Ulcerative Colitis: what it is and how to treat it

Written by: Dr. José Vicente Roig Vila
Edited by: Patricia Pujante Crespo

Ulcerative colitis affects the rectum and colon inner layer. Some symptoms include anal bleeding, diarrhea, abdominal pain, weight loss or fever. To address it correctly there are several ways, depending on the severity of the case.

Ulcerative Colitis: what it is and why it occurs

Ulcerative colitis (UC) is a chronic inflammatory disease of the inner layer (mucosa) of the colon and rectum that evolves outbreaks.

We do not know its cause, although there may be a genetic predisposition and be influenced by immune factors so that there are antibodies that act against the very mucosa of the large intestine. There may be infectious, allergic, psychological or environment that contribute to trigger this abnormal immune response factors.


Prevalence of ulcerative colitis

Ulcerative colitis most often affects young adults of both sexes. No defined risk factors, and the fact that he presented other disorders thick, such as diverticulitis, polyps or health problems generally do not influence its appearance intestine.


Symptoms of ulcerative colitis

The most important symptoms are:- Bleeding from the anus, of greater or lesser intensity- diarrhea- abdominal pain- weightloss- fever

Occasionally it can also affect other organs such as the liver, skin, eyes or joints, causing inflammation in them. Usually it develops as a crisis or inflammatory outbreaks more or less severity and affect different amount of the colon or rectum, with periods of stability between them. In addition, if the disease is extensive and of years of evolution, there is increased risk for colon cancer.


Diagnosis of ulcerative colitis

After suspicion, and in any patient with bleeding from the anus, an endoscopic examination should be performed as rectal minimum, and preferably a complete colonoscopy, especially in people over 50 years to rule out other processes such as polyps and malignant tumors of the colon and straight. The diagnosis is confirmed by biopsy and sometimes there are difficulties in differentiating disease other as Crohn's disease, which can affect, unlike ulcerative colitis, any part of the digestive tract.


Treatment of ulcerative colitis

The initial treatment is medical. It includes the use of anti-inflammatories and corticosteroids and 5-ASA and sometimes antibiotics. Corticosteroids have side effects and, therefore, try to reduce or eliminate where possible.

Major outbreaks of disease require more powerful treatment with hospitalization, special medications like immunosuppressants, or so-called biological treatments and artificial nutrition to let stand the intestine.

Close collaboration between gastroenterologists and accurate colorectal surgeons surgeons , for the guidance of medical treatment, which will be individualized depending on the evolution of each patient. The severity of the disease is highly variable, and many patients with milder forms with involvement only in the final part of the intestine can make a completely normal life. The rest usually also have a good performance between inflammatory outbreaks and in relation to the degree of involvement of colon suffering.


When surgery is required in Ulcerative Colitis

The emergency intervention may be indicated before complications that endanger life, such as massive bleeding, perforation or dilation of the colon (toxic megacolon). It is also required in patients with chronic form of the disease if proper medical treatment fails and have frequent or severe, or if you have serious side effects from the use of corticosteroids outbreaks.

Another indication is the existence of cancer (dysplasia) premalignant disorders, associated with ulcerative colitis, or have high risk of suffering. It is estimated that 20-25% of patients will require surgery.


Type operations available for ulcerative colitis

The classic standard was for years the removal of the entire large intestine, including the rectum and anus, which is called Procto-colectomy, and which can be performed in one or more stages. Its advantage is the healing of intestinal disease and prevent cancer risk. However, it is necessary to make an artificial anus or stoma in the abdomen with small intestine (ileostomy). Even today it can be a good option in certain subjects.

Some patients can also be treated by removing the colon, but keeping part of the rectum and anus if they are not affected, and suturing the small intestine to the rectum (ileo-rectal anastomosis). ileostomy is avoided but there may be risk of new rectal inflammation.

The most common alternative treatment is called proctocolectomy and ileal anal anastomosis with reservoir. It involves removing the entire colon and rectum but leaving the anus with its sphincters. The rectum is replaced by the small intestine. Be associated ileostomy but only for a few months. The reservoir helps reduce stool frequency which is 4 to 8 times a day. This is a complex operation that requires a prior evaluation of the function of the anus and sphincters, and postoperative controls.

These techniques can be performed in many cases by minimally invasive surgery (laparoscopy), which has many benefits for the patient with respect to his postoperative recovery, not performed or incisions in the abdomen be these minimum.


Does surgery cure ulcerative colitis?

It is important to recognize that no alternative becomes normal patient. All have advantages and disadvantages that must be evaluated to determine the appropriate option, which will be offering better results in each case, after discussing the pros and cons with the patient. Since ulcerative colitis is a disease of unknown cause that can affect different organs, not all manifestations of the same they are necessarily heal after removal of the colon and rectum, but most of them do. However, usually after surgery a good quality of life is obtained.

It is interesting to learn more aspects of the disease, patients opinions and expert advice, engage with regional associations of patients with ulcerative colitis and Crohn's disease, or the national confederation of associations of patients.


Edited by Patricia Crespo Pujante

*Translated with Google translator. We apologize for any imperfection

By Dr. José Vicente Roig Vila
Colon & Rectal Surgery

Dr. Roig Vila is a renowned expert in Coloproctology . He is an extraordinary Doctorate Prize and outstanding specialist in Coloproctology for the European Union , former president of the Valencian Society of Surgery (SVC) , Spanish Association of Coloproctology (AECP) and Honorary Member of the Association as well as the Spanish Association of Surgeons (AEC) among other national and international, Prize Virgili 2018 of the Catalan Society of Surgery. Pioneer in the introduction in Spain of several techniques of pelvic floor. He is currently Co-Director of the Coloproctology Unit of the Vithas Nisa Hospital 9 de Octubre de Valencia, the only one accredited as an Advanced Unit in a private Hospital by the AECP , a member of the European Society of Coloproctology and the American Society of Colorectal Surgeons , and author of more than 200 publications of colorectal surgery , as well as director of multiple courses and congresses of the specialty.

*Translated with Google translator. We apologize for any imperfection

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