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Ulcerative Colitis

One of the two major categories of IBD or inflammatory bowel disease is ulcerative colitis, which predominantly affects the large bowel. It is a chronic condition of the colon or the large intestine that produces pus and mucus. The pattern of the disease is uninterrupted extending proximally from the anal verge all the way into the large intestine. It may occasionally involve the terminal ileum due to the incompetence of the ileocecal valve. As a result of immunologic changes, there is an accumulation of T-cells in the lamina propria in the segment of the diseased colon. The ulcerated area has an overlay of granulated tissue, and mucus discharge is noted from the goblet cells.

Causes

  • Immune reactions – The coherence of the intestinal epithelial barrier is compromised due to immune reactions. Lower incidences of ulcerative colitis are found in patients with a previous appendectomy.

  • NSAIDs – Etiology of ulcerative colitis is higher in patients who use of non-steroidal anti-inflammatory drugs

  • Genetics – Individuals with a family history of the disease are at a higher risk of developing it

  • Environment – Antigens present in the environment can stimulate the body’s defenses to develop an uncontrollable inflammation

  • Psychological stress can exacerbate ulcerative colitis in an individual

  • Consumption of milk can also lead to the disease

Signs and Symptoms

  • Abdominal pain

  • Rectal bleeding

  • Fever

  • Tachycardia

  • Bloody stools

  • Persistent diarrhoea

  • Urgent and loose bowel movements

  • Loss of weight

  • Loss of appetite

  • Fatigue

Types of ulcerative colitis

Symptoms of the disease can vary according to the type and extent of the disease. There are four types of ulcerative colitis:

  • Ulcerative proctitis – bowel inflammation is at the rectum; milder form of ulcerative colitis

  • Left-sided colitis – inflammation begins at the rectum and extends up to the spleen (splenic flexure)

  • Proctosigmoiditis – this affects the rectum and sigmoid colon

  • Total colitis – also known as pan-ulcerative colitis it affects the entire colon

Diagnosis

  • Physical examination is usually unremarkable except for tenderness in the right upper quadrant.

  • CBC / complete blood count for anaemia can show haemoglobin values < 12g/dL – females, < 14 g/dL – males and platelet count may indicate > 350,000/uL)

  • Metabolic panel: magnesium < 1.5 mg/dL indicative of hypomagnesemia, albumin < 3.5 gdL indicative of hypoalbuminemia and potassium < 3.5 mEq/L indicative of hypokalemia

  • Elevated erythrocyte sedimentation rate and C-protein levels

  • Stool studies to evaluate faecal leukocytes and presence of parasites

  • Plain abdominal radiography

  • Double-contrast barium enema

  • MRI, CT scan and cross-sectional imaging evaluate the effects of ulcerative colitis on the wall of the bowel

Treatment and medication

For the mild onset of ulcerative colitis confined to the rectal area, Asacol or topical mesalazine is prescribed. Oral amino-salicylates may also be prescribed. Infliximab and Golimumab prevent the endogenous cytokines to bind the cell surface. Immunosuppressant agents to regulate the immune system and corticosteroids for suppressing inflammation are also prescribed.

Dr. Deepak assesses the severity of ulcerative colitis between mild, moderate and severe before opting for either pharmacological or surgical therapy.

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