Patient Info

Helicobacter pylori is a bacterium that causes ulcers in stomach and  upper small bowel as well as gastric cancers.

It is present in approximately one-half of the world’s population.
In the United States and other developed countries, infection is unusual during childhood but becomes more common during adulthood. However, in developing countries, most children are infected with H. pylori before age 10.

RISK FACTORS 

H. pylori is probably spread by consuming food or water contaminated with fecal matter. Children living in developing countries may become infected after swimming in contaminated pools, streams, or rivers, by drinking contaminated water, or by eating uncooked vegetables.

SYMPTOMS 

Most individuals with  this infection have no symptoms.
Some people develop more serious problems, including stomach or duodenal ulcers. Common complaints include pain or discomfort (usually in the upper abdomen), bloating, feeling full after eating ONLY a small amount of food, and dark or tar-colored stools.
People who live in countries in which infection occurs at an early age are at greatest risk of stomach cancer.

DIAGNOSIS
 
Blood tests 
Blood tests can detect specific antibodies (proteins) that the body’s immune system develops in response to the infection.
Blood tests are not recommended for follow up testing as  the antibody detected by the blood test often remains in the blood long time treatment, even if the infection is eliminated.
Breath tests 
Urea breath tests
Stool tests 
 Tests are available that detect H. pylori proteins in stool.
Endoscopy  
During an endoscopy, a flexible tube is inserted through the mouth into the esophagus, stomach, and upper region of the small intestine. The tube contains a light and camera, which can be used to examine the various areas. Small tissue samples (biopsy samples) can be taken from the stomach, which are then tested for H. pylori.

WHO SHOULD BE TESTED?

Patients with symptoms 
Diagnostic testing for H. pylori infection is done for people with active gastric or duodenal ulcers and those with a past history of ulcers.
Patients without symptoms
Generally not recommended.
Considered for those with a family history or concern about stomach cancer, particularly individuals of Chinese, Korean, or Japanese descent who have a  higher incidence of stomach cancer.

TREATMENT
 
 Patients with a history of peptic ulcer disease, active gastric ulcer, or active duodenal ulcer associated with H. pylori infection should receive treatment for the infection.
 Treatment involves taking several medications for 7 to 14 days.

For more information , please see

      www.nlm.nih.gov/medlineplus/healthtopics.html
      www.niddk.nih.gov/
      www.cdc.gov/
      www.gastro.org
      www.acg.gi.org
      www.helico.com/

The gallbladder is a pear-shaped muscular organ that is 3 to 6 inches long, located in the right upper side of the abdomen .
It  stores and concentrates bile – a green colored fluid needed to digest fats.
Gallstones are formed secondary to imbalance in bile composition, or sluggish gallbladder contractions.
One million Americans are diagnosed with gallstones every year.
Gallstones are of 2 types-
1.Cholesterol gallstones account for approximately 80 percent of gallstones in developed countries, including the United States.
3.Pigment stones, composed mainly of bile pigments and other compounds, account for  the rest

RISK FACTORS 

Gender – Gallstones are more common in women.
Ethnicity – Gallstones occur more frequently in Native Americans, Pima Indians, and Chileans.
Family history -Studies of family histories indicate that cholelithiasis runs in certain families.
Pregnancy
Use of estrogen preparations (such as birth control pills)
Obesity
Rapid weight loss (including patients who have surgical weight loss treatments)
Diabetes mellitus
Sickle cell disease
Cirrhosis

SYMPTOMS

Most  people who have gallstones do not have symptoms –NO TREATMENT IS NECESSARY.
When gallstones begin to cause symptoms such as pain, fatty food intolerance,nausea then surgery is considered.
Complications can develop if gallstones migrate and block the common bile duct causing jaundice or infection of the bile ducts that causes pain, chills, and fever. Acute pancreatitis can also occur.

DIAGNOSIS .

Gallstones are commonly detecting using ultrasound.
HIDA scan is used to diagnose cholecystitis.

TREATMENT 

Gallstones that do not cause any symptoms usually do not require treatment.
Cholecystectomy is surgical removal of the gallbladder. Removing the gallbladder generally has little or no effect on digestion.
Laparoscopic cholecystectomy uses small instruments /  a small video camera, inserted into the abdomen through three or four small incisions,to remove the gallbladder. Patients may be able to go home the same day as the surgery or may stay in the hospital for one night. Patients are usually able to return to work in one to two weeks.

Gallstone prevention 
Exercising for at least 30 minutes five days per week to maintain normal body weight.
Eating  three well-balanced meals daily, with each meal containing some fat to ensure gallbladder emptying .
Diet high in fiber, calcium and low in saturated fats.

For more information , please see

      www.nlm.nih.gov/medlineplus/healthtopics.html
      www.niddk.nih.gov/
      www.cdc.gov/
      www.gastro.org
      www.acg.gi.org

Dyspepsia is a recurrent or persistent pain that is mostly located in the upper abdomen.
About 25 percent of people in the United States  have symptoms of dyspepsia.

CAUSES 

Digestion of   food involves series of events that require coordination of the nerves and muscles of the digestive tract. Abnormalities in this system may lead to delayed emptying of the stomach contents resulting in nausea and vomiting, an early sense of fullness with eating, and bloating. Increased sensitivity to pain, psychological factors and Helicobacter pylori infection might play a role as well.

SYMPTOMS

Bloating  
Discomfort or pain in the abdominal area
Early sense of fullness with meals  
Nausea /  vomiting

DIAGNOSIS

Generally based on detailed medical history and physical examination.
The American Gastroenterological Association recommends upper endoscopy for those older than 55 or with serious symptoms, such as repeated vomiting, weight loss, difficulty swallowing, or anemia.

TREATMENT

Avoiding fatty foods which can slow the emptying of the stomach as well as eating small frequent meals are the cornerstones of treatment. Acid reducing medications and antidepressants can be  helpful. Few patients with functional dyspepsia improve following treatment of H. pylori.

For more information , please see

      www.nlm.nih.gov/medlineplus/healthtopics.html
      www.niddk.nih.gov/
      www.cdc.gov/
      www.gastro.org
      www.acg.gi.org
      www.iffgd.org

A diverticulum is a sac-like protrusion that forms in the muscular wall of the colon.
Diverticular disease is a common problem in western world that affects men and women equally.

CAUSES
 
Environmental and lifestyle factors may have a role in the development of diverticular disease . High wall tension secondary to low fiber diet  is thought to increase the risk of developing diverticula.
High fiber diet increases stool bulk and  thereby decreases the tension in the wall of the colon.

COMPLICATIONS

Diverticulitis  ( 15 to 25% )
Diverticular bleeding ( 5 to 15 % )
SYMPTOMS
Most people with diverticulosis have no symptoms and will remain symptom free for the rest of their lives.
The symptoms of diverticulitis  include pain in the lower abdomen, fever and urinary symptoms. Most cases resolve with antibiotics but about 25% will need surgery for abscess, fistula , sepsis.
Diverticular bleeding usually causes painless bleeding from the rectum.
DIAGNOSIS 
Diverticulosis is often found during tests performed for other reasons, such as routine screening for colon cancer or imaging studies such as CT scans done for evaluation of abdominal pain or rectal bleeding.

TREATMENT

Diverticulosis 
Most patients have no  symptoms and  do not require specific treatment.
Fiber supplements, can help to bulk the stools and possibly prevent the development of new diverticula, diverticulitis, or diverticular bleeding. Fruits and vegetables are a good source of fiber and can be particularly helpful in preventing and/or treating.

In the past patients with diverticular disease were advised to avoid whole pieces of fiber (seeds, and nuts) because of concern that the undigested  nuts  could become lodged within a diverticulum, causing inflammation or bleeding.  Currently most gastroenterologists do not subscribe to this view.

For more information , please see

      www.nlm.nih.gov/medlineplus/healthtopics.html
      www.niddk.nih.gov/
      www.cdc.gov/
      www.gastro.org
      www.acg.gi.org

Acute  diarrhea  is ≤14 days in duration  and is commonly due to infections with viruses and bacteria .
Most cases are self limited ,but work up is indicated in the following instances:
Profuse watery diarrhea with signs of hypovolemia
Passage of many small volume stools containing blood and mucus
Bloody diarrhea
Temperature ≥38.5ºC (101.3ºF)
Passage of ≥6 unformed stools per 24 hours or a duration of illness >48 hours
Severe abdominal pain
Recent use of antibiotics or hospitalized patients
Diarrhea in the elderly (≥70 years of age) or the immunocompromised

Stool cultures on initial presentation in the following groups of patients:
Immunocompromised patients
Patients with more severe, inflammatory diarrhea (including bloody diarrhea)
Patients with underlying inflammatory bowel disease
Some employees, such as food handlers, occasionally require negative stool cultures to return to work
Treatment
General measures such as hydration and alteration of diet.
Boiled starches and cereals ( potatoes, rice ) with salt, crackers, bananas, soup, and boiled vegetables are indicated in patients with watery diarrhea.
Secondary lactose malabsorption is common following infectious enteritis and temporary avoidance of lactose-containing foods may be reasonable.
Antimotility agent loperamide (Imodium) can  be used for the symptomatic treatment of patients with acute nonbloody diarrhea in whom fever is absent

Antibiotic therapy is not required in most cases since the illness is usually self-limited.

Chronic diarrhea, defined as the production of loose stools with or without increased stool

frequency for more than 4 weeks, is a common symptom that has prevalence in the United

States of approximately 3%–5%.

CAUSES
Irritable bowel syndrome
Inflammatory bowel disease   ( Crohn’s  and Ulcerative colitis)
Infections –   Clostridium difficile, Camyplobacter, Giardia, Amebae
Medications

DIAGNOSIS

A detailed medical history often points to the underlying cause of chronic diarrhea.

Blood tests and stool evaluation should be done prior to endoscopic evaluations

TREATMENT
Treat the underlying cause ( such as Colitis)
Relieve the diarrhea (peptobismol, psyllium, Loperamide, Lomotil)
Address any complications that result from long-standing or severe diarrhea

For more information please see
www.nlm.nih.gov/medlineplus/healthtopics.html
www.cdc.gov/
www.niddk.nih.gov
www.gastro.org
www.ccfa.org
www.ibsgroup.org
www.aboutibs.org

Crohn’ disease  is an inflammatory condition of the digestive tract.

Approximately 80 percent of patients have small bowel involvement, usually in the distal ileum.
Approximately 20 percent have disease limited to the colon.
Approximately 50 percent of patients involvement of both the ileum and colon.
A small percentage have predominant involvement of the mouth or gastroduodenal area.
Approximately one-third of patients have perianal disease.

CAUSES -GENETICS+ ENVIRONMENTAL FACTORS

The current belief is that, in a genetically susceptible person, a trigger leads the body’s immune system to inappropriately cause inflammation in the digestive tract.

SYMPTOMS

Frequent, loose bloody stools
Anemia
Abdominal pain
Weight loss
Low grade fevers
Joint pains
Eye problems
Skin rash
Liver problems
Perianal disease

DIAGNOSIS

Bloody diarrhea in any patient,especially if for long periods should prompt an appropriate work up to diagnose colitis. Blood tests, stool tests, X rays  and  colonoscopy are helpful in making a diagnosis.

COMPLICATIONS 

Stricture  A stricture is a narrowing of the colon or rectum which  can cause a blockage of the colon.
Perforation and fistulae
Bleeding
Toxic Megacolon
Blood Clots
Severe malnutrition
Gallstones
As with ulcerative colitis there appears to be an increased risk of colon cancer in patients with longstanding Crohn’s colitis.

MEDICATIONS

Many different drugs are used to treat Crohn’s disease. The choice of medications will depend upon the area of the digestive tract affected by the disease and the symptoms.
Steroids (such as prednisone and budesonide) can induce remission in patients with active, moderate to severe Crohn’s disease. However, steroids do not prolong remission and there are many serious side effects of long-term steroid use.

Sulfasalazine was one of the first drugs used to treat Crohn’s disease restricted to the colon. Sulfasalazine usually begins to reduce symptoms within a few days, but its full effect may require up to four weeks of treatment.
5-aminosalicylates – The 5-aminosalicylate (5-ASA) drugs (such as Asacol, Lialda  and Pentasa) are similar to sulfasalazine, but are less likely to cause headaches and allergic reactions.
Antibiotics – Antibiotics can reduce the number of bacteria in the intestines, which can in turn reduce inflammation. The antibiotics most frequently used are metronidazole and ciprofloxacin.
Immunomodulator drugs – Immunomodulator drugs decrease the inflammation associated with Crohn’s disease. The most commonly used drugs include azathioprine, 6-mercaptopurine.
Biologic response modifiers (Infliximab (Remicade) , Adalimumab (Humira), Natalizumab (Tysabri), Certolizumab pegol (Cimzia)) are   medications that  used as treatment options in moderate to severe Crohn’s disease who have not responded to other therapies.

SURGERY 
About 80 percent of patients with Crohn’s disease will require an operation at some time, usually to stop bleeding, to close fistulas and bypass obstructions, and often to remove the affected areas of the intestine However, surgery does not cure Crohn’s disease, and recurrence is likely.

COMMONLY USED DRUGS
Sulfasalazine ( Azulfidine)
Mesalamine( Asacol,Lialda,Pentasa,Canasa,Rowasa)
Azathioprine( Azasan,Imuran)
Mercaptopurine ( Purinethol)
Steroids (Prednisone)

For more information, please see

www.nlm.nih.gov/medlineplus/healthtopics.html
www.niddk.nih.gov/
www.cdc.gov/
www.gastro.org
www.acg.gi.org
www.ccfa.org

Constipation refers to bowel movements  that are  too hard or too small, difficult to pass with need to strain, or infrequent. Infrequent may be defined as fewer than three spontaneous bowel movements per week.
CAUSES
Low fiber diet
Medications that can cause constipation
Thyroid disease
Irritable bowel syndrome
Diabetes
Multiple sclerosis
Parkinson’s disease
Spinal cord injuries
Colon cancer

DIAGNOSIS
Clinical symptoms usually lead to a diagnosis of constipation.
Blood tests can detect hypothyroidism, anemia, hypercalcemia  which need further evaluation and treatment.
Colonoscopy is indicated in those with a recent change in bowel habits, blood in the stool, weight loss, or a family history of colon cancer.

TREATMENT
The bowels are most active following meals, and this is often the time when stools will pass most readily
Eating a diet high in fiber is important. The recommended amount of dietary fiber is 20 to 35 grams of fiber per day. For those who do not like high-fiber foods such as fruits, vegetables, and whole grains, psyllium powder mixed in an 8-ounce glass of water or another beverage one to three times daily may be considered. Numerous laxatives with
Various  mechanisms of action, safety, and experience are available .

For more information please see
www.nlm.nih.gov/medlineplus/healthtopics.html
www.cdc.gov/
www.niddk.nih.gov
www.gastro.org

www.ibsgroup.org

An average person has a 5 percent lifetime risk of developing colorectal cancer.
Most colorectal cancers develop from precancerous adenomatous polyps. A small percentage of these polyps become cancerous. This progression takes at least 10 years in most people. Early detection of lesions  increases the chances of successful treatment and decreases the chance of dying as a result of the cancer.

Colon cancer screening tests work by detecting polyps or by finding early stage cancers. Regular screening for and removal of  polyps can reduce a person’s risk of developing colorectal cancer by up to 90 percent.

RISK FACTORS 
Family history of colorectal cancer -Colorectal cancer in a family member increases an individual’s risk of cancer, especially if the family member is a first degree relative (a parent, brother or sister, or child), if several family members are affected, or if the cancers have occurred at an early age (before age 55 years)
Prior colorectal cancer or polyps
Increasing age -90% of  cancers  occur in people older than 50 years of age. Risk increases with age throughout life.
Lifestyle factors -A diet high in fat and red meat and low in fiber , sedentary lifestyle, cigarette smoking
Familial adenomatous polyposis (FAP) is an uncommon inherited condition that increases a person’s risk of colorectal cancer. Nearly 100 percent of people with this condition will develop colorectal cancer during their lifetime, and most of these cancers occur before the age of 50 years.

Hereditary nonpolyposis colon cancer (HNPCC) is another inherited condition associated with an increased risk of colorectal cancer. About 70 percent of people with HNPCC will experience colorectal cancer by the age of 65. Cancer also tends to occur at younger ages and in the part of the colon on the right side of the body.HNPCC is suspected in those with a strong family history of colon cancer; several family members from different generations may have been affected, some of whom developed the cancer relatively early in life. People with HNPCC are also at risk for other types of cancer, including cancer of the uterus, stomach, bladder, kidney, and ovary.
Inflammatory bowel disease- People with Crohn’s disease of the colon or ulcerative colitis have an increased risk of colorectal cancer. The degree of increased risk depends upon the amount of inflamed colon and the duration of disease; pancolitis (inflammation of the entire colon) and colitis of 10 years’ duration or longer are associated with the greatest risk for colorectal cancer. The risk of colon cancer is not increased in people with irritable bowel disease.
Factors that may decrease risk include a high calcium diet ( at least 1000 mg of calcium daily, either through diet or by taking a calcium supplement)

SCREENING TESTS – tests that can detect cancers at an early treatable stage (eg, stool tests), and tests that also detect pre-cancerous polyps (adenomas) and can lead to cancer prevention.

Stool tests – Colorectal cancers often bleed, releasing microscopic amounts of blood and abnormal DNA into the stool. Stool tests can detect blood or abnormal DNA makers. Guaiac testing, when performed once per year, can reduce the risk of dying from colorectal cancer by at least one-third.
Disadvantages -Guaiac testing is less likely to detect polyps than other screening tests.
If the stool test is positive, the entire colon should be examined with colonoscopy

Colonoscopy 
Procedure  – Colonoscopy requires that the patient prepare by cleaning out the entire colon and rectum by  consuming a liquid medication that causes diarrhea temporarily.  After gentle sedation, a thin, lighted tube is used to directly view the lining of the rectum and the entire colon.
Advantages-Only test that can “remove” polyps in the whole colon
Disadvantages –  Colonoscopy leads to serious bleeding or a tear of the intestinal wall in about 1 in 1,000 people.
There is also the possibility of missing polyps or cancer .
CT colonography 
Procedure  – Computed tomography colonography (CTC) is a test that uses a CT scanner to take images of the entire bowel to determine if polyps or cancers are present  

Advantages -It does not require sedation and is non-invasive
The entire bowel can be examined, and polyps can be detected about as well as with traditional colonoscopy.
Disadvantages -CTC requires a bowel prep to clean out the colon.
If an abnormal area is found with CTC, a traditional colonoscopy will be needed to remove a polyp ot biopsy a mass/cancer
Incidental findings  detected on CTC will require further testing.

Double contrast Barium enema and  flexible sigmoidoscopy  are also used for screening although less commonly than other modalities

PLEASE DISCUSS THE APPROPRIATE SCREENING MODALITY WITH YOUR PHYSICIAN
Average risk of colorectal cancer 
 People with an average risk of colorectal cancer should begin screening at age 50.
Increased risk of colorectal cancer 
 People who have one first-degree relative (parent, brother, sister, or child) with colorectal cancer or adenomatous polyps at a young age (before the age of 60 years), or two first-degree relatives diagnosed at any age, should begin screening for colon cancer earlier, typically at age 40, or 10 years younger than the earliest diagnosis in their family, whichever comes first. Screening usually includes colonoscopy, which should be repeated every five years.
People who have one first-degree relative (parent, brother, sister, or child) who has experienced colorectal cancer or adenomatous polyps at age 60 or later, or two or more second degree relatives (grandparent, aunt, uncle) with colorectal cancer should begin screening at age 40, and screening should be repeated as for average risk people.
 People with a second-degree relative (grandparent, aunt, or uncle) or third-degree relative (great-grandparent or cousin) with colorectal cancer are considered to have an average risk of colorectal cancer
Familial adenomatous polyposis — People with a family history of familial adenomatous polyposis should consider genetic counseling and genetic testing to determine if they carry the affected gene. People who carry the gene or do not know if they carry the gene should begin screening with sigmoidoscopy once every year, beginning at puberty.Colectomy is the only way to prevent colorectal cancer in people with FAP.
Hereditary nonpolyposis colon cancer — People with a family history of hereditary nonpolyposis colon cancer should consider genetic counseling and genetic testing to determine if they carry the affected gene. People who carry the gene or who do not know if they carry the gene should be screened with colonoscopy because HNPCC is associated with cancers of the right-sided colon (which cannot be seen during sigmoidoscopy).
Depending upon the family history and what is found, colonoscopy is usually repeated every one to two years between age 20 and 30 years, and every year after age 40
Inflammatory bowel disease — In people with ulcerative colitis or Crohn’s disease of the colon, the optimal screening plan depends upon the amount of colon affected and the duration of the disease.
For more information please see

      www.nci.nih.gov
      www.cancer.net/portal/site/patient
      www.nccn.org/patients/patient_gls.asp
      www.cancer.org
      www.nlm.nih.gov/medlineplus/healthtopics.html
      www.gastro.org
      www.acg.gi.org

What are colon polyps?

A polyp is extra tissue that grows inside your body. Colon polyps grow in the large intestine. The large intestine, also called the colon, is part of your digestive system. It’s a long, hollow tube at the end of your digestive tract where your body makes and stores stool.

Are polyps dangerous?

Most polyps are not dangerous. Most are benign, which means they are not cancer. But over time, some types of polyps can turn into cancer. Usually, polyps that are smaller than a pea aren’t harmful. But larger polyps could someday become cancer or may already be cancer. To be safe, doctors remove all polyps and test them.

Who gets polyps?

Anyone can get polyps, but certain people are more likely than others. You may have a greater chance of getting polyps if

• you’re over 50. The older you get, the more likely you are to develop polyps.
• you’ve had polyps before.
• someone in your family has had polyps.
• someone in your family has had cancer of the large intestine.

You may also be more likely to get polyps if you

• eat a lot of fatty foods
• smoke
• drink alcohol
• don’t exercise
• weigh too much

What are the symptoms?

Most small polyps don’t cause symptoms. Often, people don’t know they have one until the doctor finds it during a regular checkup or while testing them for something else.

But some people do have symptoms like these:

• bleeding from the anus .You might notice blood on your underwear or on toilet paper after you’ve had a bowel movement.
• constipation or diarrhea that lasts more than a week.
• blood in the stool. Blood can make stool look black, or it can show up as red streaks in the stool.

.

Who should get tested for polyps?

Talk to your doctor about getting tested for polyps if

• you have symptoms
• you’re 50 years old or older
• someone in your family has had polyps or colon cancer

How are polyps treated?

The doctor will remove the polyp. Sometimes, the doctor takes it out during sigmoidoscopy or colonoscopy. The polyp is then tested for cancer.

If you’ve had polyps, the doctor may want you to get tested regularly in the future.

How can I prevent polyps?

Doctors don’t know of any one sure way to prevent polyps. But you might be able to lower your risk of getting them if you

• eat more fruits and vegetables and less fatty food
• don’t smoke
• avoid alcohol
• exercise every day
• lose weight if you’re overweight

Eating more calcium and folate can also lower your risk of getting polyps. Some foods that are rich in calcium are milk, cheese, and broccoli. Some foods that are rich in folate are chickpeas, kidney beans, and spinach.

Also known as Ulcerative colitis (UC)

Ulcerative colitis (UC) is a disease in which the lining of the large intestine becomes inflamed. The immune system inappropriately targets the lining of the colon, causing inflammation, ulceration, bleeding and diarrhea.
Ulcerative colitis is a chronic condition and has no cure.

UC affects men and women equally.
The peak incidence of UC occurs between the ages of 15 and 30.

CAUSES  – Genes+Environmental factors

Ulcerative colitis tends to run in families.
About 10 to 25 percent of affected people have a first-degree relative (either a sibling or parent) with inflammatory bowel disease.
Environment —  Gut infections are suspected of triggering UC in people who have a genetic susceptibility.

SYMPTOMS

Frequent, loose bloody stools
Anemia
Abdominal pain
Weight loss
Low grade fevers
Joint pains
Eye problems
Skin rash
Liver problems

COMPLICATIONS 

Stricture   A stricture is a narrowing of the colon or rectum which  can cause a blockage of the colon.
Bleeding
Toxic megacolon   Severe  inflammation in the colon causes it to dilate, causing the walls to become thin  and eventually to rupture. Surgery is usually advised if this condition does not respond to medical treatment within about 72 hours.
Patients with ulcerative colitis have an increased risk of colorectal cancer. The risk begins to increase about 8 to 10 years after the symptoms of ulcerative colitis first appear. There is a 5 to 10 percent risk of cancer after 20 years and a 12 to 20 percent risk after 30 years of ulcerative colitis.
Colonoscopy is recommended 8 to 10 years after symptoms appear in people with extensive colitis, and  15 years after symptoms appear in people with left-sided colitis. Thereafter, colonoscopy should be repeated every one to three years. If advanced precancerous changes or cancer are discovered, surgical removal of the colon is usually recommended.

DIAGNOSIS

Bloody diarrhea in any patient,especially if for long periods should prompt an appropriate work up to diagnose colitis. Blood tests, stool tests and  colonoscopy are helpful in making a diagnosis.

TREATMENT

The symptoms of ulcerative colitis can fluctuate over time.
“Flare” is used to describe periods in which the disease becomes more active.
“Remission” is used to describe periods of quiescence.

Patients with abdominal cramps and diarrhea may notice relief when they reduce their intake of fresh fruit and vegetables, caffeine, carbonated drinks, and sorbitol-containing products.

Rectal inflammation  is treated with one or more medications that are given as an enema or a suppository or foam.
Some patients also require treatment with oral medications such as sulfasalazine (Azulfidine) and an 5-aminosalicylate (5-ASA).
Continuous treatment with a 5-ASA-containing drug is usually recommended, although it is often possible to taper the dose of medication.
Extensive disease  Patients with moderate /  severe symptoms may require temporary treatment with a steroid either as an outpatient or given  through the vein  in the hospital. Once remission is achieved, patients usually continue to take one of the oral 5-ASA drugs.
Refractory ulcerative colitis occurs when a person’s disease does not respond or responds poorly to the medical treatments used to treat the disease.
Most patients are treated with drugs that suppress the immune system. The most commonly used drugs are 6-mercaptopurine and azathioprine, and more recently biologic response modifiers such as  infliximab.
Surgical removal of the colon may be required if medical treatments are unsuccessful , if complications develop andif there is cancer.
Vitamins and medications — It is reasonable to take a multivitamin daily. People who take sulfasalazine should take a folic acid supplement.

COMMONLY USED DRUGS

Sulfasalazine ( Azulfidine)
Mesalamine( Asacol,Lialda,Pentasa,Canasa,Rowasa)
Azathioprine( Azasan,Imuran)
Mercaptopurine ( Purinethol)
Steroids (Prednisone)

For more information , please see

www.nlm.nih.gov/medlineplus/healthtopics.html
www.niddk.nih.gov/
www.cdc.gov/
www.gastro.org
www.acg.gi.org
www.ccfa.org