Ulcerative Colitis

What is Ulcerative Colitis?

Ulcerative colitis is an inflammation of the lining of the large bowel (colon and rectum). Symptoms include rectal bleeding, diarrhea, abdominal cramps, weight loss, and fevers. In addition, patients who have had extensive ulcer­ative colitis for many years are at an increased risk to develop large bowel cancer. The cause of ulcerative colitis remains unknown.

HOW IS ULCERATIVE COLITIS TREATED?

Initial treatment of active ulcerative colitis is medical, using anti-inflammatory medica­tions such as aminosalicylates. If these fail, prednisone can be used for a short period of time but long-term use can be associated with significant side effects. If prednisone is ineffective or cannot be discontined, immunomodulators such as 6-mercaptop-urine or azathioprine can be used to control active disease that does not merit hospitaliza-tion. In order to maintain control of the dis­ease, aminosalicylates or immunomodulators are used on a long-term basis. "Flare-ups" of the disease can often be treated by increasing the dosage of medications or adding new medications. Hospitalization may be neces­sary to put the bowel to rest and deliver steroids directly into the blood stream.

When is surgery necessary?

Surgery is indicated for patients who have life-threatening complications of inflammatory bowel diseases, such as massive bleeding, per­foration, or infection. It may also be necessary for those who have the chronic form of the disease, which fails to improve with medical therapy. It is important the patient be com­fortable that all reasonable medical therapy has been attempted prior to considering surgical therapy. In addition, patients who have long­standing ulcerative colitis may be candidates for removal of the large bowel, because of the increased risk of developing cancer. More often, these patients are followed carefully with repeated colonoscopy and biopsy, and surgery is recommended only if precancerous changes are identified.

 

What operations are available?

Historically, the standard operation for ulcera­tive colitis has been removal of the entire colon, rectum, and anus. This operation is called a proctocolectomy (Illustration A) and

may be performed in one or more stages. It eliminates the disease and removes all risk of developing cancer in the colon or rectum. However, this operation requires creation of a Brooke ileostomy (bringing the end of the remaining bowel through the abdomen wall, Illustration B) and long-term use of an appli­ance on the abdominal wall to collect waste from the bowel.

The continent ileostomy (Illustration C) is similar to a Brooke ileostomy, but an internal reservoir is created. The bowel still comes through the abdominal wall, but an external appliance is not required. Instead, the internal

reservoir is drained three to four times a day by inserting a tube into the reservoir. This option eliminates the risks of cancer and recurrent persistent colitis but the internal reservoir may begin to leak and require anoth­er surgical procedure to revise the reservoir.

Some patients may be treated by removal of the colon, with preservation of the rectum and anus. The small bowel can then be reconnected to the rectum and continence preserved. This avoids an ileostomy, but the risks of ongoing active colitis, increased stool frequency, urgency, and cancer in the retained rectum remain.

The ileoanal procedure is the most common surgical treatment for the management of ulcerative colitis. This procedure removes all of the colon and rectum, but preserves the anal canal. The rectum is replaced with small bowel, which is refashioned to form a small pouch. Usually, a temporary ileostomy is cre­ated, but this is closed a few months later. The pouch acts as a reservoir to help decrease the stool frequency. This maintains a normal route


 

of defecation, but most patients experience five to ten bowel movements per day.

This operation all but eliminates the risk of recurrent ulcerative colitis and allows the patient to have a normal route of evacuation. Patients can develop inflammation of the pouch (pouchitis), which usually responds to antibiotic treatment. In a small percentage of patients, the pouch fails to function properly and may have to be removed. If the pouch is removed, a permanent ileostomy will likely be necessary.

Which alternative is preferred?

It is important to recognize that none of these alternatives makes a patient with ulcerative colitis normal. Each alternative has perceivable advantages and disadvantages, which must be carefully understood by the patient prior to selecting the alternative which will allow the patient to pursue the highest quality of life.

What is a colon and rectal surgeon?

Colon and rectal surgeons are experts in the surgical and non-surgical treatment of colon and rectal problems. They have completed advanced training in the treatment of colon and rectal problems in addition to full training in general surgery. Colon and rectal surgeons treat benign and malignant conditions, perform routine screening examinations and surgically treat problems when necessary.


Social Links

Metrika

Yandex.Metrica