Ulcerative Colitis

Ulcerative colitis is an inflammatory bowel disease in which the inner lining of the large intestine (colon or bowel) and rectum become inflamed. Inflammation usually begins in the rectum and lower intestine and spreads upward to the entire colon. Ulcerative colitis rarely affects the small intestine except for the lower section. The inflammation causes diarrhea or frequent emptying of the colon. As cells on the surface of the lining of the colon die and slough off, ulcers form, causing pus, mucus and bleeding.

The cause of ulcerative colitis is unknown, and currently, there is no cure, except through surgical removal of the colon. Although much scientific evidence shows that people with ulcerative colitis have abnormalities of the immune system, physicians do not know whether these abnormalities are a cause or result of the disease. There is little proof that ulcerative colitis is caused by emotional distress or sensitivity to certain foods or food products, or is the result of an unhappy childhood.

Ulcerative colitis requires long-term medical care. There may be periods when the symptoms go away that last for months or even years. However, usually symptoms eventually return. Only in rare cases, when complications occur, is the disease fatal. If only the rectum and lower colon are involved, the risk of cancer is not higher than normal. However, the risk of colon cancer is greater than normal in children with widespread ulcerative colitis.

What Are the Symptoms of Ulcerative Colitis?

The most common symptoms of ulcerative colitis include:

• Abdominal pain
• Bloody diarrhea
• Fatigue
• Weight loss
• Loss of appetite
• Rectal bleeding
• Loss of body fluids and nutrients
• Anemia caused by severe bleeding

Sometimes children also experience:

• Skin lesions
• Joint pain
• Inflammation of the eyes
• Liver disorders
• Osteoporosis
• Rashes
• Anemia
• Kidney stones

The symptoms of ulcerative colitis may resemble other conditions or medical problems. Consult your child's physician for a diagnosis.

How Is Ulcerative Colitis Diagnosed?

A thorough physical examination, including blood tests to determine whether an anemic condition exists, or if the white blood cell count is elevated (a sign of inflammation), is part of the diagnostic process. Symptoms that suggest ulcerative colitis may also be evaluated with the following procedures:

• Stool sample to check for bleeding or infection
• Colonoscopy to examine inside the large intestine.
• Biopsy — to examine a sample of tissue from the lining of the colon
• Barium enema to examine the large intestine for abnormalities. An x-ray of the abdomen shows narrowed areas, blockages and other problems.

How Is Ulcerative Colitis Treated?

Specific treatment will be determined by your child's physician based on the following:

• The child's age, overall health, and medical history
• The extent of the disease
• The child's tolerance for specific medications, procedures, or therapies
• The expectations for the course of the disease
• Your opinion or preference

While there is no special diet for ulcerative colitis, children may be able to control mild symptoms simply by avoiding foods that seem to upset their intestines. When treatment is necessary, it must be tailored for each case, because what may help one patient may not help another.

Children are also given needed emotional and psychological support. Treatment may include:

Medication

Abdominal cramps and diarrhea may be helped by medications that reduce inflammation in the colon. More serious cases may require steroid drugs, antibiotics, or drugs that affect the body's immune system.

Hospitalization

Children with ulcerative colitis occasionally have symptoms severe enough to require hospitalization to correct malnutrition and to stop diarrhea and loss of blood, fluids, and mineral salts. The patient may need a special diet, feeding through a vein, medications, or, in some cases, surgery.

Surgery

Most children with ulcerative colitis do not need surgery. However, about 20 to 40 percent of ulcerative colitis children eventually require surgery for removal of the colon because of massive bleeding, chronic debilitating illness, perforation of the colon, or risk of cancer. Sometimes, removing the colon is suggested when medical treatment fails or the side effects of steroids or other drugs threaten the patient's health. There are several surgical options:

Proctocolectomy

The most common surgery is the proctocolectomy (removal of the entire colon and rectum) with ileostomy (creation of a small opening in the abdominal wall where the tip of the lower small intestine, the ileum, is brought to the skin's surface to allow drainage of waste).

Ileoanal anastomosis

Sometimes, ileoanal anastomosis (pull-through operation), can be performed. The diseased portion of the colon is removed and the outer muscles of the rectum are preserved. The ileum is attached inside the rectum, forming a pouch, or reservoir, that holds the waste. This allows the patient to pass stool through the anus in a normal manner, although the bowel movements may be more frequent and watery than usual.

Treatment at Lurie Children's

The Inflammatory Bowel Disease Program focuses on treating children diagnosed with ulcerative colitis and Crohn’s disease. The multidisciplinary team provides comprehensive care for each patient, from improving the quality of life to preventing complications of the disease.