FAMILY MEDICINE® COLUMN

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

MEDICINE PROVIDES RELIEF FOR MOST ULCERATIVE COLITIS SUFFERERS

Question: I am 45 years old and was diagnosed with ulcerative colitis in February. IÕve been taking Asacol since then and have only had some stomach upset and occasional diarrhea. What causes my disease, and are there other things I should be doing to get well?

Answer: Ulcerative colitis should be thought of as an illness that affects the entire person -- a systemic illness -- and 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 that are characteristic of ulcerative colitis. In acute episodes, there may be 20 or more bowel movements each day, and blood is frequently present in the diarrhea, too.

Symptoms of ulcerative colitis arenÕt restricted to the colon, however. Diarrhea and blood in the stools can, in turn, cause anemia, iron loss and vitamin deficiency. Other problems can also occur from this disease such as arthritis, eye inflammation and liver disease. Fortunately, treatment that improves the colon condition usually dramatically improves these other non-colon symptoms, too.

We arenÕt certain about the cause of ulcerative colitis, although it appears to be an immune system disorder that produces damage to the involved tissues. Fortunately for those with ulcerative colitis and their loved ones, there are a number of effective medicines to treat the condition. The Asacol you take, which is a common first choice for treatment of this condition, apparently is giving you satisfactory relief. The medications sulfasalazine, Dipentum, Rowasa and Pentasa also are common first choices. They act to reduce the inflammation within the colon and, thereby, relieve the symptoms. They donÕt cure the underlying disorder, however. If prompt relief isnÕt obtained with these drugs, then other drugs such as prednisone and antibiotics such as metronidazole, ciproflozacin or clarithromycin are often added. In more severe cases, medications such as 6-mercaptopurine, azathioprine or cyclosporine can be used. Treatment with one or more of these medicines gives relief for most sufferers and produces a complete remission of symptoms lasting at least five years for 70 percent of individuals.

A relapse of ulcerative colitis is often brought about by events that stimulate the immune system. Infection, either of the digestive system or in other body systems, and allergy are frequent triggers. In addition, like the first episode of ulcerative colitis, repeat episodes are usually brought under control with medicine. Regardless of your response to the Asacol, you should have periodic examinations by a gastroenterologist (specialist in digestive diseases). You see, those with ulcerative colitis have an increased risk of developing colon cancer. This is particularly true if the onset was before age 20 or after 60, and if the entire length of the colon is involved in the disorder. This risk remains high whether or not the disease calms down with treatment or not.

In the most severely effected individuals, and this is about 8 percent of the total, symptoms persist requiring the continual use of medicine. In a small portion of this already small percent of the total, surgery becomes a viable treatment option. The most damaged portions of the colon -- or in extreme cases, the entire thing -- 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 longstanding. Fortunately, this drastic but important treatment isnÕt needed very often.

"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.

Past columns are available online at http://www.FamilyMedicineNews.org.