CD-ROM Today 1996 January/CD-ROM Today 1996 January.iso/dp/0361/03617.txt

Text File | 1994-01-17 | 9.7 KB | 223 lines

$Unique_ID{BRK03617}
$Pretitle{}
$Title{Colitis, Ulcerative}
$Subject{Colitis, Ulcerative Idiopathic, Non-Specific Ulcerative Colitis
Idiopathic Proctocolitis Chronic, Non-Specific Ulcerative Colitis}
$Volume{}
$Log{}

Copyright (C) 1986, 1990, 1991 National Organization for Rare Disorders,
Inc.

87:
Colitis, Ulcerative

** IMPORTANT **
It is possible that the main title of the article (Ulcerative Colitis) is
not the name you expected.  Please check the SYNONYM listing to find the
alternate names and disorder subdivisions covered by this article.

Synonyms

     Idiopathic, Non-Specific Ulcerative Colitis
     Idiopathic Proctocolitis
     Chronic, Non-Specific Ulcerative Colitis

General Discussion

** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only.  It should not be used for diagnostic or treatment
purposes.  If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.


Ulcerative Colitis is a non-specific inflammatory disease of the bowel
characterized by chronic ulceration.  The chief characteristic of this
disorder is bloody diarrhea.  This disease of unknown cause generally begins
in the rectosigmoid area.  It may involve only the left side of the colon or
may eventually extend to involve the entire bowel.  However, in some cases it
may attack most of the large bowel simultaneously.  The disease is usually
chronic, with repeated periods of exacerbation and remission.

Ulcerative colitis is an acute nonspecific inflammation of the colon
characterized by multiple, irregular superficial ulcerations.  Thickening of
the wall of the colon with scar tissue and polyp like structures are the
result of prolonged inflammatory reactions.

Symptoms

The symptoms of ulcerative colitis may first include malaise, weakness and
fatigue.  A vague abdominal discomfort may be associated with a slight change
in the frequency and consistency of stools.  Later there may be pain along
with cramping in the abdomen, and urgency (tenesmus).  Anorexia, loss of
weight, and abdominal distention may also be present.

Ulcerative colitis generally manifests itself by means of attacks of
bloody diarrhea which may vary in intensity and duration, followed by
intervals when the patient is fairly asymptomatic.  There is an increased
urgency to defecate, mild cramps in the lower abdomen, and the stools may
contain mucus and blood.  However, in some cases the onset of the attack may
be explosive with acute symptoms.  In this instance, episodes of diarrhea may
be sudden and violent.  Patients may develop high fever, signs of peritonitis
(inflammation of the membrane lining the abdominopelvic walls) and a profound
toxemic state may exist.

Causes

The exact cause of ulcerative colitis is unknown.  The disorder may be
related to immunological agents, or may be caused by an unknown environmental
agent.  There is a documented familial tendency.  A study of the incidence of
Ulcerative Colitis and Crohn's Disease conducted in Denmark (published in
1991) indicates that relatives of people with either of these inflammatory
bowel diseases has a 10-fold increased risk of developing the disease.  This
study suggests that the cause of both disorders may be genetic.
Psychological factors may also have an effect on this disorder, but are not
considered a cause.

Affected Population

Ulcerative colitis may begin at any age, but its peak incidence is between
the ages of 20 and 25 years.  There is also a perceptible increase in
frequency in the fifth and sixth decades of life.  The disease is more
prevalent among Jews, but all ethnic groups appear to be at risk.

Therapies:  Standard

The treatment for ulcerative colitis depends upon the severity of the
disease.  Mild forms of the disease may be managed with nonspecific supportive
measures.  These include adequate physical and emotional relaxation.  The
patients may follow a normal diet refraining only from the roughage in raw
fruits and vegetables.  Approximately one third of patients find milk an
irritant and it should also be eliminated.  Anti-diarrheal agents may also be
necessary.

Sulfasalazine may be used in mild to moderate forms of the disease.  In
order to reduce gastrointestinal side effects of the drug (nausea,
indigestion, and anorexia), it should be taken with meals and the dosage
increased gradually by the patient's physician.

In cases of either mild or moderate severity, hydrocortisone enemas may
occasionally be effective in achieving remission especially if the disease is
located in the rectum or left colon.

If the disease is severe, corticosteroid therapy may be indicated.
Intensive therapy with prednisone frequently induces remission.
Sulfasalazine may be given to the patient in conjunction with prednisone.
After improvement, it may be possible to gradually taper the dosage of the
corticosteroid and ultimately withdraw it.  Chronic fecal blood loss may
require iron in order to prevent anemia.

The more severe attacks of ulcerative colitis may require hospitalization
and parenteral corticosteroid (e.g., Hydrocortisone IV) or ACTH therapy.  When
remission has been obtained, oral prednisone therapy may be substituted, then
gradually reduced after continued improvement.

Immunosuppressive drugs such as azathioprine and 6-mercaptopurine have
also been used to treat some patients with this disorder.

Occasionally surgery may be necessary (colectomy and ileostomy), and
offers the only permanent cure.  Newer surgeries which offer continence
and/or preservation of the anal sphincter are now available.

The prognosis of ulcerative colitis is uncertain.  While in most cases
the disease is chronic with repeated exacerbations and remissions, complete
recovery has occurred after a single attack in about ten percent of patients.
The disease may be more severe when the onset occurs after sixty years of
age.

Possible complications of the disease may include arthritis, inflammation
of the tissues surrounding the bile ducts known as pericholangitis, or
inflammation of the vertebrae known as ankylosing spondylitis.  Further
complications may include abcesses in the rectum or colon, fistulas or
intestinal perforations, and skin and eye disorders.  Carcinoma of the colon
may develop, but the risk is higher in those patients with universal colitis
of more than ten years duration.

The FDA recently approved the drug Dipentum (olsalazine sodium) for the
treatment of Ulcerative Colitis patients.  Dipentum is not a sulfa-related
drug and therefore does not have sulfa-related side effects.  The drug is
manufactured by Pharmcia Inc., Piscataway, NJ.

Therapies:  Investigational

George D. Ferry, M.D. has been awarded a grant from the Office of Orphan
Products Development, Food and Drug Administration, for his research on using
Olsalazine to treat childhood Ulcerative Colitis.  For more information,
please contact:

     George D. Ferry, M.D.
     Baylor College of Medicine
     Gastroenterology Research Unit, Section of Gastroenterology
     Department of Pediatrics
     1709 Dryden, Suite 1103
     Houston, TX  77030-2403
     [phone]

Studies are being conducted in the use of Sandoglobulin as a treatment
for Ulcerative Colitis.  Further investigation is needed to determine it's
safety and effectiveness.

Dr. Warren L. Beekan of the University of Vermont has received a New
Grant Award for 1990 from the Office of Orphan Products Development for
controlled trials using 4-ASA in the treatment of Ulcerative Colitis.  The
orphan drug Pamisyl (P-D) is being tested for treatment of mild to moderate
Ulcerative Colitis in patients intolerant of sulfasalazine.  The drug is
being tested by Warren Beekan, M.D., University of Vermont, Burlington, VT.

The FDA has approved the following drugs for testing as treatments for
Ulcerative Colitis patients.

The orphan drug Altracin (bacitracin) is being tested for treatment of
antibiotic-associated pseudomembraneous enterocolitis caused by toxins A and
B elaborated by clostridium difficile.  The drug is manufactured by A.L.
Laboratories, Ft. Lee, NJ.

The orphan drug short-chain fatty acid solution is being tested for
treatment of the active phase of Ulcerative Colitis with involvement
restricted to the left side of the colon.  The treatment is being tested by
Richard Breuer, M.D., Evanston, IL.

This disease entry is based upon medical information available through
March 1991.  Since NORD's resources are limited, it is not possible to keep
every entry in the Rare Disease Database completely current and accurate.
Please check with the agencies listed in the Resources section for the most
current information about this disorder.

Resources

For more information on Ulcerative Colitis, please contact:

     National Organization for Rare Disorders (NORD)
     P.O. Box 8923
     New Fairfield, CT  06812-1783
     [phone]

     National Foundation of Ileitis and Colitis, Inc.
     444 Park Avenue South
     New York, NY  10016
     [phone]

     National Digestive Diseases Information Clearinghouse
     Box NDIC
     Bethesda, MD  20892
     [phone]

     United Ostomy Association, Inc.
     36 Executive Park, Suite 120
     Irvine, CA  97214
     [phone]

References

THE MERCK MANUAL 15th ed.:  R. Berkow, et al:  eds; Merck, Sharp & Dohme
Research Laboratories, 1987.  P. 801.

CECIL TEXTBOOK OF MEDICINE, 18th ed.:  James B. Wyngaarden, and Lloyd H.
Smith, Jr., Eds.:  W. B. Saunders Co., 1988.  Pp. 753-60, 787-8.

FAMILIAL OCCURRENCE OF INFLAMMATORY BOWEL DISEASE, M. Orhold, MD, N Eng J
Med, (January 10, 1991, issue 324 (2)).  Pp. 84-88.