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Ulcerative Colitis

Overview

Ulcerative colitis is an inflammatory bowel disease (IBD) affecting your large intestine. It can involve only parts of the large intestine (e.g., colon or rectum or both) or might extend to the whole large intestine. The inflammation extends to deeper layers of the intestine wall, causing ulcers. The disease affects mainly people with hereditary predisposition between 20 -40 years old and progresses slowly over time. Although it has no known cure, it can be slowed down with proper care and treatment, reducing symptoms. Generally, the condition has a mild to the moderate course while leading to life-threatening complications in fewer cases.

Causes

The disease has been found to affect people with an abnormal immune system attacking the body’s cells in the intestinal tract. In most cases, this bizarre immune system is hereditary, while it has no such correlation with others. The disease can be aggravated by stress and improper diet.

Risk Factors

•   Age: 20-40 years:  Although the disease can occur at any age, most cases arise between 20-40 years old.

•   Other family members having the disease

Signs and Symptoms

•   Long term diarrhea, often with blood or mucus

•   Crampy abdominal pain

•   Urgency to pass stool

•   Fever

•   Weight loss

•   Loss of appetite

•   Fatigue

•   Weakness and hampered growth in children

Diagnosis

To accurately diagnose the disease, your doctor will order a series of lab tests and procedures:

1- Blood tests:

•   CBC:  to rule out anemia—the condition of low red blood cells, which can occur if the patient has long-term intestinal bleeding. ESR/CRP: markers of inflammation

•   Liver function tests (LFT’s)

•   Blood cultures

2- Stool studies:

•   Check for white blood cells or specific proteins that indicate ulcerative colitis.

•   To rule out other infections caused by bacteria, viruses, or parasites

3- Abdominal X-Ray/ CT scan:

•   To rule out complications

4- CT Enterography/MR Enterography:

•   To rule out the presence of inflammation in the intestine.

5-  Flexible Sigmoidoscopy:

•   Invasive procedure using a thin, flexible, lighted tube with a camera to view the lower end of the colon.

6- Colonoscopy:

•   Invasive procedure using a thin, flexible, lighted tube with a camera to view the whole colon.

The above invasive procedures help the doctor view the intestine, take tissue samples (biopsy) for laboratory analysis, and reach a definite diagnosis.

Treatment

There are two modalities of treatment; drug therapy and surgery. The choice of remedy depends on the stage of disease, extent, and condition of the patient. The main goal of treatment is to induce a decrease in the intensity of the disease in the first step and then to maintain this reduced severity.

Drug Therapy: There are four modes of drug therapies available, more than one drug type can also be given in combination if the disease doesn’t respond to one drug class. They are:

Anti-inflammatory Drugs

Immunosuppressant Drugs 

Biological therapy 

Symptomatic Treatment (Antidiarrheal, antispasmodic, pain relievers, and iron supplements )

Surgery: Surgical treatment is for patients not responding to drug therapy or developing complications, in which case the entire colon and rectum are removed. (proctocolectomy)

Complications

•   Severe bleeding

•   Dehydration

•   Toxic megacolon

•   Increased risk of cancer

•   Increased risk of clots in blood vessels

•   Perforation of the colon

Prevention

Ulcerative colitis has no established cure, and the prolonged course of the disease may make a patient feel helpless sometimes. But with lifestyle changes and controlling the diet and stress in life can keep the symptoms under check.

Diet

Drink plenty of fluids but avoid carbonated drinks and caffeinated drinks, which can aggravate gas and worsen diarrhea due to overstimulation of the gut.

Limit the use of  dairy products

Eating small meals throughout the day instead of big meals keeps symptoms relieved

Stress Management

Avoid undue stress in life and do regular exercise