Ulcerative Colitis

Symptoms: Diarrhoea with blood or pus, abdominal pain and cramping, rectal pain, urgency to defecate, fever, fatigue, and weight loss.

Risk Factors: Age, family history, smoking, environmental factors, race and ethnicity.

Prevalence: Currently, 5 million people worldwide are diagnosed with ulcerative colitis. In India, the total number of individuals suffering from UC is approximately 44.3 per 10000.

Severity: Mild- Severe.

Gender affected: Both male and female populations can be affected by ulcerative colitis (UC).

Which doctor to consult: A general physician, or gastroenterologist.

Overview: 

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in the digestive tract. It specifically affects the innermost lining of the large intestine (colon) and rectum.

Symptoms can develop gradually and may include diarrhoea with blood or pus, abdominal pain and cramping, rectal pain, urgency to defecate, and weight loss. The severity of symptoms can vary, and the condition can lead to life-threatening complications.

The exact cause of ulcerative colitis is not fully understood, but it’s believed to involve an abnormal immune response, genetics, environmental factors, and possibly an interaction with a virus or bacterial infection in the colon. There is no known cure, but treatment options are available that can help manage symptoms and induce long-term remission.

The primary focus of treatment is symptom management; however, many novel treatments are available that can significantly lessen discomfort and induce long-term remission.

Types of Ulcerative colitis:

Ulcerative colitis is classified into several types based on the location and extent of inflammation within the colon and rectum. Here are the main types:

Ulcerative Proctitis: Inflammation is confined to the area closest to the anus, the rectum. Rectal bleeding may be the only sign of the disease.

Proctosigmoiditis: Inflammation involves the rectum and the sigmoid colon — the lower end of the colon. Symptoms include bloody diarrhea, abdominal cramps, and tenesmus (an inability to move the bowels despite the urge to do so).

Left-Sided Colitis: Inflammation extends from the rectum up through the sigmoid and descending portions of the colon. Symptoms include bloody diarrhoea, abdominal cramping and pain on the left side, and urgency to defecate.

Pancolitis: Often affects the entire colon and causes bouts of bloody diarrhoea that may be severe, abdominal cramps and pain, fatigue, and significant weight loss.

Each type can have varying symptoms and may require different management strategies. It’s important for individuals with ulcerative colitis to work closely with their healthcare provider to determine the specific type they have and the most effective treatment plan.

Symptoms

The symptoms of ulcerative colitis can vary in severity and may include:

• Diarrhoea, often with blood or pus

• Rectal bleeding — passing a small amount of blood with stool

• Abdominal pain and cramping

• Rectal pain

• Urgency to defecate

• Inability to defecate despite urgency

• Weight loss

• Fatigue

• Fever

In children, it can also lead to failure to grow. It’s important to note that symptoms can change over time, with periods of mild symptoms or no symptoms at all (remission), and periods when symptoms become severe (flare-ups).

• Additional symptoms may include:
• Joint pain and swelling
• Nausea and decreased appetite
• Skin problems
• Mouth sores
• Eye inflammation

If you or someone you know is experiencing these symptoms, it’s crucial to seek medical attention for a proper diagnosis and better treatment plan.

Causes:

The exact cause of ulcerative colitis is not fully understood, but it is believed to be the result of a complex interplay of factors:

• Immune System Malfunction: An abnormal immune response may cause the immune system to attack the cells in the digestive tract, leading to inflammation.
• Genetics: There may be a hereditary component, as ulcerative colitis is more common in people who have family members with the disease.
• Environmental Factors: These can include certain diets, stress, and exposure to certain triggers that may activate the immune system’s response.

Other factors that might play a role include:

• Microbial Factors: Bacteria, viruses, or antigens in the environment might trigger the immune system’s response.
• Medications: Certain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and oral contraceptives, have been associated with an increased risk of developing ulcerative colitis.

It’s important to note that while these factors may contribute to the development of ulcerative colitis, none of them alone is known to cause the disease.

Risk factors:

The risk factors for developing ulcerative colitis include:

• Age: It most commonly begins before the age of 30, but it can occur at any age, and some may not develop the disease until after age 60.
• Race or Ethnicity: While it can occur in any race, white people have the highest risk, and there’s also a higher risk in people of Ashkenazi Jewish descent.
• Family History: Having a close relative with ulcerative colitis or another form of IBD increases the risk. About 10 to 20 percent of those with ulcerative colitis have a close relative with a form of IBD.
• Environmental Factors: Certain environmental conditions may act as triggers, such as diet, stress, and exposure to certain medications or infections.
• Smoking: Ulcerative colitis is sometimes referred to as a “disease of non-smokers,” suggesting that smoking may have a protective effect against the disease.

It’s important to note that having one or more risk factors does not mean a person will definitely develop ulcerative colitis, but it may increase their likelihood.

Complications:

Ulcerative colitis is a chronic condition that can lead to several serious health complications if not properly managed. Some of the potential complications include:

• Severe bleeding: Continuous inflammation can cause significant bleeding in the colon.

• Perforated colon: The wall of the colon can develop a hole, leading to a serious infection.

• Severe dehydration: Due to frequent diarrhoea, there’s a risk of dehydration.

• Inflammation of skin, joints, and eyes: Ulcerative colitis can cause inflammation in other parts of the body.

• Increased risk of colon cancer: Long-standing inflammation increases the risk of developing colon cancer.

• Blood clots: There’s a higher chance of clots forming in veins and arteries.

• Osteoporosis: Chronic inflammation and certain medications used for treatment can lead to bone thinning.

• Toxic megacolon: The colon can rapidly swell, which is a medical emergency.

It’s important to work closely with a healthcare provider to manage ulcerative colitis and monitor for these complications. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition.

Prevention:

While there is no known way to completely prevent ulcerative colitis, as the exact cause of the condition is not fully understood, there are some measures that may help reduce the risk or delay the progression of the disease. These include:

• Dietary changes: Avoiding certain foods that may trigger symptoms.

• Regular exercise: Mild exercise can help reduce stress, relieve depression, and normalize bowel function.

• Stress management: Techniques such as meditation or counselling can help manage stress, which may have an impact on symptoms.

• Avoiding nonsteroidal anti-inflammatory drugs (NSAIDs): These can irritate the bowel and may worsen symptoms.

• Quitting smoking: Former smokers have a higher risk of developing ulcerative colitis, so it’s beneficial to avoid smoking.

• Stay hydrated: Hydration correctly is key to avoiding ulcerative colitis. In addition to avoiding carbonated drinks, alcohol, and coffee, which can exacerbate diarrhoea, one must consume at least two liters of water each day.

It’s important to note that these measures may not work for everyone and they are not a guarantee against developing ulcerative colitis. Remember, maintaining a healthy lifestyle and being aware of the risk factors can be helpful, but regular medical check-ups and screenings are also crucial for early detection and management of any potential health issues.

When to visit a doctor:

If you have ulcerative colitis, it’s important to be in regular contact with your healthcare provider. You should visit a doctor or a gastroenterologist if you experience:

• Persistent changes in bowel habits

• Abdominal pain

• Blood in your stool

• Ongoing diarrhoea that doesn’t respond to over-the-counter medications

• Diarrhoea that awakens you from sleep

• An unexplained fever lasting more than a day or two

• Severe rectal bleeding

• Chronic diarrhoea that’s difficult to treat

• High fever

• Swelling of areas such as the skin or joints

• Dehydration

Diagnosis

The detailed diagnosis of ulcerative colitis typically involves a comprehensive approach that includes a combination of lab tests, endoscopic procedures, and imaging studies. Here’s a more detailed look at the diagnostic process:

Medical and Family history:

A complete medical history should be taken into consideration, including travel history, a detailed pharmacological history, and any recent antibiotic use to rule out other potential causes.

Lab Tests:

• Blood tests: These can check for anemia or signs of infection and inflammation.
• Stool studies: These can detect white blood cells, proteins, or signs of infection caused by bacteria, viruses, and parasites.

Endoscopic Procedures:

• Colonoscopy: This allows for the examination of the entire colon using a thin, flexible, lighted tube with an attached camera. Tissue samples, or biopsies, are taken for laboratory analysis to confirm the diagnosis.
• Flexible sigmoidoscopy: A similar tool is used to examine the rectum and sigmoid colon. This may be preferred if the colon is severely inflamed.

Imaging Procedures:

• X-ray: This may be used to rule out serious complications such as toxic megacolon or a perforated colon, especially if symptoms are severe.
• CT scan: A CT scan of the abdomen or pelvis can reveal the extent of the colon’s inflammation and check for complications.
• CT enterography and MR enterography: These noninvasive tests are more sensitive than conventional imaging tests for finding inflammation in the bowel. MR enterography is a radiation-free alternative.

These diagnostic tools help healthcare providers not only confirm the presence of ulcerative colitis but also determine its severity and the extent of inflammation in the colon. It’s important to undergo these tests if symptoms suggest ulcerative colitis, as early and accurate diagnosis is crucial for effective management of the condition.

Remember, only a healthcare provider can diagnose ulcerative colitis and recommend the appropriate treatment. If you suspect you have symptoms of this condition, it’s essential to consult with a medical professional.

Treatment:

The treatment of ulcerative colitis typically involves a combination of medication and, in severe cases, surgery. Here’s an overview of the treatment options:

Medications:

The treatment of ulcerative colitis is tailored based on the severity of the disease.

Mild to Moderate Ulcerative Colitis:

• Aminosalicylates: These medications can be administered as enemas, suppositories, or oral pills to reduce inflammation.
• Corticosteroids: These can be used for short-term relief of symptoms.

Moderate to Severe Ulcerative Colitis:

• Immunomodulators: Drugs like azathioprine and 6-mercaptopurine can be used to suppress the immune system’s response.
• Biologics: These are medications that target specific parts of the immune system that cause inflammation.
• Cyclosporine: This is an immunosuppressant that is sometimes used for patients who do not respond to other medications.

Severe or Fulminant Ulcerative Colitis:

• Hospitalization: To manage severe symptoms and prevent complications.
• Intravenous corticosteroids: Administered to quickly reduce inflammation.

Surgery:

• Ileoanal anastomosis: This procedure involves removing the lining of the rectum and connecting the small intestine to the anus.
• Proctocolectomy: The removal of the entire large intestine and connecting the small intestine to the anus.
• Colectomy: The removal of the colon.

Diet and Nutrition:

• Foods to eat: Low fiber foods like potatoes, white rice, and refined pasta; dairy products like yoghurt, milk, and cottage cheese; foods rich in omega-3 fatty acids like walnuts, salmon, and mackerel.
• Foods to avoid: Caffeine-laden food like tea and coffee; alcoholic drinks; carbonated drinks; foods rich in fibre like dried beans, fruits, whole grains, berries, peas, and legumes; foods rich in sulfur or sulfites like wheat pasta, breads, peanuts, raisins, and cured meats; spicy and fatty food.