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ulcerative colitisChronic Ulcerative Colitis Ulcerative colitis is a chronic inflammatory disorder of unknown cause, which is localized to the colon and spares the upper gastrointestinal tract - in contrast to Crohn disease, with which it may be initially confused. Ulcerative colitis almost always begins in the rectum and extends up the colon for a variable distance.
Ulcerative colitis has been reported in infants, but these reports may have been actually misdiagnosed milk protein intolerance.
Bloody diarrhea with mucus is the most typical first symptom of ulcerative colitis. There may be tenesmus (cramping without a bowel movement), urgency, crampy abdominal pain (especially with bowel movements), fever, severe anemia, low blood proteins (hypoalbuminemia), and elevated white cell count. The length of time symptoms are present is important for diagnosis; many conditions can temporarily mimic ulcerative colitis, but if symptoms exceed a month and lab studies do not show another cause, ulcerative colitis is suspected. The generalized or systemic signs of anorexia, weight loss, and growth failure may be present, these are more typical of Crohn disease.
Ulcerative colitis is characterized by unpredictable flareups. It usually may be quieted with medications, but eventually it recurs. Occasionally, the colitis becomes intractable and may then require surgical treatment.
There is no medical (as opposed to surgical) cure for ulcerative colitis. Treatment is aimed at controlling symptoms and reducing the risk of recurrence. Sulfasalazine (5-aminosalicylate) is the mainstay of initial treatment of the disease. It has been used extensively over many years, and its effects and side effects are well known. It is the only drug known to prevent relapses. Allergy to the sulfa component of the drug, sometimes with severe effects such as Stevens-Johnson syndrome, is the major side effect of sulfasalazine, and may affect up to 20% of patients. Other significant side effects include a reversible depression of the white cell count (leukopenia), breakdown of red blood cells (hemolytic anemia), pancreatitis, headache, nausea and vomiting, and paradoxically, bloody diarrhea. Children with moderate to severe colitis or colitis who do not improve with 5-aminosalicylate therapy are treated with corticosteroids, usually prednisone. Cases that are especially severe and resistant to drug therapy sometimes require surgical removal of the colon. The most serious acute complication is toxic megacolon with the risk of perforation; this complication always leads to immediate surgical removal of the colon (total colectomy).
After about the first ten years of the disease, the risk of colon cancer begins to increase rapidly for ulcerative colitis patients. It is thought that this risk may be prevented with periodic colonoscopy beginning after 8-10 yr of disease.
Emotional stresses may contribute to flareups of ulcerative colitis, but the old idea that certain personality types were more prone to develop the disease has been discarded. It is difficult to adjust to a chronic disorder, and varous forms of psychosocial support are an important part of therapy. The Crohn's and Colitis Foundation of America (CCFA) has local chapters throughout the United States.