When your doctor tells you that you have a disease called “ulcerative colitis”, you and your family may think it is what we normally call “chronic colitis”, but when your doctor tells you that it is an autoimmune disease that may not be cured at this time, it may be with you for the rest of your life, and you may need long-term medication. But when your doctor tells you that it is an autoimmune disease that may not be cured at this time, it may stay with you for the rest of your life, and you may need long-term medication.
What is ulcerative colitis?
Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD).
It is usually confined to the colon, and the inflammation usually starts in the rectum and can spread throughout the colon. The disease can lead to inflammation of the innermost intestinal wall of the colon, with the formation of small erosions and ulcers followed by bleeding, mucus and pus.
No one can say exactly what causes ulcerative colitis and no one can predict how the disease will affect a particular person. Perhaps some patients remain symptom-free for many years, while others have frequent recurrences. In short, ulcerative colitis is a chronic, recurrent intestinal disease that can be managed with treatment and is not yet curable. This means that the disease is long-term, but not fatal. Most people with ulcerative colitis are able to live with the disease and can live, study and work normally.
II. Epidemiological characteristics of ulcerative colitis
There are approximately 15,000 new diagnoses of ulcerative colitis in the United States each year, and the exact number in China is unclear at this time, but more and more patients are being diagnosed. Ulcerative colitis can develop at any age, but tends to occur around the age of 35.
Ulcerative colitis affects more people in developed countries and more in urban than rural areas. About 20% of patients with ulcerative colitis have a first-degree relative with inflammatory bowel disease. Children of people with ulcerative colitis may have a higher risk of developing the disease than the general population, but it is not necessarily passed on to the next generation.
III. Causes of ulcerative colitis
The exact cause of the disease is still unknown. Most experts believe that it is due to the involvement of multiple factors. Three possible factors are included: genetic factors, a transitory immune response and certain factors in the environment.
The patient may have a single or multiple genes causing susceptibility to ulcerative colitis, while some factor in the environment triggers an abnormal immune response in the body, rejecting and attacking foreign invaders, and attacking while damaging its own intestine, which is the beginning of inflammation. Then the body’s immune system continues to attack and the inflammation continues to develop damaging the intestinal mucosa thus causing the symptoms associated with ulcerative colitis.
The symptoms of ulcerative colitis
In general, the symptoms are divided into gastrointestinal symptoms and extraintestinal symptoms, gastrointestinal symptoms include: most patients have abdominal cramps and a sense of urgency to defecate, with abdominal pain mainly on the left side. Diarrhea, mucus and blood stools, and even lead to anemia. Abdominal pain and diarrhea may lead to poor appetite, weight loss, and fatigue. Growth and development may be affected in pediatric patients.
Extra-intestinal manifestations include red and itchy eyes, mouth ulcers, joint edema and pain, skin lesions, osteoporosis, urinary tract stones, and liver lesions. In some patients, extraintestinal manifestations may be the earliest manifestation of ulcerative colitis, even before GI symptoms. In other patients, they may appear at the time of disease onset.
It is important to note that patients with an 8-10 year history of ulcerative colitis, primarily with total colon involvement, are at greater risk of bowel cancer. They should communicate more with their doctors and follow up regularly to achieve the goal of cancer prevention and risk reduction.
V. Diagnosis of ulcerative colitis
Through clinical manifestations and physical examination by the doctor, followed by laboratory tests: stool routine can exclude diarrhea caused by bacteria, viruses and parasites, and also reflect intestinal bleeding; nowadays, tests for Clostridium difficile are also done to exclude co-infection. Blood tests such as routine blood tests can clarify the presence of anemia, which in turn can reflect intestinal bleeding. In addition, routine blood tests can detect elevated white blood cells, which can also reflect inflammation in the body. There is also blood sedimentation and C-reactive protein to assess inflammation, and cytomegalovirus and tuberculosis infections are also checked.
Colonoscopy is very important for the diagnosis of ulcerative colitis. The doctor can clearly visualize the inflammatory lesions in the intestine, including inflammation, bleeding, ulcers, and the extent of the lesions. During the examination, the doctor will also take a biopsy of the intestinal mucosal tissue and refer it to a pathologist for pathological diagnosis to differentiate and clarify the diagnosis with other diseases.
Treatment of ulcerative colitis
At present, the treatment of ulcerative colitis is mainly to control the development of the disease through drugs, and if it cannot be controlled, surgery can be considered. These treatments can improve the inflammation of the intestinal mucosa and heal the lesions, while relieving symptoms such as abdominal pain, diarrhea and blood in the stool. The basic goal of treatment is to eliminate symptoms and maintain asymptomatic remission, reducing the rate of surgery and hospitalization.
Patients are very different and no two people have the same disease, so treatment needs to be “tailored”. Therefore, his treatment may not be suitable for her and you should seek professional advice to develop an optimal treatment plan for you.
Medications.
The following four types of medications are most commonly used.
1. Aminosalicylic acid
These drugs include salazosulfapyridine, mesalazine, olsalazine, and balsalazide. They can be taken orally or as anal plugs or enemas to relieve inflammation and are effective in the treatment of mild to moderate ulcerative colitis, while preventing recurrence of the disease.
2. Glucocorticoids
Including prednisone and prednisolone, etc., can affect the process of inflammation and maintenance of the body, suppress the body’s immune system. Commonly used in moderate to severe ulcerative colitis. They can be administered orally, by anal plug, enema or intravenously. It is generally used for short-term induction of remission during acute attacks and is not recommended for long-term maintenance treatment.
3. Immunomodulators
Including azathioprine, 6-mercaptopurine, cyclosporine. These drugs control the development of inflammation by suppressing the immune system of the body. They are usually administered orally and start to take effect after about 3 months of administration. They are indicated for patients in whom aminosalicylic acid and hormone therapy have failed, and also to reduce or eliminate dependence on glucocorticoids. Other drugs can be used to maintain remission when they are ineffective.
4. Biological agents
is a new class of drugs indicated for patients with moderate to severe ulcerative colitis. They reduce the inflammatory response by blocking specific biological pathways, while keeping side effects to a minimum. It is currently used in patients with persistent moderate to severe ulcerative colitis who are ineffective or dependent on hormones.
For further medication, it is recommended that you consult a specialist in inflammatory bowel disease. You will need to discuss with your doctor the efficacy and safety of the various medications, the dosage to be used, and the way to monitor the efficacy and side effects.
Surgical treatment.
Most patients with ulcerative colitis respond well to medications and do not require surgical treatment. However, about 25-33% of patients may require surgery at some point.
Surgery may be required when ulcerative colitis becomes severe and various medications are ineffective, when hormonal complications occur with long-term hormone-dependent hormones, and when hemorrhage, perforation, or toxic megacolon occur. There are two types of surgery: one is to remove the entire colon as well as the rectum and perform an ileostomy (an opening in the abdomen to allow for the evacuation of feces). The other is to remove the entire colon, but leave the rectum intact and surgically connect the anal sphincter to the small intestine, thus avoiding a lifelong ileostomy. Both procedures have advantages and disadvantages, and further consultation with a professional surgeon is required.
Seven, ulcerative colitis patients diet and nutrition
You may think that you have eaten a particular food that caused ulcerative colitis, but this may not be the case, and no exact food has been found to cause the disease. Once you have the disease, however, you can ease your symptoms, replace lost nutrients and promote recovery by paying attention to your diet.
A healthy diet that ensures proper nutrition is essential to the treatment of ulcerative colitis. A healthy diet should include a wide variety of dietary components, such as protein-rich meat, fish, poultry and dairy products (if tolerated), and carbohydrate-rich bread, grains, starches, fruits and vegetables. Also, multivitamin supplementation can fill in the gaps in food intake. Limit the intake of dairy products in lactose intolerant patients and caffeine in patients with severe diarrhea. Patients also need to observe their food tolerance and choose the right food for them.
Stress and emotions in patients with ulcerative colitis.
Some people believe that people with a particular personality type are prone to ulcerative colitis or other inflammatory bowel disease. This is the wrong view. However, the organism and the mind are closely related, and emotional stress can affect the symptoms of ulcerative colitis as well as any of the other chronic diseases. Although some patients may experience a recurrence of ulcerative colitis after a traumatic experience, there is still no evidence that mental stress can cause ulcerative colitis.
It is likely that stress is a symptomatic response to the disease itself, so patients with ulcerative colitis should have the understanding and emotional support of their families and physicians. Although formal psychotherapy may not be necessary, some patients can be helped by talking to a specialist with knowledge of inflammatory bowel disease or general chronic disease.
A little help with life
To make your life easier. There are a number of different ways to cope with the disease. For example, because you have abdominal pain or diarrhea, you may be afraid to go out in public. In fact, this is not necessary. These situations can be handled as long as you make arrangements beforehand. For example, find out where the restrooms are located in restaurants, malls, theaters and transportation, and carry extra underwear or toilet paper with you. If you are traveling or going on business, you should tell your doctor in advance to prepare adequate medication.
Surviving the disease: Dancing with ulcerative colitis
Perhaps the most difficult time for patients is when they first learn they have ulcerative colitis. This slowly changes over time. You can seek help from family, co-workers, friends, doctors and fellow patients to discuss your disease and your life together. There is no reason to give up the life you used to enjoy and aspire to. Keep a positive outlook. Learn all the ways to deal with your illness and share your knowledge with others. Persevere with treatment even when the disease is in remission. Dancing with the disease is a challenge, but we believe that with everyone’s efforts we can overcome the challenge, and we believe that medicine is evolving and a cure for ulcerative colitis will eventually be found.