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Ulcerative Colitis

  • What is ulcerative colitis?

    Ulcerative colitis

    Ulcerative colitis is a type of inflammatory bowel disease affecting the innermost lining of the large intestine (colon) and rectum. Patients with this condition have chronic inflammation of the colon and ulcers that gradually worsen and can bleed and produce pus. There are several types of ulcerative colitis depending on its location.

    The condition can be debilitating and does not yet have a cure. However, through careful treatment, patients can achieve periods of disease remission, where symptoms are absent.

  • Exact ulcerative colitis causes remain unknown. Possible causes that been proposed include:

    • Immune system malfunction. An abnormal immune response may cause the immune system to attack its own digestive tract cells.
    • Heredity. Ulcerative colitis is more common in people who have family members with the disease.

    The following factors may increase a person’s risk of developing ulcerative colitis:

    • Age. Ulcerative colitis commonly develops in people under the age of 30 and over 60.
    • Ethnicity. Ulcerative colitis is more common among white people of European descent and rare in people from Asian backgrounds.
    • Family history. Having a close family member with the disease, increases a person’s risk as well.

    Preventing or reducing the risk of ulcerative colitis

    There is no firm evidence that dietary changes may prevent ulcerative colitis symptoms, however, they may be helpful in controlling the condition and lengthening periods of remission. An ulcerative colitis diet that is specific for you can prevent flare ups while helping you get the nutrition that you need. Keeping a food diary to record what and when you eat can help you identify and eliminate food items that trigger flare ups. Some changes that can be made include:

    • Limiting dairy products. This has been found to help with symptoms such as diarrhoea, abdominal pain, and gas.
    • Limiting fibre. High-fibre foods such as fruits, vegetables, and whole grains may make symptoms worse in some people. Steaming, baking, or stewing raw fruits and vegetables may help.
    • Avoid trigger foods, such as spicy foods, alcohol, and caffeine.
    • Eat small meals and drink plenty of water. Breaking meals into five or six small meals throughout the day may be helpful.
    • Manage stress by exercising regularly, resting, relaxing, or meditating.
  • Ulcerative colitis symptoms vary according to the severity and location of the inflammation. These include:

    • Recurring diarrhoea with blood or pus
    • Abdominal pain and cramping
    • Pain and bleeding in the rectum
    • Urgency to pass stools but inability to do so
    • Extreme tiredness, loss of appetite, and weight loss
    • Fever

    Most people have mild to moderate symptoms. Some people may have weeks to months of mild symptoms or be in remission (absence of symptoms), followed by periods of troublesome symptoms (flare-ups or relapses). Symptoms of a flare-up include:

    • Painful and swollen joints (arthritis)
    • Mouth ulcers
    • Painful, red, and swollen skin
    • Irritated and red eyes
    • Shortness of breath and a fast or irregular heartbeat
    • Fever
    • More blood in stools

    There are several types of ulcerative colitis depending on its location. These are:

    • Ulcerative proctitis is the mildest form where inflammation is confined to the rectum. Rectal bleeding is usually the only sign of the disease.
    • Left-sided colitis involves inflammation from the rectum extending further into the colon. Symptoms include bloody diarrhoea, pain and cramping in the left side of the abdomen, and significant weight loss.
    • Pancolitis involves inflammation of the colon in its entirety. Symptoms include bloody diarrhoea that is severe, pain and cramping in the abdomen, fatigue, and significant weight loss.
  • Ulcerative colitis is usually diagnosed after ruling out other possible causes that display similar signs and symptoms. Several tests can be performed to confirm a diagnosis of ulcerative colitis. These include:

    • Blood tests to check for anaemia or signs of infection.
    • Stool sample to test for white blood cells which can indicate ulcerative colitis or to rule out other possibilities, such as infections.
    • Colonoscopy to view the entire colon using a thin, flexible tube called an endoscope. During the procedure, biopsies (samples of tissues) may be taken to be examined in the laboratory.
    • Flexible sigmoidoscopy is done to examine the rectum and last part of the colon using an endoscope.
  • Ulcerative colitis treatment is performed with either medicines or surgery. Several types of medicines can be used depending of the severity and location of the disease. Sometimes, certain drugs that work well for one person may not work for another. Medicines that are used to treat ulcerative colitis include:

    • 5-aminosalicylic acid (5-ASA). Often used as the first step of ulcerative colitis treatment. Examples include, sulfasalazine, mesalamine, balsalazide, and olsalazine.
    • Corticosteroids. Generally reserved for moderate to severe ulcerative colitis and are given for short terms. Examples include, prednisone and budesonide.
    • Immunomodulator drugs. These reduce inflammation by suppressing the immune response. Examples include azathioprine, mecaptopurine, cyclosporine, and tofacitinib.
    • Biologics including infliximab, adalimumab, and vedolizumab.

    Surgery for ulcerative colitis can be curative but often involves removal of the entire colon and rectum. A procedure called ileal pouch anal anastomosis is performed, where a pouch is constructed from the end of the small intestine and attached to the anus to allow for waste excretion.

    If a pouch is not possible, a permanent opening in the abdomen is created through which stool is passed into an attached bag.

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  • There are several possible complications related to ulcerative colitis, such as:

    • Severe bleeding, tearing or perforation of the colon
    • Severe dehydration
    • Inflammation of the skin, joints, and eyes
    • Osteoporosis (bone loss) can develop due to prolonged use of corticosteroids or from dietary changes such as avoiding dairy products
    • An increased risk of colon cancer, especially among those who have the severe type of disease or inflammation involving most of the colon.
    • Toxic megacolon (a rapid swelling of the colon) is a rare and serious complication of severe ulcerative colitis. Inflammation of the colon causes gas to become trapped, resulting in an enlarged and swollen colon.
    • Blood clots in the veins and arteries
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