Ulcerative colitis

 

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD), which causes inflammation over long term and damages the large intestine (colon/bowels) and the rectum. The inflammatory changes usually occur only in the innermost layer of the intestine. UC typically begins in the rectum and large intestine, but if proper care is not taken, the inflammation can spread involving the entire colon.

 

 

The exact cause of UC is still unknown. Studies have shown that it is because of interaction of various factors within body. Heredity (owing to inherent genes) is believed to be one causative factor. Immune system which triggers an inappropriate response against its own body cells is also believed to be a cause. Such autoimmune reaction is usually seen in patients with inherent genes which make them more prone to UC. Certain environmental factors like bacteria or viruses are also seen triggering this abnormal immune response leading to inflammation of the colon.

 

Population at Risk

Men and women are equally affected by UC. It can start at any age, though it is commonly seen in patients between 15 years and 30 years of age.

 

 

The large intestine and the rectum plays an important role in the digestive process of food and elimination of waste, but as it gets inflamed the normal function of the colon and rectum is damaged leading to symptoms like:

1. Continuous loose stools or diarrhea

2. Abdominal pain

3. Rectal bleeding

4. Weight loss

5. Anemia

6. Fatigue

7. Nutrient deficiencies

 

 

A gastroenterologist will help in diagnosing the disease. Imaging tests like an x-ray, ultrasonography, or an endoscopy like colonoscopy may be advised which will help to get a clearer picture of the inflamed colon. Blood tests for detecting anemia or other deficiencies, and a fecal test may also be advised.

 

 

The main aim of medical treatment is to subside symptoms, maintain remission, and to improve quality of life. There is no standard treatment for all patients; it is tailor-made for every individual case. Five main categories of drugs that are usually prescribed are:

1. Aminosalicylates: It contains 5-aminosalicylic acid like sulfasalazine, mesalamine, etc. which helps to decrease inflammation of the intestine.  

2. Corticosteroids: They are effective for short term control of flare up. Drugs like prednisone, prednisolone etc.

3. Immunomodulators: They help in maintaining remission. Examples are azathioprine and methotrexate.

4. Antibiotics: Drugs like metronidazole, ciprofloxacin are prescribed if there is an infection like an abscess.

5. Biologic therapies: These are new approaches prescribed in moderate to severe cases, in which immune system is suppressed to reduce inflammation by specific pathway. Drugs like golimumab, infliximab are given to patients who have not responded to conventional therapy.

 

 

Most of the UC patients complain of urgency of bowel movement and cramps or pain in the abdomen. Inflammation can cause small ulcers and these small ulcers can join together and become large bleeding ulcers, resulting in bloody stools. If these symptoms are not treated timely, it can lead to weight loss, anemia, and fatigue. UC can also affect joints, skin, and eyes.

 

 

The prognosis in first 10 years after diagnosis is generally good and most patients achieve remission. If the patient suffers from UC for 30 years or more, he/she may require surgery in which the affected colon and rectum are removed. Most patients then undergo a procedure known as ‘Ileal pouch anal anastomosis. Surgery is needed in about 10% to 40% patients.

Since exact causes are unknown, prevention is difficult. However, once you are diagnosed as having UC, seeing a gastroenterologist on a regular basis is advisable. Receiving maintenance therapy, even when feeling well, is very important in preventing flare-ups. Understanding foods that trigger a flare-up is important and avoiding these foods can help you achieve immense control over the condition.