Q: I was prescribed a drug for weight loss. I took it for three months and stopped. I then had diarrhea for 18 months. That led to a colonoscopy which showed that I have ulcerative colitis. Please provide me with helpful information about colitis.
-- D.B., Champaign, Ill.
A: Colitis is the inflammation of the colon and can be caused by many things, especially infections. Ulcerative colitis is a separate disease that appears to be an autoimmune disease in which the body's immune system attacks and kills some of the cells lining the colon. It's not known why the body does this or what starts the process.
It's typically a lifelong condition characterized by flare-ups and remissions. The primary symptom of ulcerative colitis is bloody diarrhea. Abdominal pain and fever are also common. Symptoms may appear gradually or suddenly. It usually starts in the 20s and early 30s, but some have their first attack of ulcerative colitis after 50.
The inflammation is usually located in the lower end of the colon, but can be in other parts of the colon as well. Fortunately, in most people, the extent of the disease does not progress over time.
There is no effective medical "cure" for ulcerative colitis. The objective of current treatment is to end or decrease the intensity of each episode and to decrease the number of future attacks.
People with mild to moderate disease can eat a regular diet, but caffeine and gas-producing vegetables should be restricted. Raw fruits and vegetables should be avoided to reduce physical injury to the damaged lining of the colon. Fiber supplements decrease diarrhea and iron supplements reduce anemia.
During flare-ups, extra fluids should be consumed to replace fluids lost in diarrhea. Anti-diarrheal drugs can be taken preventively when the person expects to be where he or she will not have ready access to toilet facilities.
Mesalamine, administered as a suppository, is the prescription drug of choice for mild ulcerative colitis limited to the end of the colon.
Moderate ulcerative colitis is best treated with oral drugs. Sulfasalazine and mesalamine are effective in 50 to 75 percent of people with this condition.
For an unfortunate 25 percent of people with ulcerative colitis, the medications do a very poor job. The bad news is that surgery should then be considered; the good news is that the surgery usually takes care of the problem.
Although removal of the affected part of the intestine (called a colectomy) almost always takes care of the problem, it's important to weigh the positive and negative aspects of the surgery.
One of the negatives is the possibility of wearing an ostomy bag forever. Understandably, the impact it may have on a person's self-image and social life is a concern.
People with extensive and long-term ulcerative colitis have an increased risk of developing colon cancer. This should be monitored at regular intervals with colonoscopies and biopsies, if warranted.
In short, ulcerative colitis is a long-term disease that is usually controlled by drugs. Many people with the disease will not require surgery and those who do often get very good results. With or without surgery, almost everyone can lead a normal life.