I. What is ulcerative colitis all about? What are the symptoms? What is the incidence of the disease?
From clinical observation, the incidence rate of ulcerative colitis has been gradually increasing in the past 20 years. Ulcerative colitis can occur in all age groups, mostly in 20-40 years old, but also in children or the elderly, and there is no significant difference in the incidence of men and women. Xu Lu Zhou, Department of Splenic and Gastrointestinal Diseases, Jiangsu Provincial Hospital of Traditional Chinese Medicine
So, what is ulcerative colitis? Ulcerative colitis is a superficial, non-specific inflammatory lesion of unknown origin occurring mainly in the rectum, sigmoid colon, left hemicolectomy, or even the whole colon, characterized by ulceration and erosion. It often presents with persistent or recurrent episodes of diarrhea, mucopurulent stools with abdominal pain, shortness of breath, and various degrees of systemic symptoms.
The disease tends to have a slow onset, a long duration, and recurrent episodes over a long period of time. Some patients also have some extra-intestinal manifestations, such as skin nodular erythema, arthralgia, ocular iritis, and hepatobiliary system manifestations.
How to diagnose ulcerative colitis?
The diagnosis is mainly made by colonoscopy, which finds that the lesions generally start from the rectum, are continuous and diffusely distributed, with blurred intestinal mucosal vascular texture, congestion and edema, easy bleeding, and purulent secretions; diffuse multiple erosions or ulcers are seen in obvious lesions. If the disease is recurrent (3) chronic lesions are seen with shallow, blunt or disappearing colonic pouch, pseudo-polyps and bridge-shaped mucosa. Mostly continuous lesions, the intrinsic muscle layer of the intestinal wall is not significantly involved, so the ulcers are generally not deep and do not cause perforations, fistulas or strictures, or obstruction.
Delayed treatment or improper treatment can lead to a variety of adverse consequences, such as anemia, wasting, fever, weakness, hypoproteinemia, water-electrolyte disorders, arthritis, intestinal polyp hyperplasia, pyoderma, recurrent oral ulcers, eye disease, and even toxic megacolon, intestinal perforation, sepsis, and cancer.
The difference between the severity of ulcerative colitis
The correct determination of the severity of the disease is an important basis for assessing the condition, and we classify it into three levels: mild, moderate and severe, based on clinical symptoms and laboratory tests.
Mild: The patient has diarrhea less than 4 times a day, light or no blood in the stool, no fever, rapid pulse or anemia, and normal blood sedimentation;
Moderate: between mild and severe;
Severe: diarrhea more than 6 times a day, obvious mucus and blood stool, body temperature >37. 5℃, pulse >90 times/min, hemoglobin (Hb) 30mm/h.
V. How to follow up and review ulcerative colitis?
For patients with extensive colitis and total colitis with a disease duration of more than 8-10 years and patients with left hemicolectomy and rectosigmoiditis with a disease duration of more than 30-40 years, surveillance colonoscopy should be performed at least once every two years. The histological examination found to have heterogeneous hyperplasia, should be more closely followed up.
Six, ulcerative colitis (UC) of Chinese and Western medicine treatment
1, the active stage of the western medical treatment of UC
(1) the treatment of mild UC can be used salazosulfapyridine (SASP) preparation. Lesions distributed in the distal colon can be discretionary SASP suppository 0.5 ~ 1g, twice a day; hydrocortisone sodium succinate enema l00 ~ 200 mg, once a night to retain the enema. Or enema with equivalent dose of 5-ASA preparation.
(2) Treatment of moderate UC Modified corticosteroids, commonly prednisone 30~40 mg/d, divided into oral doses.
(3)Treatment of severe UC Prednisolone 40~60 mg/d can be given orally and observed for 7~10 days, or given directly intravenously; control of secondary intestinal infections, such as ampicillin, nitroimidazole and quinolone preparations. Patients should be made to rest in bed, and appropriate fluid and electrolyte supplementation should be given to prevent salt balance disturbance. Blood transfusion should be considered for those with large amount of blood in stool, Hb<90 g/L and persistent bleeding. In severe cases, elemental diet is available, and in severe cases, parenteral nutrition should be given. If intravenous steroid hormone use is ineffective after 7-10 days, consider cyclosporine 2-4 mg/kg daily intravenously; surgical consultation to determine the timing and mode of colectomy.
2, ulcerative colitis of Chinese medicine treatment
In the acute attack period, the disease has a pathological state of intestinal dampness and heat congestion, Qi and blood is not smooth, and the ligaments are damaged, so when the patient has pus and blood in the stool, shortness of breath and abdominal pain, attention should be paid to the movement of Qi stagnation and blood ligaments. The main treatment for this disease is to strengthen the spleen and resolve dampness: strengthening the spleen and resolving dampness and blood is the most clinically used treatment method.
In addition, the treatment can be combined with Chinese medicine enema Chinese medicine enema is generally used to astringent sores and muscle, blood circulation and detoxification drugs. Our commonly used enema protocol is composed of Phellodendron and elm, which is used once a night to treat ulcerative colitis mainly in the sigmoid colon and rectum.