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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 colitis?

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 movements)
  • Fatigue (tiredness)
  • Loss of appetite
  • Weight loss
  • Skin problems
  • Joint pain
  • Stunted growth
  • Constipation

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 diarrhea.

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.
  • Sigmoidoscopy 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
  • Biopsy 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 other problems.
  • Computed tomography (CT) scan and Magnetic resonance imaging (MRI) scan

What is the treatment for ulcerative colitis?

There is no cure currently available for ulcerative colitis and the goal of treatment is to:

  • Relieve symptoms
  • Promote the healing of damaged tissue
  • Put the disease in remission
  • Keep the disease from flaring up
  • Postpone surgery

Medication:

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

hospitalization
 

  • 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.
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.

     
  • Proctocolectomy. 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).
     

posted 02-17-2007

 

 

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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