WHAT IS ULCERATIVE COLITIS?
It is a chronic inflammatory disease of the large intestine (colon and rectum) characterized by significant bleeding from the rectum, diarrhea, abdominal pain, weight loss, and fever. In severe forms, ulcerative colitis (UC) can present as an acute and life-threatening condition where the entire colon becomes massively distended, leading to acute sepsis (acute infection) that can be fatal (toxic megacolon). Patients with long-standing UC are at high risk of developing colorectal cancer. The causes of UC remain unknown, but genetic and autoimmune theories, similar to Crohn's disease, are the most credible. The mucosa of the rectum and colon is dotted with ulcers and appears fragile and easily prone to bleeding. The attempts of the mucosa to repair damaged areas lead to the formation of "pseudopolyps" from which tumors can originate.
WHO DOES IT AFFECT?
It has an equal incidence in both sexes and primarily affects individuals between the ages of 30 and 60. However, it can also occur in pediatric patients.
HOW IS THE DIAGNOSIS OF UC MADE?
A comprehensive medical history and rectoscopy during a colon and proctology examination can raise suspicion of UC. The diagnosis is confirmed through histological examination of colon fragments removed during colonoscopy (biopsies). Sometimes, the differential diagnosis with Crohn's disease with colon-rectal involvement is not straightforward. Early diagnosis is extremely important. A simple stool test to measure a specific protein called fecal calprotectin can be important for a differential diagnosis from common colitis. A high level of this protein in the stool can be significant for further examinations (colonoscopy with multiple biopsies, histological examination, etc.) to arrive at a correct diagnosis.
HOW IS UC TREATED?
Initially, treatment is medical, involving antibiotics and anti-inflammatory medications like aminosalicylates. If these drugs are not sufficient, cortisone (prednisone) may be used, which, when used for extended periods, can have numerous side effects. If corticosteroid therapy fails, immunomodulatory drugs like 6-mercaptopurine or azathioprine are used. Aminosalicylates or immunomodulatory drugs are preferably used in maintenance therapy. In acute phases with significant liquid stools mixed with blood and mucus, hospitalization and intravenous corticosteroid (steroid) administration are necessary.
WHEN IS SURGERY NECESSARY?
Surgery is indicated when patients experience severe complications of the disease, such as massive bleeding, intestinal perforation leading to peritonitis, severe infections, or when medical therapy fails. Surgery is also recommended when UC is chronic and has been present for many years, as the risk of developing cancer is very high in such cases. In severe forms, UC can present as an acute condition where the entire colon becomes massively distended, leading to acute sepsis (acute infection) that can be fatal. This condition is known as "toxic megacolon," and surgery becomes indispensable for the patient's survival.
WHAT TYPES OF SURGICAL INTERVENTIONS CAN BE PERFORMED?
Historically, the standard surgery for complete healing would involve the removal of the entire colon, rectum, and anus. This procedure, called proctocolectomy, completely eliminates the disease, including the risk of cancer. Unfortunately, this operation requires the creation of a permanent and definitive stoma (ileostomy). This procedure is highly destructive and disabling, but many patients, especially those with severe forms, accept this solution willingly to be completely rid of UC symptoms. Another type of surgery is the removal of the entire colon while preserving the rectum and anus (total colectomy). The small intestine is then connected to the rectum (ileo-rectal anastomosis), preserving fecal continence. This procedure avoids a definitive ileostomy but does not eliminate UC from the rectum and anus, leading to urgency, diarrhea, bleeding, and cancer risk. Of course, without the colon, the disease remains more manageable.
ARE THERE OTHER SURGICAL ALTERNATIVES?
An alternative can be the removal of the colon and rectum (proctocolectomy) with the connection of the small intestine to the anus (ileoanal anastomosis). This preserves the anal canal and anus (including the sphincters). To create a kind of new rectum, connecting certain segments of the small intestine forms a pouch called the "pouch," which is connected to the anal canal (ileo-pouch). The pouch serves to slow down the transit of liquid stools, reducing the frequency of daily evacuations. To "rest" the intestinal sutures made during surgery and protect them from stool passage, a so-called "protective" ileostomy is usually created, which is temporary and closed several months after the operation (see the "stoma" chapter). Despite the ileo-pouch construction, many patients still experience from five to ten daily bowel movements of liquid or semi-solid stools. In some cases, the ileo-pouch can become infected (pouchitis), requiring long periods of antibiotic therapy. If the infection does not heal, and the pouch loses its "reservoir" function, a permanent ileostomy becomes necessary.
It is a chronic inflammatory disease of the large intestine (colon and rectum) characterized by significant bleeding from the rectum, diarrhea, abdominal pain, weight loss, and fever. In severe forms, ulcerative colitis (UC) can present as an acute and life-threatening condition where the entire colon becomes massively distended, leading to acute sepsis (acute infection) that can be fatal (toxic megacolon). Patients with long-standing UC are at high risk of developing colorectal cancer. The causes of UC remain unknown, but genetic and autoimmune theories, similar to Crohn's disease, are the most credible. The mucosa of the rectum and colon is dotted with ulcers and appears fragile and easily prone to bleeding. The attempts of the mucosa to repair damaged areas lead to the formation of "pseudopolyps" from which tumors can originate.
WHO DOES IT AFFECT?
It has an equal incidence in both sexes and primarily affects individuals between the ages of 30 and 60. However, it can also occur in pediatric patients.
HOW IS THE DIAGNOSIS OF UC MADE?
A comprehensive medical history and rectoscopy during a colon and proctology examination can raise suspicion of UC. The diagnosis is confirmed through histological examination of colon fragments removed during colonoscopy (biopsies). Sometimes, the differential diagnosis with Crohn's disease with colon-rectal involvement is not straightforward. Early diagnosis is extremely important. A simple stool test to measure a specific protein called fecal calprotectin can be important for a differential diagnosis from common colitis. A high level of this protein in the stool can be significant for further examinations (colonoscopy with multiple biopsies, histological examination, etc.) to arrive at a correct diagnosis.
HOW IS UC TREATED?
Initially, treatment is medical, involving antibiotics and anti-inflammatory medications like aminosalicylates. If these drugs are not sufficient, cortisone (prednisone) may be used, which, when used for extended periods, can have numerous side effects. If corticosteroid therapy fails, immunomodulatory drugs like 6-mercaptopurine or azathioprine are used. Aminosalicylates or immunomodulatory drugs are preferably used in maintenance therapy. In acute phases with significant liquid stools mixed with blood and mucus, hospitalization and intravenous corticosteroid (steroid) administration are necessary.
WHEN IS SURGERY NECESSARY?
Surgery is indicated when patients experience severe complications of the disease, such as massive bleeding, intestinal perforation leading to peritonitis, severe infections, or when medical therapy fails. Surgery is also recommended when UC is chronic and has been present for many years, as the risk of developing cancer is very high in such cases. In severe forms, UC can present as an acute condition where the entire colon becomes massively distended, leading to acute sepsis (acute infection) that can be fatal. This condition is known as "toxic megacolon," and surgery becomes indispensable for the patient's survival.
WHAT TYPES OF SURGICAL INTERVENTIONS CAN BE PERFORMED?
Historically, the standard surgery for complete healing would involve the removal of the entire colon, rectum, and anus. This procedure, called proctocolectomy, completely eliminates the disease, including the risk of cancer. Unfortunately, this operation requires the creation of a permanent and definitive stoma (ileostomy). This procedure is highly destructive and disabling, but many patients, especially those with severe forms, accept this solution willingly to be completely rid of UC symptoms. Another type of surgery is the removal of the entire colon while preserving the rectum and anus (total colectomy). The small intestine is then connected to the rectum (ileo-rectal anastomosis), preserving fecal continence. This procedure avoids a definitive ileostomy but does not eliminate UC from the rectum and anus, leading to urgency, diarrhea, bleeding, and cancer risk. Of course, without the colon, the disease remains more manageable.
ARE THERE OTHER SURGICAL ALTERNATIVES?
An alternative can be the removal of the colon and rectum (proctocolectomy) with the connection of the small intestine to the anus (ileoanal anastomosis). This preserves the anal canal and anus (including the sphincters). To create a kind of new rectum, connecting certain segments of the small intestine forms a pouch called the "pouch," which is connected to the anal canal (ileo-pouch). The pouch serves to slow down the transit of liquid stools, reducing the frequency of daily evacuations. To "rest" the intestinal sutures made during surgery and protect them from stool passage, a so-called "protective" ileostomy is usually created, which is temporary and closed several months after the operation (see the "stoma" chapter). Despite the ileo-pouch construction, many patients still experience from five to ten daily bowel movements of liquid or semi-solid stools. In some cases, the ileo-pouch can become infected (pouchitis), requiring long periods of antibiotic therapy. If the infection does not heal, and the pouch loses its "reservoir" function, a permanent ileostomy becomes necessary.