The Crohn's and Colitis Foundation of America (CCFA) hosted a web/tele-conference this past week called, Ulcerative Colitis - The A to Z of Treating UC. The conference speaker was Dr. Thomas Ullman from Mount Sinai Medical Center in New York City.
While much of the information Dr. Ullman discussed may be common knowledge for those of us who are veterans of living with Ulcerative Colitis (UC). I think it never hurts to recap the A to Z of this disease. He gave a lot of good information and there just might be a new tidbit of information for one or all of us.
The broad facts of Ulcerative Colitis include the following:
- UC is a disease of the rectum and large intestine (also called the colon) only.
- The prevalence of UC and Crohn's disease are about equal.
- Approximately 700,000 Americans have UC.
- 50% of UC cases are considered mild
- It is estimated that 20 - 45% of UC patients will have some sort of surgery during their illness
- In UC, the rectum is always involved. But, the disease may also travel up through the colon.
- Ten years after diagnosis, the risk of colon cancer seems to be higher in UC patients than Crohn's patients.
What exactly causes UC is not clearly known, but genetic factors, environmental factors, and a defect in the immune system are all possible causes.
Typical UC symptoms include:
- Diarrhea with blood and mucus present - this is the hallmark symptom of UC.
- Urgency to have a bowel movement
- Pain and cramping in the gut
- Loss of appetite
- Weight loss
Doctors tend to classify the severity of UC in a patient by how much of the colon is involved and the symptom pattern.
- Mild UC is classified as four diarrhea bowel movements (BM) per day with blood.
- Moderate is four to six BMs per day, with blood
- Severe is more than six BMs per day with blood.
- Proctitis is UC that involves only the rectum
- Proctosigmoiditis is UC that involves the rectum and the sigmoid colon
- Left-sided UC involves the left side of the colon from rectum to the bend in the colon
- Extensive UC or Pancolitis affects the entire colon
The typical tests used to detect UC include:
- Stool cultures
- Blood tests
- Barium x-rays
- Cat scans to look for inflammation, and
- The gold-standard test is the Biopsy of colon tissue taken during a sigmoidoscopy or a colonoscopy.
UC Treatments include various medications:
- Aminosalycilates or 5-ASA: Sulfasalazine (brand name: Azulfadine) and Mesalamine (brand names: Asacol, Pentasa, Rowasa)
- Steroids - side effects can be undesirable and difficult to live with
- Immunosuppresent Drugs or 6-MP like Imuran or Purinathol
- Biologic Therapies given via IV - Remicade is the only one used for UC
- Rectal enemas
- Antibiotics are used for certain infections but not as a long-term treatment of UC
Goals of treatment in UC are to achieve remission of symptoms, to avoid a flare-up, and to improve a patient's quality of life. Oftentimes, patients will find they are able to achieve remission using one UC medication. But other patients will need to try more than one, or use more than one medication at a time to achieve and maintain remission. UC patients also need to be made aware that these medications are not fast acting. It can often take 2-4 weeks, or more, before a patient sees any sort of response to the medication.