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The Digestive SystemUlcerative 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
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 :- Herbs < BACK TO TOP > Herbs that alleviate or prevent Ulcerative Colitis :- Boswellia serrata (Salai guggal), Plantaginis ovatae (Psyllium seeds), (source : -) | ||||||||||||||||||
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