Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that can lead to chronic inflammation and ulceration of the GI tract.UC primarily affects the innermost layers of the large intestine and rectum. Symptoms mainly progress slowly over time, rather than occurring suddenly. Changqing Li, Department of Gastroenterology, Qilu Hospital, Shandong University
The symptoms of UC are usually mild and sometimes fatal complications can occur. Although there is no definitive cure, available treatments can reduce symptoms and even maintain long-term remission.
The symptoms of UC vary from person to person, depending on the degree and location of inflammation. And doctors often classify lesions according to where they are located.
Depending on the site of involvement, you may experience the following signs and symptoms.
– Diarrhea, often accompanied by bloody stools or mucus
– Pain and cramping in the abdomen
– Rectal irritation
– Rectal bleeding – passing small amounts of blood with the stool
– A feeling of urgency in the stool
– Feeling of incomplete bowel movements
– Weight loss
– Weakness
– Fever
– Cessation of growth and development in children
Most people with UC have mild or moderate symptoms. the course of UC also varies from person to person, and some patients can remain in remission for a long time.
Types
UC is classified according to the extent of bowel segments involved. The mildest can involve only the rectum (ulcerative proctitis). Alternatively, other segments of the bowel may be involved and the symptoms may get progressively worse. Patients with the disease at a younger age are more likely to have severe symptoms.
When to go to the doctor
Seek medical help if your bowel habits continue to change or if you have the following signs and symptoms.
– Abdominal pain
– Blood in the stool
– Persistent diarrhea that has not been treated with over-the-counter medications
– Diarrhea that wakes you from sleep
– Fever of unknown origin that lasts for one or two days
Although most cases of UC are not fatal, some can lead to fatal complications.
The exact cause of UC is not known. Initially, diet and stress were suspected, but doctors now believe that these factors can exacerbate the condition but are not the cause.
One possible cause is an immune system disorder. When the immune system tries to clear an invading bacteria or virus, the abnormal immune response attacks its own cells in the digestive tract at the same time.
In patients with a family member with the disease, genetics may play an important role. However, most patients with UC do not have a family history.
UC affects men and women similarly. Risk factors may include
– Age. UC most often begins before the age of 30. However, it can start at any age, and some people do not start until after age 60.
– Race or ethnicity. Although whites are at highest risk, any other race can develop the disease. People of German-Jewish descent are at higher risk.
– Family history. If you have a close family member, such as a parent, sibling, or child with the disease, you are at higher risk of developing it.
– History of isotretinoin use. Isotretinoin is a medication used to treat cystic acne. Some studies have found isotretinoin use to be a high risk factor for IBD, but the correlation with UC needs to be further validated.
Possible complications of UC include
– Severe bleeding
– Colonic perforation
– Severe dehydration
– Liver disease (rare)
– Bone loss (osteoporosis)
– Skin, joint and eye inflammation, mouth ulcers
– Increased risk of colon cancer
– Rapid swelling of the colon (toxic megacolon)
– Increased risk of arterial and venous thrombosis
The symptoms of UC will first prompt you to seek help from your family or community doctor. Your family or community physician will recommend that you seek the advice of a gastroenterologist.
Because appointments for visits are often rushed and there is a lot of information to communicate, it is a good idea to achieve preparedness. The following information helps you how to be prepared and how to get help from your doctor.
What you can do
– Know the contraindications before making an appointment. When making an appointment, make sure the consultation has no prior things you can do, such as controlling your diet.
– Write down all your symptoms, including those that don’t seem related to the visit you’re having.
– Write down key personal information, including any major stresses or recent life changes.
– Make a list of all medications, including vitamins and other dietary supplements. If you are taking herbal products, be sure to inform your doctor of this as well.
– Request a family member or friend to go with you. Sometimes it is difficult to remember all the information from a visit. A fellow traveler may remember information you missed or forgot.
– Write down any questions you need to ask your doctor.
Doctors’ time is limited, so preparing a list of questions in advance can help use your time effectively. Rank the questions in order of importance so that you don’t run out of time. For UC, basic questions to ask include.
– What is the most likely cause of your symptoms?
– Are there other possible causes?
– What tests do I need to do? Do these tests require any special preparation?
– Will this condition be temporary or long-term?
– What are the available treatments and which ones do you recommend?
– What side effects of treatment will I encounter?
– What medications, including over-the-counter medications, do I need to avoid?
– What kind of follow-up do I need? How often do I need to have a colonoscopy?
– What alternative treatments do you recommend in addition to the primary treatment?
– I have other health problems. How can I better manage them together?
– Are there any foods I can no longer eat?
– Can I continue to work?
– Can I have children?
– Are there any general alternatives to the medications you have prescribed for me?
– Are there any pamphlets or printed materials I can get? What websites do you recommend for reference?
Help you can get from your doctor
Your doctor will ask a number of questions. Being prepared for these questions can save time discussing some of the topics you want to discuss. Your doctor may ask.
– When did you first feel these symptoms?
– Are your symptoms constant or intermittent?
– How severe are the symptoms?
– Is there any abdominal pain?
– Any diarrhea? How often?
– Any unintentional weight loss?
– What can reduce the symptoms?
– What could worsen the symptoms?
– Any history of liver disease, hepatitis or jaundice?
– Any redness, swelling or sores in joints, eyes, skin, or mouth ulcers?
– Have you ever needed to wake up at night because of diarrhea?
– Have you traveled recently? Where have you been, if at all?
– Are there any other patients with diarrhea in the family?
– Have you used any antibiotics recently?
– Are you taking NSAIDs, such as ibuprofen or naproxen, regularly?
Depending on your signs and symptoms, your doctor may diagnose UC after ruling out other possible illnesses. to confirm the diagnosis, you may have the following tests done.
– Blood tests. Your doctor may recommend a blood pressure test to rule out anemia – a condition in which there are not enough red blood cells in the blood to carry oxygen to the tissues – or to check for signs of infection.
– Stool sample. The presence of white blood cells in the stool may indicate UC. stool tests can also rule out other conditions, such as bacterial, viral, and parasitic infections.
– Colonoscopy. Your doctor uses a thin, bendable tube with a camera to examine your entire colon. During the exam, the doctor may also take small pieces of tissue for laboratory analysis. Sometimes these tissue samples can help determine the diagnosis.
– A bendable sigmoidoscope. Your doctor will use a thin, bendable endoscope to examine your sigmoid colon, which is the most terminal part of the colon. If the inflammation is severe, your doctor may choose this test instead of a full colonoscopy.
– X-rays. If symptoms are more severe, your doctor will use an abdominal X-ray to rule out serious complications, such as a colon perforation.
– CT scan. A CT scan of the abdomen or pelvis may be ordered if your doctor suspects a complication of UC or if the inflammation is coming from the small bowel. a CT scan can also reveal the extent of inflammation in the colon.
UC treatment usually includes medications or surgery.
There are several medications that are effective for UC treatment. Which drug is used depends on the severity of the disease. Medications that work for some people may not work for others, so it takes time to discover the right medication for you. In addition, because some medications have serious side effects, you need to weigh the benefits and risks of any treatment.
Anti-inflammatory drugs
Anti-inflammatory drugs are usually the first step in the treatment of IBD. They are.
– Aminosalicylic acid. Sulfasalazine can reduce UC symptoms, but has some side effects, including indigestion and headache. Some 5-aminosalicylic acid preparations, including mesalazine, balsalazide, and olsalazine, are available as oral, enema, and suppository formulations. Which dosage form to use depends on the area of the lesion. These drugs are occasionally associated with kidney and pancreatic disease.
– Glucocorticoids. Including prednisone and hydrocortisone are generally limited to patients with moderate to severe UC and do not respond to other treatments. They can be administered orally, intravenously, or by enema or anal plug, depending on the site of the frontal lesion. Glucocorticoids have many side effects, including full moon face, facial hairiness, night sweats, insomnia, and hyperactivity. More serious side effects include high blood pressure, diabetes, osteoporosis, fractures, cataracts, glaucoma and infections. They usually cannot be used for long periods of time.
Immunosuppressants
These drugs reduce inflammation, but by suppressing the immune system that triggers inflammation. For some patients, a combination of these drugs is more effective than one alone. Glucocorticoids can be used in combination with immunosuppressants, with the former inducing remission and the latter maintaining it.
Immunosuppressive agents include.
– Azathioprine and 6-mercaptopurine. These two are the most commonly used immunosuppressive agents for the treatment of IBD. Taking these drugs requires strict follow-up and regular blood tests to detect side effects, including effects on the liver and pancreas. Side effects also include reduced resistance to infection and a small increase in the risk of malignancies, including lymphoma and skin cancer.
– Cyclosporine. This drug is generally used in patients who have failed to respond to the above drugs. Cyclosporine may cause serious side effects, such as liver and kidney damage, seizures, and fatal infections, and should not be used long-term. There is also a small increased risk of cancer, so you need to inform your doctor if you have a history of cancer.
– Infliximab, adalimumab and golimumab. These drugs are called anti-tumor necrosis factor alpha inhibitors, or “biologics”, and work by neutralizing a protein produced by the immune system. These drugs are suitable for patients with moderate to severe disease who do not respond to other drugs or cannot tolerate them. The use of these drugs may induce tuberculosis and other serious infections. These drugs also increase the risk of certain malignancies, such as lymphoma and skin cancer, by a small amount.
– Vedolizumab. This drug was recently approved for use in patients with UC who do not respond to or are intolerant to biologics and other treatments. The mechanism of action is by blocking inflammatory cells from traveling to the site of infection. There is also a small increase in the risk of infection and cancer.
Other medications
For some specific symptoms of UC, you may also need some complementary treatment medications. Always remember to consult your doctor before using over-the-counter medications. He or she may recommend one or more of these medications.
– Antibiotics. antibiotics may be used to prevent or control infections in people with UC who have a fever.
– Antidiarrheal medications. For severe diarrhea, loperamide may be effective. Be careful with antidiarrheal medications because they may increase the risk of toxic megacolon.
– Pain medications. For mild pain, your doctor may recommend acetaminophen – but do not use ibuprofen, naproxen, and diclofenac sodium because they may worsen symptoms and exacerbate the disease.
– Iron supplements. If you have chronic gastrointestinal bleeding, you may develop iron deficiency anemia and need iron supplementation for treatment.
Surgery
Surgery can eliminate UC. but usually requires removal of the entire colon and rectum. Most patients need an ileoanal anastomosis to avoid an abdominal wall fistula carrying a fecal pouch. The surgeon will make a pouch at the end of the ileum. This pouch is connected to the anal canal, allowing the patient to have a relatively normal bowel movement.
In some patients, it is not possible to make a pouch. The corresponding surgeon will make a permanent opening in the abdominal wall (ileostomy) and connect the pouch to collect the stool.
Cancer Surveillance
Because the risk of cancer increases every year, you need closer follow-up. The schedule of follow-up depends on the location of the lesion and the duration of the disease.
If the lesion is beyond the rectum, you will need a colonoscopy every 1-2 years. If most of the colon is involved, you should start a follow-up program up to eight years after the diagnosis of UC, or up to 10 years if only the left hemicolectomy is involved.
If you have a rare condition other than UC, such as primary sclerosing cholangitis, a colonoscopy should be performed every two years from the diagnosis of UC.
You may sometimes feel helpless in the face of UC. But changes in diet and lifestyle can help control symptoms and prolong the time between relapses.
There is no conclusive evidence about what foods cause IBD. However, certain foods and beverages may worsen the signs and symptoms, especially during relapses.
It is advisable to create a dietary diary to record the foods you consume each day and how you feel each day, which can help with the disease. If you find that certain foods can make symptoms come back, try removing them. The following are some suggestions that may be helpful.
Foods to limit and avoid
– Limit dairy products. Some people with IBD find relief from many symptoms, including diarrhea, abdominal pain and bloating, after restricting and removing dairy products. This condition may be caused by lactose intolerance – meaning your body cannot digest the lactose in dairy products. Taking enzyme preparations, such as lactase, may also help.
– Try a low-fat diet. If you have Crohn’s disease of the small intestine, you may not be able to digest or absorb fat properly. Instead, fat passing through the digestive tract can worsen diarrhea. Try avoiding cream, margarine, creamy sauces and fried foods.
– Also limit high-fiber foods if they worsen your symptoms. High-fiber foods, such as fresh vegetables, fruits and whole grains, may worsen symptoms for people with IBD. If fresh vegetables and fruits make your symptoms worse, try cooking methods such as steaming, roasting or stewing. In general cabbage type foods can make symptoms worse, such as broccoli and cauliflower. Nuts, squash, corn and popcorn can also aggravate symptoms. If there is intestinal stricture, it is recommended to eat low fiber and low residue foods.
– Avoid other problem foods. Spice, alcohol and coffee may also be aggravating signs and symptoms.
Other dietary measures
– Eat small amounts of food. Your symptoms will be much better if you eat five to six small meals a day instead of two to three full meals a day.
– Drink adequate amounts of water. Do your best to drink an adequate amount of fluids each day. Water is the best. Alcohol and caffeinated beverages can irritate the intestines and make diarrhea worse. Carbonated beverages produce more gas.
– Consider taking vitamin preparations. Because Crohn’s disease affects the absorptive function of the intestines and eating is limited, it is helpful to consume multivitamin and mineral supplements. Consult your physician before reconsidering their use.
– Consult a nutritionist. If you begin to lose weight or your diet is too restricted, you need to talk to a registered dietitian.
Stress
Although stress does not cause IBD, it can exacerbate symptoms and trigger recurrence.
Try the following measures to manage stress.
– Exercise. Even a small amount of exercise can reduce stress, ease depression and improve bowel function. Talk to your doctor to develop an exercise program that works best for you.
– Biofeedback. This stress relief technique, with the help of a biofeedback instrument, can help you relieve muscle tension and lower your heart rate. The goal is to help you enter a state of relaxation that allows you to better cope with stress.
– Regular relaxation and breathing exercises. One of the more effective ways to cope with stress is relaxation and breathing exercises. This can be done by taking a yoga class, meditating or practicing at home through a book, CD or DVD.
Many people with digestive disorders use many forms of alternative treatments. However, there is a lack of research on their effectiveness and safety.
Commonly used alternative treatments include.
– Herbal remedies and nutritional supplements. Most alternative treatments are not regulated by the FDA. Manufacturers will claim that their treatments are safe and effective, but they do not need to be proven. However, many natural herbs and supplements are associated with adverse reactions and harmful effects. You need to inform your doctor if you decide to try any herbal products.
– Probiotics. Some researchers suspect that adding many beneficial bacteria from the normal gut can help fight disease. Although research is still limited, there is some evidence that adding probiotics along with other medications may be beneficial, although further confirmation is needed.
– Fish oil. Fish oil has anti-inflammatory properties, and there is some evidence that adding fish oil to aminosalicylic acid may be beneficial, although further confirmation is needed. Fish oil can cause diarrhea.
– Aloe vera juice. Aloe vera juice may have an anti-inflammatory effect in patients with IBD, but it can also cause diarrhea.
– Acupuncture. Only one clinical trial has found it to be beneficial. This treatment is about fine needles penetrating the skin, which can stimulate the body to produce a natural analgesic component.
– Turmeric. Curcumin is an ingredient found in the spice turmeric, and there have been clinical trials combining it with standard UC treatments. There is some evidence of benefit, but more research is needed.