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What is colitis?
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What are the symptoms of colitis?
What is the difference between ulcerative colitis and Crohn's disease?
Diagnosis of colitis
Treatment


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Ulcerative colitis is long-term inflammation of the large intestine (colon). This inflammation results in ulceration and bleeding. It makes the bowel empty more frequently, causing unpleasant diarrhoea and cramps. When symptoms are severe, bed rest may be needed. In very severe cases, hospitalisation can be required. This is a condition that tends to come and go and there can be long periods, even years, of being symptom free. However, it is highly unpredictable, so this can make management quite difficult.

The cause of colitis is not known, although it is thought that it may run in families but so far no particular patterns have been identified.


What are the symptoms of colitis?

The most common symptom is diarrhoea, which can be mixed with pus, blood or mucus. There is a feeling of urgency, which can occur quite suddenly and can be distressing.

Loss of appetite, weight loss and tiredness are common.

Colitis can affect different areas including the rectum, the lower part of the large intestines or all of the large intestine.

When colitis flares up, it causes stomach pains and sometimes nausea and fever, However, when it is inactive there may be no symptoms at all.

In severe cases there may be serious bleeding, perforation of the intestine or inflammation in the abdominal cavity. Malnutrition is also possible. There can be inflammation of the joints, eyes and skin.

When colitis has been present for several years, the risk of colon and rectal cancer can begin to rise.

Diet does not have an impact on colitis.


What is the difference between ulcerative colitis and Crohn's disease?

Crohn’s disease can affect any area of the gastrointestinal tract including the small intestine and the colon. Colitis only affects the colon.

While colitis only affects the innermost lining of the colon, Crohn’s disease affects all of the bowel wall, so it tends to be a more severe condition.

Disease lesions in colitis are more superficial. They are usually restricted to the top layer of the intestinal wall.

Another condition, irritable bowel disease, can be confused with both Crohn’s and colitis because some of the symptoms are similar. However, is a totally different disorder which affects the muscle contractions of the colon. There is no inflammation.


Diagnosis of colitis

A preliminary diagnosis can be made by the doctor based on a person’s medical history, symptoms and a physical examination. The doctor will usually take a stool specimen and send it to a laboratory for analysis. The sample will be tested to rule out infections caused by bacteria and parasites. Colitis is not caused by bacteria.

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Diagnosis is then confirmed by referral to hospital for an endoscopy. This is where the intestine is viewed using a colonoscope. This procedure is carried out by inserting the colonoscope through the back passage. A sedative is given to relax the person. The doctor usually looks at the intestine using a TV screen. Sometimes, a tissue sample will be taken for further analysis.

This is done as a day procedure and usually takes around half an hour. It can cause some minor discomfort, particularly as some air may be blown gently into the bowel to improve the view of the lining of the colon.

A barium enema x-ray may also be useful in assessing the extent of colitis. This is where a substance is introduced to the body via the back passage and then the colon is x-rayed.

Blood samples can assist in establishing how severe the inflammation is and whether the person is affected by anaemia.


Treatment

There is no cure for colitis, so the goal of health professionals is to control symptoms. There are several medications, which are useful for controlling colitis. When the disease is in remission, continuing treatment may keep it at bay.

Corticosteroids are used to reduce inflammation. This may be administered in tablet, enema or suppository form. In severe cases, admission to hospital may be required for corticosteroid injections.

Anti-inflammatory medications are used for the treatment of mild to moderate symptoms or to prevent attacks. These also come in the form of tablets, enemas or suppositories.

Another group of drugs, immune modifiers, can be effective. They can also be used to decrease the dosage of corticosteroids and in some people, can be helpful in maintaining remission. However, it can be several months before their full benefits are seen.

Where colitis is severe and treatment is not working, surgical removal of some of all of the large large intestine may be considered.

Understanding colitis is the first step towards effective management. The more you are informed, the better you can work with your health professionals towards controlling colitis and gaining a better quality of life.

For advice and support contact the Irish Society for Colitis and Crohn’s disease at www.iscc.ie



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