How Serious Is Ulcerative Colitis

People who live with ulcerative colitis are burdened by many questions, especially when they are having their first crisis and being diagnosed. These questions focus on issues of pain, symptoms, possible complications and disability

The answers to many questions are not apparent and often take a long time to determine. But most people who live with ulcerative colitis have increasingly longer periods when they feel well than they do when they are acutely ill. And this has never been more true than today, when doctors have an increasingly large arsenal of treatment options.

Moreover, the severity of the illness varies greatly for different people. One long-term study suggests that after the first attack, less than 10 percent develop chronic, longstanding, persistent symptoms, while the rest go into complete remission, and remain symptom free.

The most common concerns of people diagnosed with ulcerative colitis deal with the issues of:

Determining The Severity Of The Disease

The severity of the disease can be measured objectively by determining symptoms such as:

• The number of stools in a day
• Appetite
• Fever
• The number of days in a month when an individual must modify his or her work, home, or social schedule because of diarrhea, fatigue, fever, and other symptoms

It can also be measured subjectively, through questioning by a doctor of an individual's general state of being, such as whether that person is angry, depressed, in pain, embarrassed by needing to use the toilet frequently in social or business situations.

The severity of the objective signs seen on x-rays does not necessarily correspond to how severe the subjective symptoms are. One individual with disease that looks severe on radiological exam might have the ability to lead a relatively normal life, while another person with few objective signs of disease may find the conditions totally debilitating, both physically and mentally.

Can Ulcerative Colitis Cause Serious Complications?

In some people, ulcerative colitis can cause serious complications that include:

• Severe bleeding that may require blood transfusions
• Toxic megacolon, a dangerous condition where the colon becomes extremely distended (swollen), causing a person to become severely ill, with a distended belly and a high fever. The colon expands and becomes paralyzed. Occasionally, it may rupture. If this occurs, up to 30 percent may not survive it. The diagnosis is confirmed by simple x-ray of the abdomen.
• Perforation (a hole in the colon), which can cause widespread infection and can be life threatening

Not everyone who has ulcerative colitis will experience complications from the illness, however. In cases where a first attack comes on very suddenly, complications will occur in about 10 percent of individuals. Effective treatments are available for these complications.

Need To Know: Q. Is ulcerative colitis life threatening? A. Ulcerative colitis is very rarely life threatening. Cases of toxic megacolon or excessive bleeding due a very severe flare-up where the colon swells up massively can be life threatening, which is why surgery is undertaken quickly if these conditions develop. Normally, ulcerative colitis is a chronic, life-long illness, characterized by periods of few symptoms, known as remission, and periods of very active disease, known as flare-ups. The mortality rate is the same as for the general population, unless the initial attacks were very severe, or the inflammation is extensive affecting all or most of the colon, in which case it is a bit higher.

Possible Increased Risk Of Colon Cancer

Individuals with ulcerative colitis have a slightly increased risk of developing colorectal cancer. The increase in risk is dependent on the amount of colon involved. The incidence is greatest for those with pancolitis. However, the severity of the colitis symptoms has no bearing on any increased risk.

The risk of colon cancer developing, according to various studies, is estimated at 5 percent to 10 percent after 10 years, rising to 15 percent to 40 percent after 30 years

Thus, for individuals with ulcerative colitis, the risk of developing colorectal cancer increases over time, as is true for the general population. Therefore, regular screenings--either a colonoscopy with biopsy, or a barium enema --should begin eight years after the diagnosis.

Nice To Know: Scientists are still searching for the link between ulcerative colitis and colon cancer. Some scientists in the United Kingdom have suggested that the increased risk is not as great as has been thought. Other scientists have studied whether increased incidence of colon cancer in those with ulcerative colitis can be reduced by more aggressive treatment of the early cellular changes that may indicate a later development of cancer. Still others are seeking new strategies for dealing with polyps in those with ulcerative colitis as a way to reduce the incidence of colon cancer.