Introduction:

Ulcerative colitis is an inflammatory bowel disease (IBD) that causes long-lasting inflammation in part of your digestive tract.Like Crohn's disease, another common IBD, ulcerative colitis can be debilitating and sometimes can lead to life-threatening complications. Because ulcerative colitis is a chronic condition, symptoms usually develop over time, rather than suddenly.

Ulcerative colitis usually affects only the innermost lining of your large intestine (colon) and rectum. It occurs only through continuous stretches of your colon, unlike Crohn's disease, which occurs anywhere in the digestive tract and often spreads deeply into the affected tissues.

There's no known cure for ulcerative colitis, but therapies are available that may dramatically reduce the signs and symptoms of ulcerative colitis and even bring about a long-term remission.

Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs. For these reasons, doctors often classify ulcerative colitis according to its location.

Signs and symptoms that may accompany ulcerative colitis, depending on its classification:

Ulcerative proctitis:  In this form of ulcerative colitis, inflammation is confined to the area closest to the anus (rectum), and for some people,rectal bleeding may be the only sign of the disease. Others may have rectal pain and a feeling of urgency. This form of ulcerative colitis tends to be the mildest.

Proctosigmoiditis:This form involves the rectum and the lower end of the colon, known as the sigmoid colon. Bloody diarrhea, abdominal cramps and pain, and an inability to move the bowels in spite of the urge to do so (tenesmus) are common problems associated with this form of the disease.

Left-sided colitis: As the name suggests, inflammation extends from the rectum up through the sigmoid and descending colon, which are located in the upper left part of the abdomen. Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss.

Pancolitis: Affecting more than the left colon and often the entire colon, pancolitis causes bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue, and significant weight loss.

Fulminant colitis: This rare, life-threatening form of colitis affects the entire colon and causes severe pain, profuse diarrhea and, sometimes, dehydration and shock. People with fulminant colitis are at risk of serious complications, including colon rupture and toxic megacolon, a condition that causes the colon to rapidly expand.The course of ulcerative colitis varies, with periods of acute illness oftenalternating with periods of remission. But over time, the severity of the disease usually remains the same. Most people with a milder condition, such as ulcerative proctitis, won't go on to develop more-severe signs and symptoms.

When to see a doctor See your doctor if you experience a persistent change in your bowel habits or if you have any of the signs and symptoms of ulcerative colitis, such as:

• Abdominal pain
• Blood in your stool
• Ongoing bouts of diarrhea that don't respond to medications
• PUO (Pyrexia of unknown origin)

Diet and Life style Modification in Ulcerative colitis: There's no firm evidence that what you eat causes inflammatory bowel disease. But certain foods and beverages can aggravate your symptoms, especially during a flare-up in your condition. It's a good idea totry eliminating from your diet anything that seems to make your signs and symptoms worse. Here are some suggestions that may help:

Limit dairy products: If you suspect that you may be lactose intolerant, you may find that diarrhea, abdominal pain and gas improve when you limit or eliminate dairy products. You may be lactose intolerant that is, your body can't digest the milk sugar (lactose) in dairy foods. If so, try using an enzyme product, such as Lactaid, to help break down lactose. If you need help, a registered dietitian can help you design a healthy diet that's low in lactose. Keep in mind that with limiting your dairy intake, you'll need to find other sources of calcium, such as supplements.

Experiment with fiber: For most people, high-fiber foods, such as fresh fruits and vegetables and whole grains, are the foundation of a healthy diet. But if you have inflammatory bowel disease, fiber may make diarrhea, pain and gas worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them. Check with your doctor before adding significant amounts of fiber to your diet.

Avoid problem foods: Eliminate any other foods that seem to make your symptoms worse. These may include "gassy" foods, such as beans, cabbage and broccoli, raw fruit juices and fruits, popcorn, caffeine,and carbonated beverages.

Eat small meals: You may find that you feel better eating five or six small meals rather than two or three larger ones.

Drink plenty of liquids: Try to drink plenty of fluids daily. Water is best. Beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.

Ask about multivitamins: Because ulcerative colitis can interfere with your ability to absorb nutrients and because your diet may be limited, vitamin and mineral supplements can play a key role in supplying missing nutrients. They don't provide essential protein and calories, however, and shouldn't be a substitute for meals.

Talk to a dietitian: If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.

Stress 

Although stress doesn't cause inflammatory bowel disease, it can make your signs and symptoms much worse and may trigger flare-ups. Stressful events can range from minor annoyances to a move, job loss or the death of a loved one.

When you're stressed, your normal digestive process can change, causing your stomach to empty more slowly and secrete more acids. Stress can also speed or slow the passage of intestinal contents. It may also cause changes in intestinal tissue itself.Although it's not always possible to avoid stress, you can learn ways to help manage it.

Some of these include:

Exercise: Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your doctor about an exercise plan that's right for you.

Biofeedback: This stress-reduction technique helps you reduce muscle tension and slow your heart rate with the help of a feedback machine. You're then taught how to produce these changes yourself. The goalis to help you enter a relaxed state so that you can cope more easily with stress. Biofeedback is usually taught in hospitals and medical centers.

Regular relaxation and breathing exercises: An effective way to cope with stress is to perform relaxation and breathing exercises. You can take classes in yoga and meditation or practice at home using books, CDs or DVDs.

Hypnosis: Hypnosis may reduce abdominal pain and bloating. A trained professional can teach you how to enter a relaxed state.

Other techniques.

Set aside time every day for activities you find relaxing — listening to music, reading, playing computer games or just soaking in a warm bath.

Tests and Diagnosis

Your doctor will likely diagnose ulcerative colitis only after ruling out other possible causes for your signs and symptoms, including Crohn's disease, ischemic colitis, infection, irritable bowel syndrome (IBS), diverticulitis and colon cancer. To help confirm a diagnosis of ulcerative colitis, you may have one or more of the following tests and procedures:

Blood tests: Your doctor may suggest blood tests to check for anemia or infection. Tests that look for the presence of certain antibodies can sometimes help diagnose which type of inflammatory bowel disease you have, but these tests can't definitely make the diagnosis.

Stool sample: The presence of white blood cells in your stool indicates an inflammatory disease, possibly ulcerative colitis. A stool sample can also help rule out other disorders, such as those caused by bacteria, viruses and parasites. In particular, infection with the bacterium Clostridium difficile can be responsible for diarrhea, but it's also more common among people with ulcerative colitis. Your doctor can also check for a bowel infection, which is more likely to occur in people with ulcerative colitis.

Colonoscopy: This exam allows your doctor to view your entire colon using a thin, flexible, lighted tube with an attached camera. During the procedure, your doctor can also take small samples of tissue (biopsy) for laboratory analysis. Sometimes a tissue sample can help confirm a diagnosis.

X-ray: A standard X-ray of your abdominal area may be done to rule out toxic megacolon or a perforation if these conditions are suspected because of severe symptoms.

CT scan: A CT scan of your abdomen or pelvis may be performed if your doctor suspects a complication from ulcerative colitis or inflammation of the small intestine that might suggest Crohn's disease. A CT scan may also reveal how much of the colon is inflamed.

Treatment and Drugs

The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission. Ul cerativecolitis treatment usually involves either drug therapy or surgery.Doctors use several categories of drugs that control inflammation in different ways. But drugs that work well for some people may not work for others, so it may take time to find a medication that helps you. In addition, because some drugs have serious side effects, you'll need to weigh the benefits and risks of any treatment.

Anti-inflammatory drugs

Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:

Sulfasalazine :

Sulfasalazine can be effective in reducing symptoms of ulcerative colitis, but it has a number of side effects, including nausea, vomiting, diarrhea, heartburn and headache. Don't take this medication if you're allergic to sulfa medications.

Mesalamine (Mesacol, Asacol, Pentasa, Rowasa) and Balsalazide (Balacol) These medications are available in oral forms and also in topical forms, such as enemas and suppositories. Which form you take depends on the area of your colon that's affected by ulcerative colitis. These medications tend to have fewer side effects than sulfasalazine and are generally very well tolerated. Your doctor may prescribe a combination of two different forms, such as an oral medication and an enema or suppository. Mesalamine can relieve signs and symptoms in more than 90 percent of people with mild ulcerative colitis.

People with proctitis tend to respond better to combination therapy with oral mesalamine and suppositories. For left-sided colitis, a combination of oral mesalamine and mesalamine enemas seems to work better than either agent alone if symptoms are mild to moderate. Rare side effects include headache, kidney problems and pancreas problems (pancreatitis).

Corticosteroids: Corticosteroids can help reduce inflammation, but they have numerous side effects, including weight gain, excessive facial hair, mood swings, high blood pressure, type 2 diabetes,osteoporosis, bone fractures, cataracts, glaucoma and an increased susceptibility to infections. Doctors generally use corticosteroids only if you have moderate to severe inflammatory bowel disease that doesn't respond to other treatments. Corticosteroids aren't for long-term use, and the dose is usually tapered down over two to three months.

They may also be used in conjunction with other medications as a means to induce remission. For example, corticosteroids may be used with an immune system suppressor — the corticosteroids can induceremission, while the immune system suppressors can help maintain remission. Occasionally, your doctor may also prescribe short-term use of steroid enemas to treat disease in your lower colon or rectum. Immune system suppressors These drugs also reduce inflammation, but they target your immune system rather than treating inflammation itself. Because immune suppressors can be effective in treating ulcerative colitis, scientists theorize that damage to digestive tissues is caused by your body's immune response to an invading virus or bacterium or even to your own tissue.

By suppressing this response, inflammation is also reduced. Immunosuppressant drugs include:

Azathioprine (Azoran): Because azathioprine act slowly — taking three months or longer to start working — it is initially combined with a corticosteroid, but in time, they seem to produce benefits on theirown and the steroids can be tapered off.Side effects can include allergic reactions, bone marrow suppression, infections, and inflammation of the liver and pancreas. 

There also is a small risk of development of cancer with these medications. If you're taking either of these medications, you'll need to follow up closely with your doctor and have your blood checked regularly to look for side effects. If you've had cancer, discuss this with your doctor before starting these medications.

Infliximab (Remicade): This drug is specifically for those with moderate to severe ulcerative colitis who don't respond to or can't tolerate other treatments. It works quickly to bring on remission,especially for people who haven't responded well to corticosteroids. This drug can sometimes prevent surgery for some people. It works by neutralizing a protein produced by your immune system known as tumornecrosis factor (TNF). 

Infliximab finds TNF in your bloodstream and removes it before it causes inflammation in your intestinal tract.Once started, infliximab is generally continued as long-term therapy,although its effectiveness may decrease over time.

Surgery

If diet and lifestyle changes, drug therapy, or other treatments don't relieve your signs and symptoms, your doctor may recommend surgery.Surgery can often eliminate ulcerative colitis. But that usuallymeans removing your entire colon and rectum (proctocolectomy). In the past, after this surgery you would wear a small bag over an opening in your abdomen (ileal stoma) to collect stool. But a procedurecalled ileoanal anastomosis eliminates the need to wear a bag. Instead, your surgeon constructs a pouch from the end of your small intestine. 

The pouch is then attached directly to your anus. This allows youto expel waste more normally, although you may have more-frequent bowel movements that are soft or watery because you no longer have your colon to absorb water.