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Dr Helen Webberley MBChB MRCGP MFSRH

GMC no 3657058

Colitis

‘Col’ ‘itis’ literally means, ‘colon inflammation’.  It is frequently confused with diverticulitis which is a completely different condition frequently seen in older patients who have been constipated, characterised by pockets which form in the colon.

There are several types of colitis;

  • ulcerative colitis (a chronic inflammatory condition of the bowel)
  • Crohn’s colitis (another type of chronic inflammatory condition similar to ulcerative colitis)
  • ischaemic colitis (caused by a poor blood supply to the bowel, seen in elderly patients)
  • pseudomembranous colitis (a severe condition caused by the infection C. diificile)

When patients talk about having colitis they generally mean ulcerative colitis (UC).

Ulcerative colitis in it’s mildest form, just affects the lower (distal) part of the colon (rectum only or rectum and sigmoid colon). This is by far the commonest type of UC. It can however extend to affect the whole colon in some patients. Generally if you have UC in the distal colon, it doesn’t ‘spread’ to the rest of the colon. Patients fear that if not ‘caught early enough’ it spreads to the rest of the colon like cancer. This is not the case.

Why does ulcerative colitis occur?

Nobody really knows what causes colitis despite huge resources being ploughed into researching it.

  • There doesn’t seem to be an infective cause so you can’t catch it from somebody else or pass it on.
  • There is a genetic element and frequently other family members have either UC or Crohn’s disease.
  • It may occasionally be triggered by a gut infection such as salmonella or campylobacter

What are the symptoms?

Frequent diarrhoea – this is sometimes mixed with blood and mucus (a clear/yellowish discharge). The diarrhoea is usually worse in the mornings and a typical scenario would be the need to open your bowels several times first thing in the morning but then not again for the rest of the day. Patients with more severe UC may get diarrhoea all day and even overnight but this is unusual.

Abdominal pain –  is not a typical feature although you may experience discomfort and bloating.

Weight loss and poor appetite – usually only seen in severe flare-ups

Extra-intestinal disease – occasionally patients may develop skin rashes, inflammatory eye conditions, joint problems and even biliary and liver problems, but these are fortunately rare.

How is UC treated?

UC usually responds well to a special anti-inflammatory drug called mesalazine. It is a safe drug with few side-effects although kidney damage does occur rarely. It can also have the paradoxical effect of worsening diarrhoea.

Mesalazine is marketed by lots of different pharmaceutical companies under different names, in different doses and in different guises. It can be administered in tablet form, as sachets that can be dissolved in water, as liquid or foam enemas, or as suppositories. Your gastroenterologist will be able to advise what is best for you.

Topical steroids (as foam enemas or as solutions) are also used in milder distal forms of UC.

Oral steroids (prednisolone) tends to be reserved for more severe forms of UC. They are ussally started in high doses and as the diarrhoea settles the dose is reduced.

Immunosuppressants (Azathioprine, 6 mercaptopurine and occasionally methotrexate) are used when it is difficult to wean the steroid doses down. These drugs need to be carefully monitored but are quite safe otherwise.

Cyclosporin is used only in patients with severe UC and under specialist centre supervision.

Biologics are again only used by specialists.

Surgery

Unfortunately, when medical therapy fails to control symptoms, surgery is the only option. This usually involves removing part or all of the colon. An ileostomy ( a bag usually on the right side of the lower abdomen) often has to be created. This may be permanent although there are lots of clever options available these days for reversal. Your surgeon will be able to advise you of these.

Is there a cancer risk?

Unfortunately the answer is yes. For those patients with only distal disease, the risk is relatively small. For those patients with more extensive disease and have had UC for more than 10 years then the risk does go up significantly. For these patients a screening programme is usually offered with regular colonoscopies (endoscopic examination of the colon) every 2 to 3 years

Screening for bowel cancer

As mentioned above, the recommended screening programme for patients with extensive disease for more than 10 years is pretty well embedded within NHS practice.

Screening for those patients with less extensive disease (predominantly left sided disease or just the rectum alone) is less clear. These are defined as having intermediate or low risk.

These patients can be offered screening at 3 years or 5 years respectively but unfortunately experience shows that take-up is low (both from Gastroenterology clinics and by patients themselves.

For any further information, please ask!

Dr.Helen Webberley in the news!

The silent killer in your home: NHS reveal the REAL danger of carbon monoxide poisoning

GP Dr Helen Webberley has treated many patients with the symptoms of carbon monoxide poisoning and warns of the damage that long-term exposure to the gas can lead to.
She said: “People should not think there is a safe level of poisoning, as exposure to the gas over time, even at a low level, can lead to brain damage.
“Everyone must be vigilant to symptoms which include dizziness, headaches, breathlessness and loss of consciousness.”

 

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