrating but can reduce your body’s ability to absorb protein, fat, carbohydrates, vitamins, and minerals. Being unaware of food allergies or lactose intolerance can lead to eating foods that cause more irritation and inflammation. 

Regular exercise keeps all our internal organs working at their best. As many as 1 of every 4 people with inflammatory bowel disease have joint inflammation as well. Inflammation and corticosteroid use can weaken muscles which then puts a strain on joints. Exercise strengthens muscles and protects your joints. Exercise can also lower stress and elevate mood; this can only be a plus for someone dealing with a chronic condition. 

Surgery

For some patients, surgery is needed. From the Mayo Clinic:

Surgery can eliminate ulcerative colitis and involves removing your entire colon and rectum (proctocolectomy).

In most cases, this involves a procedure called ileoanal anastomosis (J-pouch) surgery. This procedure eliminates the need to wear a bag to collect stool. Your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus, allowing you to expel waste relatively normally.

In some cases, a pouch is not possible. Instead, surgeons create a permanent opening in your abdomen (ileal stoma) through which stool is passed for collection in an attached bag.

I hope this helps explains exactly what colitis is.