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|Quick reference medical handouts used
by Pediatric offices
Ulcerative Colitis in Children
What is ulcerative colitis?
Ulcerative colitis is an inflammatory
disease in which the inner lining of the large intestine and rectum
become inflamed (irritated or raw and swollen. The
inflammation causes diarrhea and as cells on the surface of the lining
of the colon die and slough off, ulcers form, causing pus, mucus, and
bleeding.Ulcerative colitis can affect the entire colon, but it is
usually in the rectum and the lower part of the colon. People of
all age groups can get ulcerative colitis, but it usually begins
between the ages of 15 and 30. Ulcerative colitis affects males and
females equally and often runs in families. I
What causes ulcerative colitis?
Although many theories about what
causes ulcerative colitis exist, none has been proven and the cause
remains unknown. The most widely held theory is that the
body's immune system (that fights off infection) reacts to a virus or
bacteria. This reaction cannot stop and causes chronic (ongoing)
inflammation in the intestine. Having an immediate family member (such
as a parent or sibling) with ulcerative colitis increases the risk.
There is little evidence that ulcerative colitis is caused by
emotional distress or allergy to certain foods.
What are the symptoms of ulcerative
The symptoms of ulcerative colitis
will vary from person to person and may include:
- Cramps and abdominal pain
- Diarrhea or rectal urgency
- Rectal bleeding (blood in bowel
- Fatigue (tiredness)
- Loss of appetite
- Weight loss
- Skin problems
- Joint pain
- Stunted growth
In some cases, this condition can
involve other complications such as joint pain, eye problems, skin
rash or liver disease. However, these complications are more common
with Crohn’s disease, an inflammatory bowel disease that mainly
affects the small intenstines.
How is ulcerative colitis diagnosed?
Ulcerative colitis is diagnosed by a
complete medical history and physical examination along with medical
tests. The main goal of the tests is to make sure that the disease is
ulcerative colitis and not some other kind of disease that causes
Testing for ulcerative colitis
includes the following:
- Blood tests
check for anemia (low red blood cell count), which can mean bleeding
in the colon or rectum. They can also show if there is an increased
number of white blood cells, which might mean that there is
inflammation somewhere in the body. Newer blood tests are now
available. These tests measure
antibodies 9 pANCA) to a normal cell
component that are present in most people with ulcerative
colitis ,and are rarely found in normal people.
- Stool cultures
tell if there is an infection by a parasite, virus or bacteria.
Stool can also be tested for occult (hidden) blood that is not seen
on the stool.
is a test using a flexible tube with a light and camera lens at the
end (sigmoidoscope) that is put into the rectum and lower colon
(sigmoid colon). It lets the doctor see inflammation in the lining
of the rectum and lower colon.
- Colonoscopy: a long, flexible
instrument (containing a light and camera) that examines the inside
of the large intestine
is a tissue sample that is taken for examination and testing in a
laboratory. In ulcerative colitis, a biopsy (a small piece of tissue
from the lining of the large bowel) is usually done during a
sigmoidoscopy or colonoscopy.
- Barium enema / X-ray
is a procedure that examines the large intestine for abnormalities.
A chalky fluid called barium is put into the rectum as an enema. The
barium coats the inside of the colon so that it will show up on an
X-ray film (picture). An X-ray of the colon shows ulcers (sores) and
- Computed tomography (CT) scan and
Magnetic resonance imaging (MRI) scan
What is the treatment for ulcerative
There is no cure currently available
for ulcerative colitis and the goal of treatment is to:
- Relieve symptoms
- Promote the healing of damaged
- Put the disease in remission
- Keep the disease from flaring up
- Postpone surgery
Three different types of medicines
may be used to help control the symptoms of ulcerative colitis. Each
helps decrease the inflammation in the lining of the colon.
- Aminosalicylates (5-ASA drugs)
alter the body's ability to create and maintain inflammation. These
drugs are used to treat mild cases. They may be taken by mouth or
given as an enema or suppository. Examples include Asacol®, Pentasa®,
Colazal®, Dipentum® and azulfidine.
- Corticosteroids (such as
prednisone) also affect the body's ability to create and
maintain inflammation. These medicines are given by mouth or by vein
(intravenous) to quiet down medium to severe disease symptoms, but
they are not recommended for long-term use because of their side
effects. Steroids may also be given as an enema or suppository for
inflammation in the last part of the colon.
- Immunomodulatory medicines are
used in patients when aminosalicylates and cortiosteroids do not
work or when patients cannot get off the steroids without their
symptoms coming back. These drugs quiet down the immune system but
they can take as long as three months to work. Some examples are
Imuran®, (azathioprine) and purinethol (6-MP).
Medication is the treatment of choice
for most patients. Medications can control and/or prevent inflammation
a child’s intestines and help
- Children with ulcerative colitis
occasionally have symptoms severe enough to require hospitalization
to correct malnutrition and to stop diarrhea and loss of blood,
fluids, and mineral salts. The patient may need a special diet,
feeding through a vein, medications, or, in some cases, surgery.
- Most children with ulcerative colitis do
not need surgery. However, about 20 to 40 percent of ulcerative
colitis children eventually require surgery for removal of the colon
because of massive bleeding, chronic debilitating illness,
perforation of the colon, or risk of cancer. Sometimes, removing the
colon is suggested when medical treatment fails or the side effects
of steroids or other drugs threaten the patient's health.
Two types of surgery are common:
- Ileoanal anastomosis.
This operation removes the diseased part of the colon. The outer
muscles of the rectum are not removed. The ileum is attached inside
the rectum, forming a pouch to hold waste. This allows the patient
to pass stool through the anus in a normal manner. Bowel movements
may be more frequent and watery than usual.
This surgery removes the entire colon and rectum. A small opening is
then made in the front of the abdominal wall and the tip of the
ileum (end of the lower intestine) is brought to the skin's surface
(this procedure is called an ileostomy). The opening of the
ileostomy (called a stoma allows drainage of waste into a bag
(outside of the body).
As a reminder, this information should not be relied on as
medical advice and is not intended to replace the advice of your childs pediatrician.
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