INFLAMMATORY BOWEL DISEASE (IBC): ULCERATIVE COLITIS
We talked about functional digestive disorders such as the syndrome irritable bowel syndrome, bloating, bloating as mostly a consequence of lifestyle and stress. In contrast to these functional disorders, we will now discuss chronic inflammatory bowel disease (IBD) in the next 2 articles, including Crohn’s disease and ulcerative colitis.
The UK affects only the colon and rectum and, unlike Crohn’s disease, only affects the colon’s mucous membrane.
ULCEROSIS COLITIS (UK)
It is an inflammatory bowel disease that causes chronic inflammation of the intestinal mucosa, abdominal cramps/pain, and diarrhea. Like Crohn’s disease, it is a chronic condition and can, in some cases, lead to life-threatening complications.
UK is a CHRONIC disease of unknown cause and has a major impact on sufferers’ quality of life.
Incidence:
Approximately 10-12 cases per 100,000 people are diagnosed.
It occurs less frequently in South America, Asia, and Africa and is more common in Jews, whites, and women.
It can occur at any age, but the frequency is higher in people between 15. and 25. and between 55. and 65. years of age.
SYMPTOMS:
Bleeding from the colon, with or without mucus
Abdominal cramps and pain, incomplete bowel movement, and constant urge to stool.
Weight loss
Fatigue, exhaustion, especially if the inflammation affects the entire intestine, fever and tachycardia may also occur.
Extraintestinal manifestations UK: arthritis, ankylosing spondylitis (HLA B-27, sacroiliitis, canker sores, eye inflammation (iritis), kidney stones, skin rashes, and skin changes: erythema nodosum, pyoderma gangrenosum)
CAUSE:
As it usually happens, the cause is unknown: the autoimmune component is postulated, most patients with the UK have positive p-ANCA (antineutrophil cytoplasmic antibodies) in the blood, genetic predisposition as well as various negative environmental factors, the diet may play a role (milk can worsen symptoms UK) and smoking.
Some experts believe that the “trigger” is a virus or bacteria that causes inflammation and thus triggers avalanche inflammatory reactions causing colitis.
RISK FACTORS FOR UK
- Age
- Family history / genetic predisposition
- Use of isotretinoin (Accutane): a drug used in the treatment of acne, has led to the UK in some people, although a cause-and-effect relationship is not certain
- Caucasians and Jews
- Use of nonsteroidal anti-inflammatory drugs (ibuprofen, piroxicam, naproxen, diclofenac); these medications DO NOT CAUSE the disease but can worsen the symptoms.
COMPLICATIONS:
- Prolonged and heavy bleeding from the gastrointestinal tract
- Bowel perforation
- Dehydration
- Osteoporosis
- Inflammatory processes on the eyes, joints, skin
- Toxic megacolon: dangerous enlargement of intestinal vortices
ANKYLOSIS SPONDYLITIS
DIFFERENTIAL DIAGNOSIS:
Other diseases that can be similarly presented: malignant diseases of the gastrointestinal tract
Collagen or lymphocytic colitis
Infectious colitis: Caused by bacteria, virus, parasite
Radiation colitis
Ischemic colitis in the elderly population
PROCESSING:
After the anamnesis and clinical examination, laboratory processing follows complete blood count, electrolytes (sodium, potassium), calcium, sedimentation, CRP, liver tests (AST; ALT; bilirubin, alkaline phosphatase), proteins, albumin in the blood.
Irigography can be done in mild cases. In severe cases, it can precipitate intestinal perforation.
Examination of stool for bacteria, parasites, and leukocytes
Stool test for occult blood (hemoccult)
Computed tomography of the abdomen: in case of elevated liver tests or if any of the UK’s complications are suspected.
The gold standard is COLONOSCOPY: a gastroenterologist examines the colon completely using a thin, flexible tube that visualizes the intestinal mucosa and takes a biopsy for pathohistological analysis (this is crucial)
THERAPY / MEDICINES
Sulfasalazine: reduces UK symptoms but unfortunately has several side effects: nausea, vomiting, reflux, headache. It should not be taken by people allergic to sulfa preparations.
Mesalamine, balsalazide, olsalazine: this group of drugs is used in oral form or as suppositories, and a combination may be prescribed. In people with a mild form of UK mesalamine, more than 90 percent of cases are effective.
Corticosteroids: dramatically reduce inflammation signs but have several negative side effects: weight gain, high blood pressure and sugar, osteoporosis, decreased immunity, and more frequent infections. They are also used in combination with immune system suppressants (cyclosporine, azathioprine, infliximab)
Azathioprine, mercaptopurine: sometimes 3 months are needed to notice the therapy’s effect. They are used in combination with steroids or as monotherapy.
Cyclosporine: this is a potent drug and is reserved for those patients who have not responded to the second therapy already mentioned and for candidates for surgery. The effects of treatment are seen after 7-14 days. It has several side effects, including severe kidney damage. Be sure to tell your doctor if you have had any malignant disease.
Infliximab: is a newer drug belonging to a group of necrosis factor inhibitors.
Infliximab binds to necrosis factor in the blood and removes it before it reaches the intestines, where it causes inflammation. Side effects are allergic reactions, reactivation of tuberculosis, and viral hepatitis.
Nicotine patches: no known mode of action but reduce UK symptoms: do not start smoking for this reason!
Occasionally antibiotics, antidiarrheals (to prevent diarrhea), analgesics are prescribed. Avoid NSAIDs.
Iron preparations in anemia.
DIET; ALTERNATIVE and others…
- Reduce or even eliminate dairy products from the diet
- Vegetables steamed or in water instead of raw, high-fiber foods can make UK ailments worse (beans, fruits, vegetables)
- If a food causes your symptoms, do not eat it
- Eat smaller meals more often
- Consume enough fluids a day: water is your best friend. Avoid coffee, black tea, fizzy drinks.
- Exercise regularly
- Reduce stress (relaxation techniques, hypnosis, biofeedback, etc.)
- Some research speaks in favor of taking pre and probiotics in UK therapy / no definitive recommendations).
- Aloe vera
- Acupuncture: Several studies have shown a positive effect on the symptoms of the disease
