INFLAMMATORY BOWEL DISEASE (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, which includes Crohn’s disease and ulcerative colitis.
The UK affects only the colon and rectum and, unlike Crohn’s disease, only affects the mucous membrane of the colon.
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 the quality of life of sufferers.
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.
Bleeding from the colon, with or without mucus
Abdominal cramps and pain, feeling of incomplete bowel movement and constant urge to stool
Fatigue, exhaustion, especially if the inflammation affects the entire intestine, fever and tachycardia may 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)
As it usually happens, the cause is unknown: the autoimmune component is postulated, most patients with UK have positive p-ANCA (antineutrophil cytoplasmic antibodies) in the blood, genetic predisposition as well as various negative environmental factors, 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 an avalanche inflammatory reactions causing colitis.
RISK FACTORS FOR UK
- Family history / genetic predisposition
- Use of isotretinoin (Accutane): a drug used in the treatment of acne has led to 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
- Prolonged and heavy bleeding from the gastrointestinal tract
- Bowel perforation
- Inflammatory processes on the eyes, joints, skin
- Toxic megacolon: dangerous enlargement of intestinal vortices
Other diseases that can be similarly presented: malignant diseases of the gastrointestinal tract
Collagen or lymphocytic colitis
Infectious colitis: caused by bacteria, virus, parasite
Ischemic colitis in the elderly population
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, blood albumin
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 complications of UK 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 a number of 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 is effective in more than 90 percent of cases.
Corticosteroids: dramatically reduce the signs of inflammation but have a number of 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 effect of the therapy, they are used in combination with steroids or as monotherapy.
Cyclosporine: this is a very 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 a number of 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 medicines called 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 completely 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 you symptoms, just don’t 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 supports 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