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BACKGROUND


Symptoms


The first symptom of UC is a progressive loosening of the stool. The stool is generally bloody and may be associated with “crampy” abdominal pain and severe urgency to have a bowel movement. The diarrhea may begin slowly or quite suddenly. Loss of appetite and subsequent weight loss and fatigue are common. In cases of severe bleeding, anemia may also occur. In addition, there may be skin lesions, joint pain, eye inflammation, and liver disorders. Children with UC may fail to develop or grow properly.


Approximately half of all patients with UC have relatively mild symptoms: multiple stools a day, with or without blood, some pain and cramping, a constant feeling of the need to empty the bowel, and no fever or a low-grade fever. Severely ill people experience more than six bloody stools a day, with fever and/or anemia. In general, the severity of symptoms correlate with the extent of colon involved with the disease. The symptoms of UC tend to come and go, with fairly long periods in between flare-ups in which patients may experience no distress at all. Periods of remission can span months or even years, although symptoms do eventually return. The unpredictable course of UC may make it difficult for physicians to evaluate whether a particular course of treatment has been effective or not.


Treatment Options


The treatment of UC involves medications that decrease the abnormal inflammation in the colon lining and thereby control the symptoms, with the goal of maintaining this induced remission. Medical options are centered around 5-ASAs and topical (rectal) therapy for people with mild to moderate symptoms. ASAs are more effective in UC than CD. Probiotics in combination with 5-ASA are also used in mild to moderate UC. However, due to long-term side effects they should not be used for maintenance therapy. Immune modifiers can be used to replace corticosteroids once symptoms of a flare come under control. Biological therapy (infliximab) is indicated in patients who have failed conventional therapy or who are hospitalized with severe UC not improving with corticosteroids. Cyclosporine, a potent immunosuppressant used to prevent rejection in transplant medicine may be used for a hospitalized patient with severe UC.


Surgery


In one-quarter to one-third of patients with UC, medical therapy is not completely successful or complications arise. Under these circumstances, surgery may be considered. This operation involves the removal of the colon (colectomy). Unlike CD, which can recur after surgery, UC is “cured” once the colon is removed.


Depending on a number of factors, including the extent of the disease and the patient’s age and overall health, one of two surgical approaches may be recommended. The first involves the removal of the entire colon and rectum, with the creation of an ileostomy or external stoma (an opening on the abdomen through which wastes are emptied into a pouch, which is attached to the skin with adhesive). A more recently developed procedure also calls for removal of the colon, but it avoids an ileostomy. By creating an internal pouch from the small bowel and attaching it to the anal sphincter muscle, the surgeon can preserve bowel integrity and eliminate the need for the patient to wear an external ostomy appliance.


THE IMPACT OF INFLAMMATORY BOWEL DISEASE IN CANADA 22


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