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Ulcerative Colitis

Ulcerative colitis is a chronic autoimmune condition that causes ulcers on the colon lining. It is also considered a type of inflammatory bowel syndrome that causes irritation, inflammation and infection (rarely) in the large intestine.

Ulcerative colitis initiates from the rectum and can spread further affecting the entire colon. This condition can cause bleeding and discharge.

Symptoms: Ulcerative Colitis

Ulcerative colitis leads to abdominal comfort, rectal bleeding, and ulcers producing pus or mucus. Its symptoms can significantly help early identification of the condition, type and severity of ulcers.

Common symptoms of ulcerative colitis include:

  • Diarrhoea, often with blood or pus due to inflammation and the sore ulcer is a characteristic symptom of ulcerative colitis.

  • Abdominal pain and cramping due to inflammation or infection in the large intestine.

  • Rectal pain, often during bowel movements or cramps

  • Rectal bleeding, i.e. passing blood with stool is an important symptom, but it varies among people in terms of severity and reoccurrence.

  • The urgency to defecate is a common symptom in mild to moderate conditions.

  • Inability to defecate despite urgency and tenesmus with pain and cramping.

  • In severe cases, it may lead to weight loss, anaemia and weak eyesight due to reduced RBC levels, loss of appetite and excessive diarrhoea.

  • Fatigue due to dehydration, less nutrition reaching the body and anaemia.

  • Fever is observed in response to inflammation in 40% of patients and is a common sign of a moderate or severe condition.

  • In children, growth impairment is a concern. The inflammation in the child’s large intestine, diarrhoea, insufficient nutrition, low RBC and blood in the stool can compromise child growth.

Ulcerative colitis may result in other conditions such as arthritis, eye inflammation, osteoporosis and liver diseases. These complications may arise out of inflammation which resolves after complete treatment of ulcerative colitis.

Types of Ulcerative Colitis

Identification of the location of ulcerative colitis improves its treatment and cure. There are five major types of ulcerative colitis:

1. Ulcerative proctitis:

This affects the rectum, the part of the colon nearest to the anus. It is mild but causes rectal bleeding.

2. Left-side colitis:

This involves inflammation from the rectum to the left side of the colon. Signs of left-side ulcerative colitis include excessive weight loss, cramps, blood in stool, and diarrhoea.

3. Proctosigmoiditis:

Commonly known as sigmoid colon, this condition affects the rectum and lower end of the colon. Signs include blood in diarrhoea, cramps, abdominal pain and tenesmus.

4. Pancolitis:

This causes inflammation of the entire colon or large intestine. It is known to develop over a prolonged period with mild symptoms.

5. Active severe ulcerative colitis:

It is a rare but serious condition that leads to severe health outcomes such as heavy bleeding, fever, weakness, pain and diarrhoea.

Ulcerative Colitis: Causes

Ulcerative Colitis is an autoimmune condition where the body’s immune system attacks healthy tissues and bacteria of the large intestine instead of infection. There is no scientific proof of food or hormones leading to ulcerative colitis. While evidence of the exact origin of the condition remains inconclusive, the following factors may be playing a role:

  • Genes

  • Infection due to some bacteria or virus

  • Reaction in digestive tract pathogen

  • Immune disorders

  • Stress

  • Certain food choices or diets

Ulcerative Colitis: Diagnosis

Before diagnosis healthcare professionals often ask about symptoms, medical history and medicinal support with a physical examination. Diagnosis methods prescribed for ulcerative colitis can be

Lab Test

1. Blood test

This is an essential diagnostic test for the identification of ulcerative colitis. It involves blood count to track the chances of anaemia. Tests for inflammation, indicated by an increased level of C-reactive protein and sedimentation rate.

2. Stool studies

This is conducted to examine inflammation, blood infection, and the presence of parasites or bacteria in the colon.

Imaging Procedure

1. X-Ray

This is recommended in special cases by doctors to examine certain complications in the abdomen.

2. CT Scan

This is used to diagnose any complications or severity and inflammation in the colon.

3. Computerised tomography (CT) enterography and Magnetic resonance (MR) enterography

These tests help identify the location and severity of inflammation in the bowel. Non-invasive tests and radiation-free techniques are prioritised by healthcare experts.

Endoscopic Procedures

1. Colonoscopy

This is performed by inserting a flexible tube inside the colon attached to the camera. It helps in marking the exact location and level of inflammation. Tissue samples can be collected, if required.

2. Flexible sigmoidoscopy

This investigates only the lower part of the colon, i.e. the rectum and sigmoid colon with the help of a thin, slender tube.

Ulcerative Colitis: Treatment

Treatment of ulcerative colitis focuses on reducing inflammation, curing infections or suppressing immunity to treat and prevent further ulcers.

  • Medicine

    Different types of drugs are effective to prevent and treat ulcerative colitis. The selection of medications depends upon the cause and severity of the condition.

    1. Anti-inflammatory drugs: This is the first choice treatment to reduce and manage inflammation to ease bowel movement. Drugs prescribed by doctors can belong to any of these two classes: 5-aminosalicylates (Sulfasalazine, mesalamine, olsalazine etc) and corticosteroids (ideal for short-term uses for moderate or severe ulcers)

    2. Immune system suppressors: They are used to suppress the response of the immune system toward inflammation. A combination of medicine, Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan) are commonly prescribed. Other medications such as cyclosporine and tofacitinib are preferred depending on the situation.

    3. Biologics: The mechanism of action of biologics involves targeting proteins produced by the immune system. Infliximab, adalimumab, golimumab, ustekinumab and vedolizumab are generally recommended.

    4. Anti-Diarrheal medications: Loperamide is prescribed to treat severe diarrhoea.

    5. Pain relievers: Abdominal cramps and pain are treated with painkillers such as acetaminophen, ibuprofen, and diclofenac.

    6. Antispasmodics are prescribed to treat severe cramps and iron supplements are prescribed in low RBC in blood to prevent anaemia.

Diet

Ulcerative colitis remission is common in most cases, but diet management improves the quality of life. Patients are suggested to eat a low-fat diet, and add more fibre-rich food and vitamin C to recover fast. Tough-to-digest food is to be avoided because it can irritate the intestine.

Surgery

Surgery leads to the complete removal of the colon and rectum called proctocolectomy. Some cases may require the removal of the diseased part of the colon.

Cancer surveillance

Ulcerative colitis increases the risk of colon cancer. However, regular check-ups, diet plans and strict medication reduce the chances of developing cancer.