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Ulcerative Colitis

WHAT IS ULCERATIVE COLITIS?

Ulcerative colitis is an inflammation of the lining of the large bowel (colon).  Symptoms include rectal bleeding, diarrhoea, colicky abdominal pains, weight loss and fever. The exact cause of ulcerative colitis remains unknown however it seems that the patients own immune system for some reason is activated and attacks the large bowel.

In addition, patients who have had extensive ulcerative colitis for many years are at an increased risk to develop large bowel cancer

HOW IS ULCERATIVE COLITIS DIAGNOSED?

A patients history and examination often give clues to this diagnosis. However blood tests for raised inflammatory markers and a colonoscopy with biopsies are usually required to confirm the diagnosis.

Colonoscopy also determines the amount of bowel involved and the severity of the inflammation. Other causes of colonic inflammation need to be excluded such as infection so stool cultures are also performed.

HOW IS ULCERATIVE COLITIS TREATED?

Initial treatment of ulcerative colitis is medical, using antibiotics and anti-inflammatory medications. These are often necessary on a long-term basis. Steroids have significant side effects, and, therefore, are usually only used for short periods.

"Flare-ups" of the disease can often be treated by increasing the dosage of medications or alternative immunosuppressive agents. Hospitalization may be necessary to manage these flare ups and consider whether surgery is necessary.

WHEN IS SURGERY NECESSARY?

Surgery is indicated for patients who have life threatening complications of inflammatory bowel disease, such as massive bleeding, perforation or infection. It may also be necessary for those who have the chronic form of the disease, which fails medical therapy.

It is important the patient be comfortable that all reasonable medical therapy has been attempted prior to considering surgical therapy, and often these decisions are made by joint discussions between medical and surgical experts with interests in bowel disease.

Patients who have long standing ulcerative colitis and show signs of cancer or "pre-cancer" may be candidates for removal of the colon. More often, these patients are followed carefully with repeated colonoscopy and biopsy, and only if precancerous signs are identified is surgery recommended.

WHAT OPERATIONS ARE AVAILABLE?

Historically, the standard operation for ulcerative colitis has been removal of the entire colon, rectum, and anus.This operation is called a pan-proctocolectomy and may be performed in one or more stages. It cures the disease and removes all risk of developing cancer in the colon or rectum. However, this operation requires creation of a Brooke ileostomy. This involves bringing the end of the remaining small bowel through the abdomen wall, and the need to wear a bag to collect bowel contents.

Some patients may be treated by removal of the colon, with preservation of the rectum and anus. The small bowel can then be reconnected to the rectum and continence preserved. This avoids an ileostomy (i.e. the need to wear a bag), but the risks of ongoing active colitis, increased stool frequency, urgency, and cancer in the remaining rectum.

An alternative to these procedures is an ileo-anal pouch. This procedure removes all of the colon and rectum, but preserves the anal canal. The rectum is replaced with small bowel, which is refashioned to form a pouch. Usually, a temporary ileostomy is created, but this is closed after a few months.

The pouch acts as a reservoir to help decrease the stool frequency. This maintains a normal route of defecation, but most patients experience five to ten bowel movements per day. This operation all but eliminates the risk of recurrent ulcerative colitis and cancer and allows the patient to pass stools through the back passage. This operation avoids the need for a permanent bag.

Patients can develop inflammation of the pouch, which requires antibiotic treatment. In a small percentage of patients, the pouch fails to function properly and may have to be removed. If the pouch is removed, a permanent ileostomy will likely be necessary.

WHICH ALTERNATIVE IS PREFERRED?

It is important to recognize that none of these alternatives makes a patient with ulcerative colitis normal. Each alternative has advantages and disadvantages, which must be carefully understood by the patent prior to selecting the alternative which will allow the patient to pursue the highest quality of life.

Therefore discussion with the surgeon and colorectal nurse specialists regarding the risks and benefits of each alternative is essential in each individual case. Often patients can be given the opportunity to discuss each option with patients who have already had each procedure.

If you wish to arrange an appointment with Dr. Rob Church at Al Zahra Hospital Dubai

Contact Al Zahra Call Center on +971 4-378-6666