ULCERATIVE COLITIS

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Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that attacks your large intestine (colon). It causes irritation, inflammation, and ulcers (sores) that can be quite uncomfortable. There’s no cure for UC, but with the right treatment, you can manage your symptoms and live a full life.

What’s the Cause?

The exact cause of ulcerative colitis remains a mystery. However, researchers believe a combination of factors might be at play:

• Immune System Mishap: A malfunctioning immune system mistakenly attacks healthy tissue in your colon, causing inflammation.
• Genetics: Having a family member with UC increases your risk.
• Environmental Triggers: Certain factors like viruses, bacteria, or diet might play a role in triggering the disease in susceptible individuals.

Types of Ulcerative Colitis

The type of UC depends on the location within the colon:

1. Ulcerative proctitis: Affects only the rectum, often causing rectal bleeding.
2. Proctosigmoiditis: Involves the rectum and sigmoid colon, leading to bloody diarrhea, belly cramps, and tenesmus.
3. Left-sided colitis: Inflammation extends from the rectum to the left side of the colon, causing cramps, bloody diarrhea, and unintentional weight loss.
4. Pancolitis: Inflammation affects the entire colon, resulting in severe symptoms like bloody diarrhea, abdominal pain, fatigue, and significant weight loss.
5. Acute severe ulcerative colitis: Rare and severe, it affects the entire colon and causes intense pain, heavy diarrhea, bleeding, and fever.

Ulcerative colitis vs Crohn’s disease, and irritable bowel syndrome (IBS)

Ulcerative colitis, Crohn’s disease, and irritable bowel syndrome (IBS) share some similar symptoms, but they affect the digestive system differently.

1. Ulcerative Colitis (UC):
   • UC targets the large intestine’s lining, leading to inflammation and ulcers.
   • Diagnosis involves various tests like blood tests, stool samples, flexible sigmoidoscopy, and colonoscopy.
   • Treatment aims to alleviate symptoms and prevent flare-ups through diet adjustments, medication, or surgery.
2. Crohn’s Disease:
   • Unlike UC, Crohn’s disease affects various parts of the digestive tract, not just the large intestine.
   • Symptoms may include abdominal pain, diarrhea, weight loss, and fatigue.
   • Diagnosis and treatment methods are similar to UC but may vary depending on the affected areas.
3. Irritable Bowel Syndrome (IBS):
   • IBS doesn’t involve inflammation or ulcers but affects intestinal muscle function, leading to symptoms like abdominal pain, bloating, and changes in bowel habits.
   • Diagnosis usually involves ruling out other conditions through symptoms and tests like blood work and colonoscopy.
   • Management focuses on symptom relief through dietary changes, stress management, and medication.

Symptoms of Ulcerative Colitis

The primary symptom of UC is bloody diarrhea, often accompanied by pus in stools. Other symptoms may include:

• Cramping belly pain
• Urges to defecate suddenly
• Loss of appetite
• Weight loss
• Fatigue
• Fever
• Dehydration
• Joint pain
• Canker sores
• Light-sensitive eye pain
• Anemia
• Skin sores
• Feeling of incomplete bowel emptying
• Nocturnal bowel movements
• Incontinence
• Pain or bleeding during bowel movements

Symptoms can vary in severity and may recur intermittently over time, with some individuals experiencing symptom-free periods for weeks or even years.

Getting Diagnosed:

If you’re experiencing these symptoms, your doctor will likely take a multi-step approach to diagnosis:

• Medical History and Physical Exam: Discussing your symptoms and conducting a physical exam of your abdomen.
• Stool Tests: To rule out other conditions like infections.
• Blood Tests: To check for inflammation and anemia (common in UC).
• Colonoscopy and Biopsy: This procedure allows your doctor to directly visualize the inside of your colon and take tissue samples for analysis.

Treatment of Ulcerative Colitis

There’s no cure for ulcerative colitis, but effective treatments can manage symptoms and improve your quality of life. Here are some common approaches:

1. Dietary adjustments may involve avoiding trigger foods such as spicy or high-fiber dishes and managing lactose intolerance.
2. Medications:
   • Antibiotics to combat infections and promote healing.
   • Aminosalicylates containing 5-aminosalicylic acid (5-ASA) to reduce inflammation and control symptoms.
   • Corticosteroids for anti-inflammatory effects, particularly in severe cases.
   • Immunomodulators to regulate the immune system’s response to colon inflammation.
   • Biologics, made from living cell proteins, for severe UC cases.
   • Janus kinase inhibitors (JAK inhibitors) and Sphingosine 1-phosphate (S1P) receptor modulators for maintaining remission.
   • Loperamide may be prescribed to alleviate diarrhea, with caution under medical supervision.
3. Surgery:
   • Colectomy or proctocolectomy may be necessary if other treatments fail or if UC is severe.
   • Ileal pouch-anal anastomosis (IPAA) surgery creates a small intestine pouch to restore normal waste expulsion, eliminating the need for a collection bag.

Treatment plans may vary depending on the individual’s symptoms, disease severity, and response to therapy. It’s essential to work closely with healthcare providers to manage UC effectively.

Complications of ulcerative colitis

1. Bleeding: Chronic inflammation in the colon can lead to bleeding, potentially causing anemia due to blood loss.
2. Osteoporosis: Prolonged steroid use or dietary issues associated with UC may weaken bones, increasing the risk of osteoporosis.
3. Dehydration: In severe cases, the colon may fail to absorb sufficient fluids, necessitating intravenous fluid administration to prevent dehydration.
4. Extraintestinal Inflammation: UC-related inflammation can extend beyond the colon, affecting joints, skin, or eyes.
5. Fulminant Colitis: In severe UC attacks, the colon may perforate or become infected, leading to a life-threatening condition characterized by abdominal swelling and cessation of waste movement in the intestines.
6. Megacolon: Fulminant colitis can cause the colon to enlarge dangerously, possibly leading to rupture, which requires emergency surgical intervention.
7. Liver Disease: Inflammation of bile ducts or liver tissue and the development of scar tissue in the liver may occur in some UC patients.
8. Colon Cancer: Individuals with UC, especially those with extensive colon involvement or a long disease duration, have an increased risk of developing colon cancer.

Prognosis

• UC typically presents as a chronic condition with periods of symptom exacerbation (flares) and remission.
• While some individuals may experience only one flare, others may face recurrent and severe complications.
• Early detection and intervention can improve outcomes, with about half of colon cancer cases being survivable if diagnosed and treated promptly.

Living with Ulcerative Colitis

While UC can be challenging, you can take control and manage it effectively. Here are some tips:

• Partner with Your Doctor: Open communication with your doctor is crucial for creating a personalized treatment plan.
• Join a Support Group: Connecting with others who understand your condition can be a source of strength and information.
• Manage Stress: Stress can worsen symptoms. Explore relaxation techniques like yoga or meditation.
• Maintain a Healthy Lifestyle: Eat a balanced diet, get regular exercise, and prioritize sleep to support your overall well-being.

Sources:

• National Institutes of Health (NIH): https://www.niddk.nih.gov/about-niddk/strategic-plans-reports/burden-of-digestive-diseases-in-united-states/inflammatory-bowel-disease
• Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-20353326
• Crohn’s and Colitis Foundation: https://www.crohnscolitisfoundation.org/
• National Institute of Diabetes and Digestive and Kidney Diseases
• Cleveland Clinic
• American College of Gastroenterology
• Merck Manual