ULCERATIVE COLITIS. 1. What does it consist of?

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2 ULCERATIVE COLITIS 1. What does it consist of? Ulcerative colitis is an inflammatory disease that affects the long bowel (colon). The most frequent symptoms are rectal bleeding, abdominal pain, weight loss and fever. The patients that develop this disease for a long time are more likely to suffer from colon cancer in the future. The cause for this disease is still unknown. 2. How is it treated? The initial treatment is medical and is based on the intake of antibiotics and antiinflammatory agents for long periods of time (salazopirin, prednisone, etc.). This disease develops in several outbreaks that can be treated increasing the doses of the prescribed drugs or adding new ones, like 6-Mercaptopurine. Sometimes, the patient needs to stay at hospital in order to follow a strict diet for the intestine to rest. 3. When is surgery required? Surgery is indicated in patients that present serious inflammatory complications like massive intestinal bleeding, perforations or infections. It is also indicated for certain patients that suffer from the chronic variety of this illness and do not respond to the medical treatment. It is important to highlight that before performing any surgical intervention, all possible medical treatments must be tried out. Patient who had suffered a colon disease for a long time and present malignant symptoms can be candidate for colon resection (due to the high risk or colon cancer), although the most frequent treatment for them is a careful monitoring with colonoscopies and colon biopsies. Surgery is only recommended in case any pre-malignant sign is found. 4. What does the surgical treatment consist of? The classical intervention is proctocolectomy, which consists on the resection of the entire colon, rectum and anus in one intervention or in several stages. This technique ensures the recovery of the patient and rules out any possibility of developing any colorectal cancer in the future. It requires performing an ileostomy (opening the distal part of the remaining intestine through the skin) and the use of a pouch attached to the abdominal wall in order to collect the stool.

3 The continent ileostomy is similar to the permanent type, but the first creates an "internal reservoir". The intestine communicates with the exterior but it is not necessary to use a collecting pouch permanently. The internal reservoir is emptied three or four times a day with a drainage tube. The only complications are possible leaks, a situation that requires surgery. This treatment rules out any cancer, recurrence or persistence risk. Some patients are treated with a colon resection but keeping their rectum and anus. The small bowel is connected to the rectum, so the ileostomy is not necessary and the fecal continence is not lost. The disadvantages are the increasing frequency and need for defecation and the remaining risk to develop an active colitis or cancer in the rectal area that has been maintained. The ileoanal procedure is the most modern technique for treating ulcerative colitis. It consists of resecting the colon and rectum but keeping the anal canal. The rectum is substituted with the small bowel, which is reshaped into a small pouch. A temporal ileostomy is normally necessary, but it can be closed a few months later. The small pouch generated will act as a reservoir and contributes to the reduction of the amount of stool. Thanks to this technique, the ulcerative colitis is very unlike to appear again and the defecation rhythm improves as well. The reservoir might be inflammed later, but it can be treated with antibiotics. Only very few patients require the resection of the reservoir because of a functional failure. In such cases, a permanent ileostomy is necessary. 5. Which is the best option? You must know that none of these alternatives brings the patient back to a complete normal state. Each surgical technique has advantages and disadvantages that must be completely understood by the patient before choosing the one can that can ensure them a better life quality. 6. What are colorectal surgeons? Colorectal surgeons are experts on surgical and non-surgical treatments for any condition in the colon or rectum. These professionals are specialized in colon and rectum pathologies after ending their formation s specialists in general and digestive surgery. They treat benign and malignant conditions, carry out studies for the early detection of certain illnesses and proceed with the surgical treatment when this is indicated.

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