Ulcerative Colitis; Its Symptoms, Treatment, Diet & Causes.

Ulcerative Colitis (Colitis/Proctitis)

Ulcerative colitis is an inflammatory bowel disease (IBD). It causes ulcers in the lining of the large intestine. Ulcerative means that ulcers tend to develop. It usually affects the distal end of the large intestine and rectum.

Ulcerative colitis has no known cause. However, there is a genetic element to vulnerability. It is also called colitis or proctitis.

The inflammation caused by colitis makes the colon empty frequently. This causes recurring diarrhoea. Some ulcers form in places where the inflammation has killed the cells lining the colon. In addition, the ulcers often bleed and produce pus.

Ulcerative Colitis and Crohn’s Disease

Ulcerative colitis is similar to crohn’s disease. However, Ulcerative colitis affects only the colon and rarely moves to the small intestine. Crohn’s disease can affect the entire digestive tract - mouth, oesophagus, stomach, duodenum, large intestine, appendix, and anus.

A “cure” for ulcerative colitis is complete colon removal. Ulcerative colitis is usually confined to the mucosal and submucosal lining of the colon. It affects whole areas of intestine.

On the other hand, Crohn's disease tends to be patchy. The risk of colorectal cancer development in ulcerative colitis patients is up to 5 times greater than the general population after 10 years following the diagnosis.

Symptoms of Ulcerative Colitis

Chronic diarrhoea. Occasionally the diarrhoea is bloody.

Abdominal pain and discomfort

Bloating

Nausea

Fatigue

Weight loss

Loss of appetite

Rectal bleeding

Loss of body fluids

No infective cause of diarrhoea is found when one has this disease. Inflammatory changes are often restricted to the left side and distal parts of the large intestine, however, any part of the colon can be affected.

Inflammatory changes can expand over time and affect larger areas of the colon. Long periods of inflammation lead to fibrotic changes and can cause colon de-haustration. This can result in the narrowing of the bowel.

The disease is unpredictable in severity from patient to patient and time to time. This makes long-term projections very difficult. A patient may remain out of serious condition for years when the symptoms subside.

A patient with this condition is under major risk of carcinoma after 10 years. This may require frequent surveillance biopsies or prophylactic bowel removal.

Its symptoms such as pain, vomiting and chronic diarrhoea, etc can cause life to be agonizing but the disease is very rarely fatal on its own. Most patients enjoy normal life when symptoms are suppressed.

Ulcerative colitis may cause other problems such as arthritis, inflammation of the eye, liver disease (e.g. hepatitis, cirrhosis, and primary sclerosing cholangitis), osteoporosis, skin rashes, and anaemia.

Patients may also have other autoimmune features and extra-bowel complications including,

Iritis

Uveitis

Eviscerates

Migratory polyarthritis

Sacroiliitis

Erythematic

Nodosum

Fingertip clubbing

Ankylosing spondylitis

Primary sclerosing cholangitis.

No one knows why problems occur outside the colon.

Fistula formation in patients with Ulcerative Colitis is rare but does occur. Unlike in Crohn's disease, the probability of its recurrence is low.

Anal fissures are much more common. They are the mechanism through which fistulas can be formed in ulcerative colitis patients.

Deep fissures can reach glands in the anal walls, which then become infected and form abscesses, which, in turn, lead directly to fistula formation.

Fistula formation is often found in former smokers. Stopping smoking can cause a reduction in the protective mucus lining the colon. When the protective mucus is reduced, the bacteria in the colon can attack the colon lining causing the immune system to become active and fight the bacteria.

For unidentified reasons, this causes damage (ulcers) to the lining of the colon walls in one or more places. Resumption of nicotine either through patches or through smoking can cause the symptoms to subside. However, the benefits of smoking resumption as opposed to the other health risks of smoking are uncertain.

Causes of Ulcerative Colitis

The cause of this disease is unknown. However, infective agents are suspected. There is also a genetic component to vulnerability. Immune system over-activity has also been suspected as a cause.

It is likely that ulcerative colitis is a result of a combination of environmental, genetical, bacterial and other factors. There is no way to prevent ulcerative colitis.

Ulcerative colitis is not caused by emotional distress or sensitivity to certain foods and food products

This disease can occur in people of any age. However, it most often it starts between ages 15 and 30. It can also occur between ages 50 and 70. Children and adolescents can develop the disease. It does affect men and women equally.

Diagnosis of Ulcerative Colitis

Ulcerative colitis can be difficult to diagnose because its symptoms are similar to Crohn's disease.

A long-standing history of bloody diarrhoea, with no sign of infection, is consistent with ulcerative colitis. A diagnosis is usually achieved through colonoscopy or sigmoidoscopy with biopsy.

Blood tests can be done to check for anaemia. This could indicate bleeding in the colon or rectum. Blood tests could also uncover a high white blood cell count. This would be a sign of inflammation somewhere in the body.

In colonoscopy or sigmoidoscopy, the doctor inserts an endoscope (a flexible, lighted tube connected to a computer and TV monitor) into the anus to see the inside of the colon and rectum. The doctor can see any inflammation, bleeding, or ulcers in the colon.

Biopsy involves taking a sample of tissue from the lining of the colon to view under a microscope.

A barium enema x ray of the colon may also be required. In this procedure, the colon is filled with barium, which is a chalky white solution. The barium shows up white on x ray film. This allows the doctor a clear view of the colon including any ulcers and other abnormalities in the colon.

Ulcerative colitis most often affects the rectum and the distal left side of the colon, but can occur anywhere in the large intestine. Pan-colitis is a full-blown inflammation of the entire colon including the appendix and is especially hard to treat.

Living with Ulcerative Colitis

Patients with this disease might initially have bloody diarrhoea. The severity of the diarrhoea is variable from time to time.

Because of destruction of the nerves in the bowel, movement may be impaired, and the intestine may dilate. This may, in some cases, result in an extreme diarrhoeal disease - toxic mega colon. However, the probability of occurrence is very low, and is further reduced by regular routine surveillance by colonoscopy.

Eventually the inflamed mucosa may develop a risk of malignancy. This requires biopsy every few months.

Sometimes the risk of malignancy is such that bowel resection is offered. Many secondary complications are due to the nature of some medication prescribed for treatment of the symptoms, particularly corticosteroids and immunosuppressive agents. Long-term use of these drugs should be avoided if possible.

Ulcerative Colitis Treatment

In most ulcerative colitis cases, symptoms can be suppressed through anti-inflammatory medication. Most patients may never require any kind of surgery for their condition.

A definitive treatment and cure for Ulcerative colitis has not been found. Current treatment for the condition aims at reducing symptoms and preventing deterioration. It is also aimed at improving nutritional deficiency and ensuring normal growth and development in child patients.

This is achieved mainly through medication and at times surgery. However, every person experiences ulcerative colitis in a different way. Treatment therefore has to be adjusted for each individual. Emotional and psychological support is particularly important.

Drugs that are commonly used to treat this condition include,

Anti-inflammatory drugs; these help control inflammation and include sulfasalazine, sulfapyridine, olsalazine, mesalamine, and balsalazide. People with mild or moderate ulcerative colitis are treated with this group of drugs first. In severe cases, corticosteroids such as prednisone and hydrocortisone may be given. These are steroids and can be given orally, intravenously, through an enema, or in a suppository, depending on the location of the inflammation. These steroids can cause side effects including weight gain, acne, facial hair, hypertension, mood swings, and increased risk of infection. Therefore, they are not recommended for long-term use.

Immunosuppressive agents such as azathioprine, 6-mercaptopurine (6-MP), and cyclosporine. These reduce inflammation by affecting the immune system. They are slow acting. It can take up to 6 months before their full benefit is seen. Patients taking these drugs are monitored for complications such as pancreatitis, hepatitis, reduced white blood cell count, and an increased risk of infection.

Anti-diarrhoeal drugs (e.g. loperamide) should be avoided unless under specific instructions from the doctor, as they can worsen the disease.

Ulcerative Colitis Surgery

Some 25 percent to 40 percent of ulcerative colitis patients will eventually have their colons removed because of considerable bleeding, severe illness, rupture of the colon, or risk of cancer.

Surgery is only recommended in cases where drug treatment has proven ineffective or if the side effects of corticosteroids or other drugs threaten the patient's health.

Surgery to remove the colon and rectum is known as proctocolectomy. Since ulcerative colitis affects only the colon, a complete large intestine removal can be considered a cure.

A more elegant and functionally pleasing resolution may be a j-pouch surgery. In j-pouch surgery, a part of the terminal ileum is used to create a "pouch" which is then connected to the anus.

This preserves the appearance of normal bowel function. However, bowel movements are to some extent more frequent.

Ulcerative Colitis Diet

There is no confirmed link between dietary habits and the onset of the disease. Opinions are divided on this issue, but it is safe to say that no particular diet can influence length of period when the symptoms go away or cause inflammation if none is present.

The advice for patients is to avoid foods that have caused them discomfort in the past, and try to eat as healthy as possible. During acute onsets of the disease, a patient should try to maintain a low fat and bland diet to allow faster and easier healing.

In addition, during the acute phase of the disease, bulky foods, milk, and milk products can increase diarrhoea and cramping.

Usually, patients are advised to eat a healthy, well-balanced diet with adequate protein and calories. A multiple vitamin is also recommended. Iron may be prescribed if anaemia is present.