Overview of Ulcerative Colitis
Nonspecific ulcerative colitis (UC) is a chronic nonspecific inflammatory disease of the colon and rectum, the etiology of which is not well understood, with lesions confined to the mucosa and submucosa of the large intestine. The lesions are mostly located in the sigmoid colon and rectum, but may also extend to the descending colon or even the entire colon. The course of the disease is long and often recurrent. It is also known as “ulcerative colitis” or “idiopathic colitis” abroad. In Chinese medicine, it is called “dysentery”, “diarrhea”, “blood in the stool”, “intestinal wind” and “dirty poison”. “Dirty poison”.
The disease can occur at any age, but is more common in 20 to 40 years old, more women than men.
Etiology
This disease is a kind of inflammatory bowel disease whose etiology and pathogenesis are still unclear. Most scholars now believe that the occurrence of this disease is related to immune factors and genetic factors, while various other factors are mostly predisposing factors.
(I) Immune factors
1. Humoral immunity
Immunoglobulin is often elevated in patients with this disease, and a variety of non-specific anti-colonic antibodies can be found in the serum.
2. Cellular immunity
The development of this disease is related to the decline of cellular immunity.
3. Immune complex
The immune complex may be one of the causes of the localized lesions that produce this disease.
(ii) Genetic factors
Most scholars believe that genetic factors are important factors in the development of UC. Relevant data show that patients with inflammatory bowel disease have a higher family incidence rate compared with the general population, and the closer the blood relationship, the higher the incidence rate. In addition, there are regional differences in the occurrence of this disease, and the familial and incidence rates in Europe and the United States are significantly higher than those in the Asian population. In the racial difference, the incidence rate of white people is high, and the incidence rate of black people is low.
(C) Dysbiosis of intestinal flora
Some scholars believe that the proportion of pathogenic bacteria and normal flora in the intestinal tract is the trigger point for the development of UC.
(D) Environmental factors
A series of studies have shown that poor diet, fatigue, mental stress, smoking, appendectomy, taking birth control pills, pregnancy, etc., can make susceptible people’s immune response to intestinal bacteria decreased, resulting in a decrease in intestinal tolerance to normal flora, which in turn triggers ulcerative colitis.
(E) Infectious factors
Infection is closely related to the occurrence of ulcerative colitis, and infection can promote the occurrence of ulcerative colitis, but the specific mechanism of action needs to be further studied.
(F) Other factors
Food allergies, mental disorders, and factors such as nitric oxide, vascular injury and platelet aggregation, and anti-endothelial cell antibodies are all associated with the development of UC.
Symptoms
1. Blood in stool
Blood in the stool is the early and most important symptom of UC, with fresh or dark-colored blood stool in the early stage and mucus or pus blood stool in the later stage. Fresh blood is mostly from rectal ulcers, and the amount of blood is usually large. Bleeding for a long time can lead to anemia.
2. Abdominal pain
In the severe and active stage, abdominal pain is more obvious and refuses to be pressed, which can be relieved after defecation or by giving painkillers.
3. Urgency and heaviness after defecation
Anxious to have a bowel movement, but the bowel movement is not smooth, and the anus is heavy, mostly accompanied by pus and blood stools. Frequent bowel movements.
4. Diarrhea
Whether diarrhea and the number of times of diarrhea reflect the scope of ulcer invasion. If it only occurs in the rectum, the stool will usually be shaped and diarrhea is rare. However, if the whole colon is involved, diarrhea will occur, up to dozens of times a day, with severe weight loss.
5. Extra-intestinal symptoms
Occasionally accompanied by arthritis, iridocyclitis, liver dysfunction and skin lesions and fever.
Examination
1. Abdominal palpation
There may be pressure pain in the left lower abdomen or the lower abdomen. In severe cases, abdominal pressure pain, rebound pain and abdominal muscle tension may occur, and attention should be paid to whether there is complication of acute abdomen.
2. Endoscopy
This is the most important means of examination for UC. Under the microscope, the intestinal mucosa is congested, edematous, granular protrusions, multiple punctate or patchy shallow erosion or ulceration, with mucus or yellowish-white moss on the surface. The intestinal mucosa is fragile, and it is easy to bleed when the angle of the mirror is rubbed over it. Pseudopolyps can be seen due to edema and lymphatic tissue proliferation.
3.X-ray examination
The texture of intestinal mucosal folds is disorganized, the edge of intestinal tube is blurred, and the edge of intestinal tube can be seen as burr-like or jagged changes in severe cases. If a round filling defect is seen, it is often a pseudo-polyp. In severe cases, the intestinal pouch disappears, and the intestinal tube is like a narrow lead tube.
4. Laboratory examination
(1) Fecal examination
Blood, pus and mucus can be seen by naked eye, and a large number of erythrocytes, leukocytes, pus cells and macrophages can be seen microscopically in the acute stage, and there is no pathogenic bacteria in stool culture.
(2) Blood test
Most patients with severe disease have mild to moderate anemia, decreased hemoglobin and normal white blood cells.
(3) Immunologic examination
(1) Humoral immunity Immunoglobulin is measured during the active period, and IgG, IgM and IgA can be seen to be increased, with IgG being the most common to be increased significantly.
(2) Cellular immunity: T-lymphocyte percentage is lower than normal in some patients.
5. Pathologic examination
Mucosal inflammatory cell infiltration, anisotropic epithelial cell hyperplasia, abnormal arrangement of glands, epithelial fibrosis, crypt formation, etc. can be seen.
Diagnosis
1. Clinical manifestations
Typical clinical manifestations are chronic diarrhea, mucous blood stools, chronic recurrent or persistent abdominal pain, which may be accompanied by different degrees of systemic symptoms. In a few patients, the typical symptoms are not obvious, only constipation or no obvious bloody stools, should be combined with auxiliary examination to assist in the diagnosis. Patients should be carefully asked about their past medical history, and attention should be paid to the presence of joints, oral cavity, eyes, skin, liver, spleen and other extra-intestinal manifestations.
2. Sigmoid and fiber colonoscopy
(1) The affected colonic mucosa shows multiple superficial ulcers, accompanied by congestion and edema, and the lesions mostly start from the rectum and often involve other colons, with a diffuse distribution.
(2) The appearance of the intestinal mucosa is rough and uneven, finely granular, and the tissue is fragile and prone to bleeding or covered with purulent secretions, resembling a thin layer of moss attached.
(3) The colonic pouch tends to be flattened or blunted, and sometimes multiple pseudo-polyps of different sizes can be seen.
3. Barium enema
(1) Shortening of the colon, disappearance of the colonic pouch or tubular appearance of the colon.
(2) Multiple ulcers or multiple pseudo-polyps.
(3) Pathologic changes of colon mucosa biopsy show inflammatory reaction, and mucosal erosion, crypt abscess, abnormal arrangement of colon glands and epithelial changes are often seen.
Classification
1. According to disease
It can be classified as mild, moderate and severe.
2. According to clinical course
It can be categorized into incipient, chronic recurrent, chronic persistent and acute fulminant.
3. According to the scope of lesions
It can be divided into proctitis and sigmoiditis, left hemicolonitis, right hemicolonitis, regional colitis and total colitis.
Complications
Complications of non-specific ulcerative colitis may include toxic colonic dilatation; intestinal perforation; hemorrhage; polyps; carcinoma; small bowel inflammation; and complications related to autoimmune reactions, such as arthritis, skin and mucosal lesions, and eye lesions.
Treatment
Once UC is diagnosed, it should receive systematic treatment as soon as possible.
1. General therapy
Mild to moderate: Eat high nutritious and easily digestible food. Pay attention to rest and prevent overwork.
Severe: fasting, giving nutritional elements intravenously, correcting water-electrolyte imbalance, anemia, hypoproteinemia and other symptoms. Bed rest.
2. Drug treatment
(1) Aminosalicylic acid, commonly used drugs include salazosulfapyridine (SASP), olsalazine and mesalazine.
(2) Glucocorticoid hormone, commonly used drugs include prednisone and prednisolone, which is one of the effective drugs to inhibit inflammation in the acute active phase of UC.
(3) Immunosuppressants are suitable for those who are hormone-ineffective or dependent, and those who cannot undergo surgical treatment.
(4) Probiotics can be used in conjunction with any of the above drugs.
(5) Traditional Chinese medicine (TCM) Clinical treatment is based on strengthening the spleen, warming the kidney, eliminating dampness and removing blood stasis.
3. Surgery
Drug treatment is the first treatment for UC, but when internal medicine treatment is ineffective or accompanied by serious complications or even life-threatening, surgical treatment should be chosen. Commonly used surgical procedures include transabdominal colectomy, total colorectal resection with permanent terminal ileostomy or ileal pouch anal anastomosis to reconstruct the “new” rectum to restore intestinal continuity. The final decision on whether surgery is needed and how to proceed is made by the surgeon on a case-by-case basis.
Prognosis
UC is a chronic disease, which means that it can be stubborn and recurring, but is generally not life-threatening.
Prevention
The disease is characterized by recurrent and prolonged episodes, which can cause great financial and psychological stress. Many patients feel that they are wearing a heavy hat, which presses them all day long and makes them breathless.
Therefore, once the disease, it is very important to adjust the psychological state. Correctly treat the disease, set up the confidence to fight a long battle, maintain a happy mood, so that they are full of positive energy, the body’s positive vitality in order to overcome the disease.
Pay attention to the combination of work and rest, not too tired. Patients with fulminant, acute attacks and severe chronic type should rest in bed.
You should eat soft, easily digestible, nutritious and enough calories food. It is advisable to eat small meals and supplement multivitamins can promote the healing of ulcers. Eat less raw, cold, greasy and multi-fiber food.
Appropriate physical exercise to enhance physical fitness, pay attention to food hygiene, avoid intestinal infections to induce or aggravate the disease. Avoid tobacco, alcohol, spicy food, milk and dairy products.
Self-conditioning at the same time to strictly follow the doctor’s instructions, take medication on time and regular review is to ensure that the premise of the disease is cured.