COLITIS
Also known as Ulcerative colitis (UC)

Ulcerative colitis (UC) is a disease in which the lining of the large intestine becomes inflamed. The immune system inappropriately targets the lining of the colon, causing inflammation, ulceration, bleeding and diarrhea.
Ulcerative colitis is a chronic condition and has no cure.

UC affects men and women equally.
The peak incidence of UC occurs between the ages of 15 and 30.

CAUSES  - Genes+Environmental factors

Ulcerative colitis tends to run in families.
About 10 to 25 percent of affected people have a first-degree relative (either a sibling or parent) with inflammatory bowel disease.
Environment —  Gut infections are suspected of triggering UC in people who have a genetic susceptibility.

SYMPTOMS 

Frequent, loose bloody stools
Anemia
Abdominal pain
Weight loss
Low grade fevers
Joint pains
Eye problems
Skin rash
Liver problems

COMPLICATIONS 

Stricture   A stricture is a narrowing of the colon or rectum which  can cause a blockage of the colon.
Bleeding  
Toxic megacolon   Severe  inflammation in the colon causes it to dilate, causing the walls to become thin  and eventually to rupture. Surgery is usually advised if this condition does not respond to medical treatment within about 72 hours.
Patients with ulcerative colitis have an increased risk of colorectal cancer. The risk begins to increase about 8 to 10 years after the symptoms of ulcerative colitis first appear. There is a 5 to 10 percent risk of cancer after 20 years and a 12 to 20 percent risk after 30 years of ulcerative colitis.
Colonoscopy is recommended 8 to 10 years after symptoms appear in people with extensive colitis, and  15 years after symptoms appear in people with left-sided colitis. Thereafter, colonoscopy should be repeated every one to three years. If advanced precancerous changes or cancer are discovered, surgical removal of the colon is usually recommended.

DIAGNOSIS 

Bloody diarrhea in any patient,especially if for long periods should prompt an appropriate work up to diagnose colitis. Blood tests, stool tests and  colonoscopy are helpful in making a diagnosis.

TREATMENT 

The symptoms of ulcerative colitis can fluctuate over time.
"Flare" is used to describe periods in which the disease becomes more active.
"Remission" is used to describe periods of quiescence.

Patients with abdominal cramps and diarrhea may notice relief when they reduce their intake of fresh fruit and vegetables, caffeine, carbonated drinks, and sorbitol-containing products.

Rectal inflammation  is treated with one or more medications that are given as an enema or a suppository or foam.
Some patients also require treatment with oral medications such as sulfasalazine (Azulfidine) and an 5-aminosalicylate (5-ASA).
Continuous treatment with a 5-ASA-containing drug is usually recommended, although it is often possible to taper the dose of medication.
Extensive disease  Patients with moderate /  severe symptoms may require temporary treatment with a steroid either as an outpatient or given  through the vein  in the hospital. Once remission is achieved, patients usually continue to take one of the oral 5-ASA drugs.
Refractory ulcerative colitis occurs when a person's disease does not respond or responds poorly to the medical treatments used to treat the disease.
Most patients are treated with drugs that suppress the immune system. The most commonly used drugs are 6-mercaptopurine and azathioprine, and more recently biologic response modifiers such as  infliximab.
Surgical removal of the colon may be required if medical treatments are unsuccessful , if complications develop andif there is cancer.
Vitamins and medications — It is reasonable to take a multivitamin daily. People who take sulfasalazine should take a folic acid supplement.

COMMONLY USED DRUGS

Sulfasalazine ( Azulfidine)
Mesalamine( Asacol,Lialda,Pentasa,Canasa,Rowasa)
Azathioprine( Azasan,Imuran)
Mercaptopurine ( Purinethol)
Steroids (Prednisone)

For more information , please see

      www.nlm.nih.gov/medlineplus/healthtopics.html
      www.niddk.nih.gov/
      www.cdc.gov/
      www.gastro.org
      www.acg.gi.org
     www.ccfa.org