Ulcerative colitis affects the inner lining of the colon and rectum. Some symptoms are: anal bleeding, diarrhea, abdominal pain, weight loss or fever. There are several ways to treat it correctly, depending on the severity of the case.
Ulcerative colitis: what is it and why does it occur?
Ulcerative colitis (UC) is a chronic inflammatory disease of the inner lining (mucosa) of the colon and rectum that progresses in flare-ups.
We do not know its cause, although there may be a genetic predisposition and it may be influenced by immune factors so that there are antibodies that act against the mucosa of the large intestine itself. There may be infectious, allergic, psychological or environmental factors that contribute to trigger this abnormal immune response.
Prevalence of ulcerative colitis
Ulcerative colitis most frequently affects young adults of both sexes. There are no definite risk factors, and having had other large bowel disorders, such as diverticula, polyps, or general health problems, does not influence its occurrence.
Symptoms of ulcerative colitis
The most important symptoms are:
- bleeding from the anus, of greater or lesser intensity
- diarrhea
- abdominal pain
- weight loss
- fever
Occasionally it can also affect other organs, such as the liver, skin, eyes or joints, producing inflammation in them. It usually develops as inflammatory crises or flare-ups of varying severity and affecting different amounts of colon or rectum, with periods of stability in between. In addition, if the disease is extensive and has been evolving for years, there is an increased risk of developing colon cancer.
Diagnosis of ulcerative colitis
After suspicion, and in any patient with bleeding from the anus, an endoscopic examination should be performed, at least rectally, and preferably a complete colonoscopy, especially in patients over 50 years of age, to rule out other processes such as polyps and malignant tumors of the colon and rectum. The diagnosis is confirmed by biopsies and sometimes there are difficulties in differentiating the disease from others such as Crohn’s disease, which, unlike ulcerative colitis, can affect any part of the gastrointestinal tract.
Treatment of ulcerative colitis
The initial treatment is medical. It includes the use of anti-inflammatory and corticosteroids and 5-ASA and sometimes antibiotics. Corticosteroids have side effects and, therefore, attempts are made to reduce or eliminate them when possible.
Severe disease outbreaks require a more powerful treatment with hospital admission, special medications such as immunosuppressants, or the so-called biological treatments, as well as artificial nutrition to rest the intestine.
Close collaboration between gastroenterologists and coloproctological surgeons is necessary for the orientation of medical treatment, which will be individualized according to the evolution of each patient. The severity of the disease is very variable, and many patients with mild forms with involvement only in the final part of the intestine can lead a completely normal life. The rest also usually have a good evolution between inflammatory outbreaks and in relation to the degree of colon involvement they suffer.
When is surgery required in ulcerative colitis?
Intervention may be indicated on an emergency basis in the event of life-threatening complications such as massive bleeding, perforation or dilatation of the colon (toxic megacolon). It is also required in patients suffering from a chronic form of the disease if a correct medical treatment fails and they present frequent or severe flare-ups, or if they have serious side effects derived from the use of corticosteroids.
Another indication is the existence of cancer, pre-malignant alterations (dysplasia) associated with ulcerative colitis, or a high risk of developing them. It is estimated that 20-25% of patients will require surgery.
Type of operations available for ulcerative colitis
The classic standard was years ago the removal of the entire large bowel, including rectum and anus, called procto-collectomy, which can be performed in one or several stages. Its advantage is the cure of the intestinal disease and avoidance of the risk of cancer. However, it is necessary to perform an artificial anus or stoma in the abdomen with the small intestine (ileostomy). Even today it can be a good option in certain subjects.
Some patients can also be treated by removing the colon, but keeping part of the rectum and anus if these are not very affected, and suturing the small bowel to the rectum (ileo-rectal anastomosis). An ileostomy is avoided but there may be a risk of new rectal inflammation.
The most common treatment alternative is the so-called total proctocolectomy and ileoanal anastomosis with reservoir. It consists of removing the entire colon and rectum but leaving the anus with its sphincters. The rectum is replaced by small bowel. An ileostomy must be associated but only for a few months. The reservoir helps to reduce the frequency of bowel movements, which will be 4 to 8 times a day. This is a complex operation, which requires a previous assessment of the function of the anus and sphincters, and postoperative controls.
These techniques can be performed in many cases by minimally invasive surgery (laparoscopy), which has many benefits for the patient in terms of postoperative recovery, as there are no or minimal incisions in the abdomen.
Does surgery cure ulcerative colitis?
It is important to recognize that no alternative makes the patient normal. All of them have advantages and disadvantages that must be evaluated in order to decide the appropriate option, which will be the one that offers the best results in each specific case, after discussing the pros and cons with the patient. Since ulcerative colitis is a disease of unknown cause that can affect different organs, not all manifestations of ulcerative colitis will necessarily be cured after removal of the colon and rectum, although most of them will. However, generally after surgery a good quality of life is obtained.
It is interesting to learn more about the disease, patients’ opinions and expert advice by contacting regional associations of patients with ulcerative colitis and Crohn’s disease, or the national confederation of patients’ associations.