Ulcerative Colitis

Ulcerative colitis is a chronic inflammatory bowel disease affecting millions worldwide. Persistent abdominal pain or blood in stool could be signs of ulcerative colitis disease. This gastrointestinal condition causes inflammation & ulcers in the colon and rectum, leading to uncomfortable symptoms. Let's explore what ulcerative colitis is, its symptoms, and different ulcerative colitis treatment options. 

What is Ulcerative Colitis? 

Ulcerative colitis is a chronic inflammatory bowel ailment. It causes inflammation & ulcers in the lining of the large intestine (colon and rectum). This lifelong condition affects millions of people worldwide, making it one of the most common types of inflammatory bowel disease alongside Crohn's disease. 

Types of Ulcerative Colitis 

Ulcerative colitis affects different parts of the colon and rectum, leading to various types of the condition. The three main ulcerative colitis types are: 

• Ulcerative proctitis, affecting about one-third of patients, involves inflammation limited to the rectum. 
• Left-sided ulcerative colitis causes inflammation from the rectum to the splenic flexure, including proctosigmoiditis. 
• Extensive colitis, or pancolitis, affects the entire colon. 

Symptoms of Ulcerative Colitis Disease 

Ulcerative colitis has a range of symptoms that can vary in severity. Common ulcerative colitis symptoms include: 

• Diarrhoea, which may contain blood or pus 
• Abdominal pain 
• Abdominal cramping 
• Tenesmus- an urgent need to have a bowel movement, even if the bowels are empty 
• Fatigue 
• Fever 
• Weight loss 
• In children, the disease can slow growth and development. 

As the condition progresses, symptoms may worsen. Severe cases can lead to frequent bloody diarrhoea, nausea, and extreme tiredness. 

Causes of Ulcerative Colitis 

One cannot pinpoint the exact cause of ulcerative colitis, but researchers believe it involves a complex interplay of factors, including: 

• Genetics play a significant role, with 8% to 14% of patients having a family history of the disease. A person's risk increases fourfold if they have a first-degree relative with ulcerative colitis. 
• Environmental factors also contribute to the development of this inflammatory bowel disease. Interestingly, former smokers have a higher risk of developing ulcerative colitis compared to active smokers. The gut microbiome, consisting of bacteria, viruses, and fungi in the digestive system, differs in people with ulcerative colitis.  
• Age also influences risk, with most diagnoses occurring between ages 15-30 or after 60. 
• While stress and diet don't cause ulcerative colitis, they can trigger symptom flare-ups in those who have the condition. 

Complications of Ulcerative Colitis 

Ulcerative colitis can lead to various complications affecting the digestive system and other body parts. 

• One common side effects of ulcerative colitis is anaemia, resulting from severe bleeding in the colon. 
• Patients with ulcerative colitis also have a heightened chance of developing colon cancer, especially if the inflammation is extensive or long-standing. 
• The disease can cause osteoporosis, weakening the bones and making them more susceptible to fractures. 
• In some cases, inflammation spreads to the liver, leading to primary sclerosing cholangitis, which impairs liver function. 
• Children with ulcerative colitis may experience growth and development issues due to limited nutrient absorption. 

Diagnosis 

Diagnosing ulcerative colitis includes a combination of methods. They review the patient's medical and family history, followed by a physical examination. 

• Blood Tests: To check for anaemia and signs of infection or inflammation. 
• Stool Samples: Help rule out other conditions with similar symptoms. 
• Endoscopic Procedures: Doctors may perform colonoscopy or flexible sigmoidoscopy to view the colon's lining and take tissue samples for biopsy. 
• Imaging Tests: Radiology investigations such as X-rays or CT scans help assess the extent of inflammation and rule out complications. 

Treatment 

The goal of ulcerative colitis treatment is to reduce inflammation and induce remission. 

Medications: Doctors use various medications to achieve this, tailoring the treatment to each patient's needs. 

• Anti-inflammatory drugs are often the first choice for mild to moderate cases. These can be taken orally or applied topically to calm the inflamed colon and rectum. 
• For more severe cases, doctors may prescribe corticosteroids, but their long-term use is limited due to side effects. 
• Immunosuppressants and biologics are options for those who don't respond well to other treatments. 

These medications target specific areas of the immune system to reduce inflammation. 

Surgical Intervention: Surgery may be necessary sometimes, especially if complications arise or other therapies prove ineffective. 

When to See a Doctor 

Seek immediate medical care in a hospital if you have signs of dehydration, high fever, or heavy rectal bleeding. It's essential to report any new or worsening symptoms, as they could signal a need for treatment adjustments. 

Prevention 

While there's no guaranteed way to prevent ulcerative colitis, certain lifestyle choices may help lower the risk and manage symptoms, including: 

• A well-balanced diet comprising fruits, vegetables & whole grains can promote gut health. It's helpful to keep a food diary to identify potential trigger foods. 
• Regular exercise can decrease inflammation and strengthen the intestinal lining. 
• Managing stress through techniques like deep breathing, meditation, or yoga can also positively impact gut health. 
• For those with a family history of ulcerative colitis, genetic testing and early screening may be beneficial. 

Conclusion 

Ulcerative colitis can have a lasting effect on the lives of those affected, presenting a range of symptoms and potential complications. From persistent abdominal pain to the risk of colon cancer, this chronic inflammatory bowel disease poses serious challenges. However, many individuals can manage their symptoms effectively with proper diagnosis and treatment. 

FAQ's 

1. How serious is ulcerative colitis? 

Ulcerative colitis can have a deep impact on a person's life. Its severity varies, ranging from mild cases with occasional discomfort to severe forms that can lead to life- threatening complications. The condition increases the risk of colon cancer, anaemia, and osteoporosis. In rare cases, it can cause toxic megacolon or colon perforation, which requires immediate medical attention. While ulcerative colitis is serious, many people manage their symptoms effectively with proper treatment and lifestyle adjustments. 

2. Can ulcerative colitis go away? 

Ulcerative colitis is a lifelong condition, but it doesn't mean constant suffering. Many patients experience periods of remission where symptoms subside or disappear entirely. These remission periods can last for months or even years. However, flare-ups can occur unpredictably. 

3. What foods are bad for ulcerative colitis? 

While trigger foods vary among individuals with ulcerative colitis, some common culprits include: 

• Dairy products 
• High-fibre foods like raw vegetables and whole grains 
• Spicy foods 
• Alcohol and carbonated drinks 
• Red and processed meats 
• Sugary foods and artificial sweeteners 
• High-fat foods 

4. Can ulcerative colitis be cured permanently? 

Currently, there's no medical cure for ulcerative colitis. Treatment focuses on managing symptoms, reducing inflammation & extending periods of remission. However, surgical removal of the entire colon and rectum (total colectomy) can eliminate the disease. This procedure is a last resort when other treatments fail or complications arise. 
 

Dr. Snehal Makeshwar

MBBS, MD (Medicine), DNB (Gastroenterology), Fellowship in EUS
Ganga CARE Hospital Limited, Nagpur

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