Re: Ulcerative Colitis

Posted By HFHSM.D.-ym on September 23, 1998 at 22:02:41:

In Reply to: Ulcerative Colitis posted by Concerned Sister on September 23, 1998 at 01:09:41:






: Hello Doctor,
:       My 55 year old brother is in the hospital with a very bad case of Ulcerative Colitis. Upon entering the hospital, he was very ill, with yellowing of the skin around the eyes and face area, bloody diahrea, etc.. I have seen the Colonoscopy pictures-and they showed total coverage of ulcers in the large colon, with a pencil size opening in a 6 to 8 inch area. It has been 3 weeks, of being on Predizone, weight loss of 49 lbs., and now a feeding tube to keep anything from the intestines. They just started him on Kerafate. The stomach area was not checked out-but he has terrible bloating-looks like a pregnant woman and is very uncomfortable. He also has had over 40 IV's. He is allowed some ice chips a day-but nothing else by mouth. Biopsies were taken of different areas of the colon, and showed no cancer. I am worried about the stomach and his chances of improving and leading a normal healthy life again. He is very weak and worn out-but is on a walking schedule everyday in the hall corridors to help keep up his strength. He does appear to be improving slowly-but will remain in the hospital for some time yet. Is there something more to be done for him, and anything to insure that this will not return when he is well enough to leave the hospital.
: Should the stomach have been checked out to make sure what is going on there? Sorry this is long-but have one more question.
: About 1 year ago, he wasn't feeling good, and the Dr. put him on
: 40 MG of Prozac a day-could this have caused the problems he now has? He is off of it since this happened. Thank you very much for any answers.
Dear Concerned,
Ulcerative colitis is an inflammatory condition that only affects the large intestine. If the large intestine is completed removed surgically the risk of colon cancer is obliterated. It sounds like your brother's colon is narrowed (strictured) in some areas. It is sometimes difficult to rule out cancer in these areas. If it becomes impossible to adequately survey his colon (with colonoscopy) and he is refractory to medical therapy surgery is an option. The bloating may be secondary to colonic inflammation or a secondary process in the stomach. The inflammation of ulcerative colitis does not involve the stomach. On the other hand, Crohn's disease of the stomach has been described. If your brother is truly jaundiced it may be necessary to rule out a condition called primary sclerosing cholangitis (disease of the bile ducts characterized by scarring and inflammation) which is an extraintestinal manifestation associated with ulcerative colitis. It would be extremely unlikely that Prozac had anything to do with the development of ulcerative colitis. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call  1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: ulcerative colitis
Thank you Doctor, for taking the time to answer my questions. And with your answers, I have a few more questions. Is there any knowledge of what does cause Ulcerative Colitis? And yes, my brother does have an area in the large colon-about 6-8 inches that the opening is about the size of a pencil. All of the large colon is very ulcerated. What are his chances of getting cancer of the colon from this illness? And is Ulcerative colitis curable, if everything does heal up? Could a person have Crohns disease in the stomach and Ulcerative Colitis in the colon at the same time?
We are from a relative small town and his Doctor is confereing with a specialist in Fargo, ND on how to treat his illness-but the specialist has not seen him yet.
     On the jaundice when he first entered the hospital, his Dr. said it was because the infection had started to go into the blood stream, and had he waited a few more hours to go to the hospital, he may not have been with us.  Is this the possible cause of the jaundice, or would it only be caused by the problems you mentioned with the bile ducts? Last night he had a terrible night-with diahreah-passing lots of black blood, and puss, etc. The Dr. says this is good, as it means the infection is moving out. Is this your opinion too?  Sorry for so many questions, but I am really worried about my brother and worried that something may be passed by in his treatment he is receiving here. I do know they would remove the colon as a last resort- as want to try these treatments first. Does it generally take a long time for the Prednizone and Kerafate to heal this problem-it is now going on 4 weeks in the hospital. Thank you very much for your patience in answering my questions.
Dear Concerned Sister,
The pathogenesis (cause) of ulcerative colitis is essentially unknown at this time. Some theories that have been proposed include: poor blood flow (ischemia), immunological  and autoimmune mechanisms and allergic reactions or bacterial infection. No matter what the cause, the end result is the same. An inflammatory response is triggered which cause ulceration, pus, bleeding and inflammation of the lining of the large intestine.
The development of colon cancer in ulcerative colitis depends upon the extent of disease and the duration of illness. Patients with universal (total) involvement  of the colon and patients who have had disease for over 7 years have a much higher risk of developing colon cancer when compared to the general population. In patients with ulcerative pancolitis for greater than 20 years the relative risk for duration of disease may be as high as 30-40 percent. For this reason, it is recommended for patients with ulcerative colitis to undergo biannual colonoscopy with biopsy (to look for dysplasia, a precancerous change in colon cells) starting at 7 years of disease and annually once the disease is present for 10 years.  
Ulcerative colitis is not curable with medications. If no extraintestinal manifestations are present and surgery is performed ulcerative colitis can be considered cured. It is unlikely that a single patient would have both ulcerative colitis and Crohn's disease.
It is possible that jaundice can be secondary to overwhelming sepsis (bacterial infection). An abdominal ultrasound may help to differentiate biliary obstruction from other causes. If his infection is resolving and his jaundice and liver enzymes are improving with treatment, then this would support this possibility.
The response to steroids should be within a few weeks. If your brother is not improving, he might end up needing surgery. Good luck to you and your brother.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call  1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: ulcerative colitis