Ulcerative colitis is one of the two major long-term inflammatory conditions that a gastroenterologist can help to diagnose and treat. The other is Crohn’s disease.
Symptoms vary with this condition, and flares can come on unannounced.
It is therefore vital to not ignore the early symptoms and to seek help from specialists that can ensure the right course of treatment for you.
The sickest patients who have uncontrolled, bloody diarrhoea will need hospital admission. Despite the best efforts from doctors and researchers up to 20% of patients still need surgery for their condition.
An inflammation in the lining of the bowel is termed “Colitis”.
There are many causes of colitis, for example a bug such as E. coli.
Ulcerative colitis is another cause of colitis and comes about due to an exaggerated immune response to something (a bug or bacterium) within the human colon.
This ‘something’ has not been identified as yet and the exact mechanism by which some individuals develop ulcerative colitis is not yet fully known.
It is known, however, that a variety of genes are involved, so although this bowel disease is not entirely genetic, it has genetic elements to it.
There may be a number of as yet unidentified environmental triggers as well. For example, for some reason, smoking can protect some individuals from developing the condition; when they stop smoking the colitis may begin.
There are medications available to treat ulcerative colitis.
Currently, these typically include drugs that act as topical anti-inflamatories, the so-called 5ASA medications.
Failure of these to be effective may lead to a doctor prescribing a patient a course of steroids.
Over time if a patient requires more than one or two courses of steroid, other drugs may be required, which lessen the need for steroids in the future. These drugs are known as thiopurines.
If a patient with ulcerative colitis is still unwell, despite these medications, more powerful drugs that target components of the immune system are used. These drugs are called biologics, because they are antibodies given either via an IV infusion or as a small injection under the skin every few weeks.
Failure of all of these therapies may lead to a patient requiring surgery to have their colon removed. This is called a colectomy.
The patient may be left with a stoma, but often this is temporary while further surgery is planned to create a new rectum out of part of the small intestine. If this is possible, the stoma can be reversed and the patient now has what is known as a ‘pouch’. It is possible to sit on the toilet normally but the frequency with which they do so would be about 6 times a day.
Colorectal surgery is a specialty that deals with operations relating to the large bowel or colon, and the rectum. A specialist colorectal surgeon often treats patients with cancer of the large bowel and rectum, and they remove these tumours.
These types of surgeon also look after patients who require surgery for ulcerative colitis.
If a patient requires surgery, it frequently will involve removal of the entire colon and rectum. Patients may be left either temporarily or permanently with a stoma, otherwise known as an ileostomy. This is an opening on to the belly where bowel contents can empty into a bag.
They can also operate to treat inguinal hernias and they can remove an acutely inflamed appendix.
Gastroenterologists and colorectal surgeons need to work closely together so that the best treatment decisions can be made for patients under their care.
Feel reassured that you are not alone and that specialist help is available.