What is Ulcerative Colitis?
Ulcerative colitis, which is the most common type of inflammatory bowel disease, is a condition of episodic inflammation of the lining, or mucosa, of the colon, resulting in bloody diarrhea. The other type of inflammatory bowel disease is Crohn’s disease.
The cause of ulcerative colitis is unknown, but both environmental and genetic factors are thought to have a role. The condition is more common in North America and Northern Europe than in other parts of the world. The risk of ulcerative colitis is increased if there is a family history of inflammatory bowel disease.
Ulcerative colitis is less common in smokers and smokers who have ulcerative colitis tend to have mild disease. Having had an appendectomy at a young age decreases the risk of developing ulcerative colitis. The inflammation in ulcerative colitis is felt to possibly be due to an immune response against the bacteria that normally live in the colon. The inflammation usually starts at the rectum, which is the end of the colon, and it can extend in a continuous manner to involve more areas and possibly the entire colon.
If the inflammation of ulcerative colitis only involves the rectum it is called ulcerative proctitis . If the rectum and the adjacent area, which is known as the sigmoid colon, are involved, it is called proctosigmoiditis. If the inflammation is more extensive but still limited to the left side of the colon that is known as left-sided colitis. Involvement of more than the left side of the colon is referred to as pancolitis.
It is possible that over time the inflammation may spread to areas of the colon that were not involved at the time of diagnosis. Ulcerative colitis does not affect the small intestine, except for occasional involvement of the ileum, which is located adjacent to the colon.
Besides bloody diarrhea, attacks of ulcerative colitis might cause abdominal pain, weight loss, anemia, passage of mucus, and fever. Most people will have periods of relapse and remission. In addition, ulcerative colitis may have manifestations outside of the colon, possibly causing arthritis, skin and mouth lesions, inflammation of the eyes, and liver disease.
A number of medications may be used in the treatment of ulcerative colitis. The aminosalicylates, which include mesalamine, olsalazine, sulfasalazine, and balsalazide, are often the medication of choice both to achieve and to maintain remission.
Glucocorticoids may be used to achieve remission when aminosalicylates are not adequate, but are not effective in the maintenance of remission. The immunosuppressive agents azathioprine or 6-mercaptopurine might be prescribed in order to avoid the use of glucocorticoids, which can cause a number of serious side effects, including elevated glucose, osteoporosis, thinning of the skin, weight gain, cataracts, and several others.
Other medications that might be used in serious cases of ulcerative colitis include the immunosuppressive agents cyclosporine and tacrolimus, and the biologic agents, such as infliximab and adalimumab.
Up to about 30 percent of people with ulcerative colitis will ultimately require surgery, either due to failure of medical treatment or to complications. Removal of the entire colon (total colectomy) can cure the colonic manifestations of ulcerative colitis. However, total colectomy may not affect the risk or severity of ulcerative colitis associated liver disease.
People with ulcerative colitis have an increased risk of colorectal cancer beginning about eight years after diagnosis, and thus periodic colonoscopy with biopsies to look for dysplasia or cancer is important. The cancer risk is related to the duration of disease and the extent of the colon involvement.
Underwriting Ulcerative Colitis
The underwriter considers a number of factors when evaluating applicants with ulcerative colitis, including current status, the extent of colon involvement, time since diagnosis, treatments prescribed, complications, and results of colonoscopy.
Applicant 1 was diagnosed with ulcerative colitis five years ago, with disease limited to the proctosigmoid area. No treatment has been necessary for the past three years, and a recent colonoscopy was normal. This case can be Standard Plus.
Applicant 2 has had pancolitis for fifteen years with associated arthritis, is taking azathioprine, and recently had a benign colonoscopy with biopsies. This case can be Table Three off of a Standard Plus base rate.
Applicant 3 has had ulcerative colitis for ten years. A recent colonoscopy showed three areas of dysplasia. Complete removal of the colon has been recommended, which the applicant is considering. The dysplasia is premalignant and no offer can be made at this time. If the colon is removed reconsideration can be given based upon review of the pathology report. This case is a decline.