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Dictionary The Digestive System

Ulcerative Colitis

Synonyms :  UC

Clinical features, Diagnosis, Management, Prognosis, Nutrition, Herbs,

The cause remains unresolved, but current interest is focused on defects in the mucous gel barrier, either primary or acquired by bacterial sulphatases. The existence of true autoimmunity in ulcerative colitis is uncertain, and the evidence is conflicting. Psychological stress has been implicated in development of recurrences, but may also be only secondary to the condition. Genetic factors are important, as a family history is often found. Ulcerative colitis can occur at any age, especially between 10 and 40 years, equally affecting both sexes. Estimated prevalence is 70-150 cases per 100,000 population.

The disease always involves the rectum (proctitis) and may involve a variable part of the colon, but the colonic disease is always continuous with that in the rectum, in contrast to Crohn’s disease which is usually discontinuous.

Characteristic features of ulcerative colitis are ulcerations and sloughing of the mucosa exposing granulation tissue (young soft and spongy connective tissue seen in tissue repair). The normal mucosa that remains becomes oedematous, hyperplastic and raised in attempt to repair the damage, giving the appearance of pseudopolyposis (visually resembling real polyps which are benign tumour growth). The inflammation is mucosal and submucosal in contrast to Crohn’s disease where the whole wall is involved (transmural inflammation). In acute rapidly advancing disease the bowel may be greatly dilated (toxic dilation) and the bowel wall becomes thin and may rupture, causing very serious and frequently fatal peritonitis.

The summary of differences between ulcerative colitis and Crohn’s disease

Ulcerative colitis

Crohn’s disease

Always starts in the rectum

Usually starts in the terminal ileum and proximal colon

It is confined to the colon

It can affect any part of the gastrointestinal tract

There are no skipped segments but always continuous lesion

It shows segmental pattern of bowel involvement

Inflammation is mucosal and submucosal

Inflammation is transmural (the whole wall is involved)

No thickening of the wall and no bowel lumen narrowing

Marked thickening of the wall and bowel lumen narrowing

Granulomas characteristically absent

Granulomas characteristically present

Ulcers are shallow and there are no fissures and fistulas

Ulcers are deep with formation of fissures and fistulas

There is a greater risk for carcinoma than in Crohn’s disease due to associated epithelial hyperplasia and dysplasia

There is some risk for carcinoma

Clinical features:  < BACK TO TOP >

           The disease is characterised by exacerbations and remissions, the first attack often being the most severe (in general the clinical course is very variable).

           Features are determined by the extent of colon involvement, the severity of inflammation and the duration of the disease.

           The principal sign is diarrhoea with loose bloody stools containing mucus and pus.

           Patients frequently complain of colicky lower abdominal pain (cramps) that is relieved by defecation and sometimes tenesmus (an ineffective painful straining to empty the bowels).

           In chronic colitis the bowel is permanently damaged and becomes incapable of absorbing fluid properly; constant diarrhoea, dehydration and weight loss are frequent in this setting.

           The signs and symptoms may be trivial when the disease is confined to the rectum (e.g., one or two semi formed stools per day, containing little or no blood).

           Various extraintestinal manifestations, described earlier, can be observed.

           Emotional stress often accompanies relapse of the disease.

           Cancer of the colon occurs with an increased frequency in ulcerative colitis of more than 10 years?duration

Diagnosis:  < BACK TO TOP >

           Tenderness may be present on palpation of the colon, especially in the left lower abdominal quadrant.

           Blood tests usually show anaemia from blood loss (iron deficiency) and there may be leukocytosis and a raised ESR (all of these are non-specific).

           The stool should be examined/cultured for pathogenic bacteria and parasites to exclude an infective cause.

           The double contrast barium enema will demonstrate the severity and extent of the disease, showing ulceration and pseudopolyposis.

           Sigmoidoscopy is essential in most patients and can show characteristic mucosal changes; biopsies can eventually confirm the diagnosis.

           Colonoscopy is frequently used to assess the extent and severity of colitis, and is more accurate than barium enema.

Management  < BACK TO TOP >

             Initially, the correction of nutritional status, dehydration and electrolyte deficiencies is the major concern; the patient is advised to avoid food that seems to aggravate the condition. However, there is no evidence that special diets or other dietary intervention have any specific therapeutic effect in ulcerative colitis.

             Corticosteroids are the cornerstone of treatment and can be administered locally in the form of suppositories, foams and enema, or as a systemic treatment orally (usually prednisolone).

             Sulphasalazine, mesalazine and olsalazine contain 5-aminosalicylic acids as an active ingredient and are aimed at suppressing inflammation through inhibition of prostaglandin synthesis. These preparations may be given orally or in form of foam or gel enemas.

             Immunosuppressive agents used in the treatment of Crohn’s disease can also be used in ulcerative colitis, usually together with corticosteroids. TNF inhibitors do not appear to be of any significant benefit because patients with ulcerative colitis apparently do not have significantly elevated levels of TNF.

             Approximately 20-25% of patients require proctocolectomy during the course of their disease, a major indication being failure to respond to intensive medical treatment. In the past the entire colon and rectum were removed and ileostomy was performed (a small opening is created in the lower right corner of the abdomen through which the cut ends of the small intestine are brought out). A bag is kept over the opening, which accumulates waste matter and requires emptying several times a day.

             Now, advances in surgical technique have allowed the creation of an ileal reservoir or pouch, and with ileoanal anastomosis the need for permanent ileostomy is diminishing. Restorative surgery of this nature should be considered in every patient.

Prognosis  < BACK TO TOP >

  • - - 

Nutrition  < BACK TO TOP >

Nutrition that alleviate or prevent Ulcerative Colitis :-
Fish oil Folic acid Probiotics

Herbs  < BACK TO TOP >

Herbs that alleviate or prevent Ulcerative Colitis :-

Boswellia serrata (Salai guggal), Plantaginis ovatae (Psyllium seeds),

(source : -)

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