FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

SURGERY MAY BE "BEST HOPE" FOR SEVERE CASES OF ULCERATIVE COLITIS

Question: My son has had ulcerative colitis for the last 22 years. He has slowly gotten worse despite taking many medications prescribed by the specialists he has seen. Is there any hope for a cure for this disease?

Answer: Ulcerative colitis should be thought of as an illness that affects the entire person a systemic illness that usually causes colon problems as its first symptom. These symptoms are the consequence of chronic inflammation of the walls of the large intestine, which is also called the colon. The illness derives it name, ulcerative colitis, from the presence of ulcers within the inflamed areas. These ulcers and areas of inflammation are the cause of the symptoms of abdominal pain, cramping and diarrhea. In acute episodes there may be 20 or more bowel movements each day, and blood is frequently present in the diarrhea, too. Obviously, an individual with symptoms this severe is quite ill and may require hospitalization.

Symptoms of ulcerative colitis aren't restricted to the colon, however. Diarrhea and blood in the stools can, in turn, cause anemia, iron loss, vitamin deficiency and other related problems. Medical science has identified clear explanations for these symptoms. However, arthritis, eye inflammation and liver problems are also often associated with ulcerative colitis, and we don't really know why. Fortunately, treatment that improves the colon condition usually dramatically improves these other non-colon symptoms. And, as with most chronic illnesses, there is a strong emotional component to ulcerative colitis.

We don't know the cause of ulcerative colitis. In fact, the diagnosis is established by ruling out other illness that have similar symptoms, a so called "diagnosis by exclusion." This doesn't mean that there is no hope for those who suffer from it. Medical science is still striving to understand the cause of ulcerative colitis, and then to identify a cure for it.

Fortunately for those with ulcerative colitis and their loved ones, there are a number of effective medications to treat the condition. Obviously, your son has taken several of these without satisfactory relief. The medications prednisone and sulfasalazine are common first choices. They act to reduce the inflammation within the colon and, thereby, relieve the symptoms. If prompt relief isn't obtained with these drugs, however, an antibiotic such as ampicillin or metronidazole is often added along with drugs that specifically slow the diarrhea. In more severe cases, medications such as 6-mercaptopurine and azathioprine can be used.

I'd guess that your son has taken many of these medications some time during the 22 years he's had this disease. He has obviously had periodic examinations by his gastroenterologist (specialist in digestive diseases), and this is necessary even for those who have had excellent relief from their symptoms. You see, those with ulcerative colitis have a significant risk of developing colon cancer. This is particularly true if the onset was before age 20 or after 60, and the risk remains high whether or not their disease calms down with treatment.

In the most severely effected individuals, the enter colon is surgically removed. This is necessary when a type of cell that suggests cancer may be but a few months away is found in the colon tissue - a condition called dysplasia. The colon may also need to be removed when bleeding and/or infection are severe and long-standing. In this surgery not only the colon but also the rectum are removed, and then the small intestine is drained to a new opening on the abdominal wall. This is called "a total proctocolectomy with ileostomy" for those of you keeping up on your medical lingo. This is not a surgery to be undertaken lightly. Fortunately, it does restore those who had a bleak outlook to a nearly normal life.

So, there is hope for your son, but a "cure" for his ulcerative colitis is currently beyond our abilities.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.