Male1: Sometimes kids get diarrhea and it lasts longer than we like and sometimes there is mucus and blood in it, and the doctors—I am going to send you to a gastroenterologist, he uses this term, it could be a thing called colitis. What does the word colitis mean? Is that something very serious?
Male2: Well colitis simply means inflammation of the colon and this spectrum of condition may be quite broad from extremely serious on one extreme to very mild and temperate on the other extreme.
Male1: But if you see blood and maybe some mucus in the stool and he says to you, it could be a thing called ulcerative colitis. What is ulcerative colitis?
Male2: Ulcerative colitis is a serious condition. It is a condition in which it has a strong genetic component and a large proportion of children with ulcerative colitis have close or extended relatives with similar category of medical condition.
Male1: What part of the intestine is involved in ulcerative colitis?
Male2: Ulcerative colitis by definition is when only the colon or the large intestine is involved.
Male1: It can involve any portion—all of it or some of it, is that true?
Male2: Correct. It may involve any portion of the colon and the condition is usually spread from the rectum up.
Male1: What age usually is the most common age that you start seeing a kid with a diagnosis?
Male2: Well, the most common age when the children develop ulcerative colitis is age after ten years. There is no proportion of children who have ulcerative colitis before ten.
Male1: This hints along the way, but most of the time it is around ten or eleven years old, is that correct?
Male2: It is after ten.
Male1: And if you do make the diagnosis, how do you make it correctly?
Male2: Well, the diagnosis of ulcerative colitis, like a majority of pediatric illnesses, is first of all made on the basis of clinical observation and a suspicion on a clinical basis. The children with ulcerative colitis, usually present with bloody diarrhea. In other words, the child has blood and mucus in the stool and the stool becomes liquid and frequent.
Male1: So once you have that high index of suspicion, how you could you definitely make a diagnosis.
Male2: Definitive diagnosis of ulcerative colitis made on the basis of colonoscopy, a procedure when an endoscope is placed inside the colon and the colonic mucosa or the internal lining of the colon maybe viewed and a biopsy may be done.
Male1: So now you made the diagnosis, what would be the approach to treating it?
Male2: Well there are several medications that are available to treat ulcerative colitis. There are some more conservative category of medications, in other words, the medications which I use for the durations and still are being used quite successfully, which are so-called sulfa medications. T he medications which contain what we call sulfa component of five aminosalicylic component, it is actually similar to aspirin.
Male1: And that sometimes does a very good job, is that true?
Male2: Sometimes it does an excellent job.
Male1: But say it does not work, what is the next step?
Male2: Well, unfortunately, some children do not respond to this common mainstream medication and need to be placed on different category of drugs. For example, steroids.
Male1: If you do steroids and you do that, what is your next step?
Male2: Well, in majority of children, one or another combination of sulfa drugs and steroids work well, yes it is a category of children who would not respond to or another drug, which I just mentioned and the different medication need to be used as well. The so-called immunosuppressive medications. The whole new category of drugs are being used—the new category of drugs which are becoming more and more--
Male1: What are the new type of drugs?
Male2: The new category of drugs that are becoming more and more cooperative in therapy of colitis or inflammatory bowel disease is the so-called immunosuppressive therapy.
Male1: Now, if we use these new drugs and that colon is still irritated, is there a risk of that area becoming cancerous down the road?
Male2: The risk is very, very small and rarely not appreciated well enough yet. The multiple studies done at the present time and on the wait to appreciate the degree of risk of use of immunosuppressive drugs.
Male1: Sometimes, they do surgery for colitis, is that correct?
Male2: In rare cases, the ulcerative colitis is a condition which is from pediatrics that usually well controllable by conservative management without surgery.
Male1: But it has to be followed very carefully because of all of these risk factors, right?
Male2: Correct.
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