Causes, Symptoms And Treatment Of Ulcerative Colitis

What is ulcerative colitis?

Ulcerative colitis is an inflammatory disease of the large intestine (the colon), which is associated with ulceration (ulcers). Along with Crohn's disease is the major chronic intestinal inflammation.

Ulcerative colitis symptoms

Ulcerative colitis is a chronic inflammatory bowel disease. It is a chronic inflammation of the lining of the colon. In contrast to Crohn's disease comes only in the large intestine (colon) for. Ulcerative colitis always begins in the rectum and may extend gradually over the whole large intestine. In 75% of patients, the inflammation is restricted to the left part of the large intestine (the descending part). There are also people who just have an inflammation of the rectum (proctitis).

The main symptoms are diarrhea attacks and bloody stools. Often, the patient complains of abdominal pain, fatigue and fever. Periods with these symptoms often resolve spontaneously over again, allowing patients and physicians think that the "stomach flu" is healed. When the symptoms are, however, a longer time or to come back associated with large loss of weight must always be given to the diagnosis of ulcerative colitis.

Symptoms of inflammation outside of the colon in ulcerative colitis are rare. In about 5% of the cases can skin, eye and joint complaints occur and inflammation of the liver tissue. Usually, these phenomena are accompanied by increased activity of the colitis.

What causes ulcerative colitis?

The exact cause of ulcerative colitis is unknown. However, there are several factors known to contribute.

• Abnormal composition of the microflora (bacteria in the intestines).

Factors that may alter composition of gut bacteria are a Western diet (lots of sugars and fats) antibiotics and chemotherapy and excessive hygiene. An abnormal immune response in the mucous membranes of the intestine against the bacteria that are located there, is the basis of the damage of the intestine in CU patients. The microflora of patients with UC differs markedly with those of healthy people. The quantities of the different types of bacteria are different and the places where the bacteria in the intestine are different. This leads to possible sites in the gut that are chronically inflamed. Studies with probiotics and antibiotics show that there is to achieve therapeutic gain falls from the manipulation of the bacteria in the intestines.

• Deviations from the epithelial cells.

The epithelial cells of patients with UC function different from that of healthy people:

1. Reduced beta-oxidation. (Plays a role in the breakdown of fatty acids).
2. The wall of the cells is more easily penetrable; they are less protected.
3. Examination of darmwandbiopten of people with IBD, it was found increased oxidation. Recently an article was published that a theoretical model suggests that may explain these increased oxidation. In particular, it is stated that the intestinal lining cells of people with ulcerative colitis have a insufficient capacity is available to keep the antioxidant potential levels. As a result, there is insufficient defense against toxic elements from the environment that end up in the gut, so that there is increased oxidative stress in the intestinal wall cells with ulcerations and bleeding as a result. Relationship is also established between this oxidative stress and carcinogenesis.
4. Butyrate (a metabolite) can not be used as nutrients by the cells, causing some to die.
5. Deviations in the genes for certain receptors through which these epithelial cells are more susceptible to bacteria.
6. The cells have a deficiency of naturally occurring antibacterial acting substances (defensins).

• Heredity

Children of a parent with CU have 5 times more chance that they will get the disease. The genes IBD1 to be IBD9 with Crohn's disease and CU associated. Other relevant genes are the NFkappaB1 gene, involved in immune responses, and the genes that code for the toll-like receptors 4 and 9, that affect the protection from bacteria. The role of genetics is also evident from the following:

1. CU comes in some families common.
2. In the case of family members shows the disease is often the same course.
3. Frequent appearance of the disease in certain ethnic groups. (e.g. Ashkenazi Jews)

• Stress.

Stress, depression, death, divorce or other traumatic events may worsen the course of UC.

• Nutrition.

There is evidence that a diet high in dairy products and low dietary fiber may have a negative effect. This would, in particular, be caused by the sulfur-containing milk proteins. Our modern diet could also contribute to the increase in chronic inflammation. The elimination of these and other products out of the power supply has in many cases, improvement in the effect.

• Appendectomy.

The removal of the vermiform appendix of the cecum at a young age reduces the risk of getting CU by 70 percent.

Ulcerative colitis diagnosis

The diagnosis sometimes lasts several months. Sometimes it's still not clear at first whether there is indeed a chronic bowel inflammation. On the other hand, it happens that the diagnosis is made during an (emergency) operation for instance because a appendicitis is suspected. With targeted suspected (bloody diarrhea more than a week or two), the doctor will usually order blood tests and a short colonoscopy that the diagnosis often within a week is round.

• Anamnesis

First, the doctor will ask supplementary try to get a better picture of the complaints. These are questions about the nature and duration of abdominal pain and diarrhea, possibly weight loss, disorders of the anus and symptoms of skin, joints and eyes. It is also usually asked to avoid these problems in the area or with relatives.

• Physical examination

Although often no abnormalities are found, the physical examination remains important. The weight, the overall impression and the examination of the eyes, joints, skin and in particular of the stomach and the anus are important for diagnosis and treatment. In addition, in view of fistulas or other abnormalities around the anus.

• Laboratory research

First of all, the blood is examined. Blood tests usually consists of see if there is anemia (hemoglobin levels or Hb), of inflammation (blood sedimentation or BSE) or of poor nutritional status (albumin content). An additional resource in the diagnosis is to determine p-ANCA (perinuclear antineutrophil cytoplasmatic antibodies) antibodies and antibodies against b. and Brewer's yeast (so called anti-Saccharomyces cerevisiae antibodies, or ASCA). More than half of patients have this p-ANCA antibodies. Positive p-ANCA antibodies in combination with negative ASCA antibodies, is suggestive for ulcerative colitis. If vice versa (negative p-ANCA and positive ASCA), this can fit in Crohn's disease. No deviations to the blood test shows, then IBD less likely, but not impossible. The stool is usually examined to rule out other causes of the symptoms. That could, for example, an infection with bacteria, parasites or worms. Sometimes asked to spare for some days on the stool to investigate whether the fat content herein is increased. That may be a sign of impaired fat absorption.

• Endoscopy

Endoscopy is usually the research that is diagnosed or rejected. With the aid of a flexible endoscope, a thin and flexible hose, the interior of the large intestine and a part of the small intestine can be visualized. In this way, or can be made visible, and where there is an inflammation. It can be removed for examination under the microscope with tweezers small pieces of tissue (biopsies). The endoscopic image of the intestine, combined with microscopic examination of the biopsies taken together supply the diagnosis. Before a endoscopy can take place, the intestine must first be emptied as much as possible. For example, an optimal search can take place of the inside of the intestinal wall. This unloading is done at a full colonoscopy is usually the day before the study. The patient drinks a laxeervloeistof and that day may continue to use only liquid food. Just before the investigation is still frequently administered an enema. Through the anus is hereby introduced a fluid to remove the remaining feces. In a "short colonoscopy" this is often all that is needed.

X-ray, ultrasound and CT scans as discussed below are only exceptionally necessary or helpful in the diagnosis of ulcerative colitis.

• Radiological studies

This is mainly carried out for the exploration of the small intestine. Usually by a thin probe, through one nostril, contrast dye placed in the small intestine. Then pictures. In this way can be investigated if there is inflammation or a narrowing (stenosis) is in the small intestine and if there are connections between intestine and other organs exist (fistulas). Again, the intestine must be emptied as well as possible. Also a photo of the colon can be made. This is called a ' X-Colon '. It is bariumpap with a small probe placed in the large intestine through the anus. X-rays are then made.

• Ultrasound

Ultrasound is sometimes used in IBD to see if the intestinal wall is thickened, and if there is an inflammation outside of the intestine. After the skin is smeared with a conductive gel ultrasound, the doctor goes to a device over the abdomen. This device emits sound waves that are reflected back, hence the name 'echo'. This echo is collected and converted into an image on the echograph.

• CT-scan

A CT scan is mainly made to examine whether there is an abscess (pus in a cavity), is in the abdomen. The day before the examination the patient drink contrast. On the day the patient is in the supine position pushed by an X-ray machine. The diagnostic radiographer makes pictures of the stomach in which the internal organs can be studied in detail.

Ulcerative colitis treatment

Medications
It will often be started with a treatment medicine after the diagnosis. These drugs have on the one hand to inhibit the inflammation. On the other hand they suppress the formation of new infections. In addition, drugs are often prescribed in order to prevent diarrhea and anemia. An IBD patient must therefore generally long-term treatment with drugs and prolonged supervised by a specialist. The treatment of IBD is called symptomatic, aimed at inhibition of the ignition. This means that the treatment suppresses the signs and symptoms, but the disease itself does not heal. Approximately 80% of IBD patients are placed prolonged use of medications.

In addition to beneficial effects, in some cases, side effects can also occur. This is one of the reasons why, for long-term use of drugs often the blood is monitored. The choice of medication is dependent upon the severity of the inflammation and of the place. For example, there are drugs that act mainly in the small intestine. Other works precisely in the last part of the colon.

Medications may be administered in different ways: through the mouth, through a blood vessel or through the anus with a suppository or an enema. In addition, there are drugs that act at a particular site in the body and others who work in the whole body. The route of administration of a drug is dependent on the location of the inflammation is located.

The main drugs are:

• Salazopyrine: The oldest known cure for IBD, inflammatory, tablet form.
• 5-ASA formulations: The active ingredient of Salazopyrine, inflammatory, tablet or enema. If the patient is not allergic, it can be given in the long run, and thus falls under the "maintenance drug". There are few side effects;
• Corticosteroids:

1. Prednisone: This drug is more potent than 5-ASA preparations, but because of the side effects when used alone is not sufficient or not responded to another drug. There are a number of years also locally acting corticosteroid such as budesonide. These are characterized by an equally strong efficacy and would have less side-effects. There are several undesirable effects in use of prednisone, which are present to a lesser degree of Budesonide. In the long term, osteoporosis is a known side effect, which is countered with extra calcium.

• Azathioprine: Will be used alongside prednisone to reduce side effects. It takes an average of 2 to 3 months to give the therapy outcome. Tablet or intravenously (in the vein).
• Methotrexate: Does the immune system.
• Infliximab (anti-TNF): One of the newer funds registered for the treatment of severe, active Crohn's disease and moderate to severely active ulcerative colitis in patients who have not responded adequately to conventional therapy including corticosteroids and 6-MP or AZA, or which such therapies are intolerant to or have medical contraindications for such therapies. Also known as Remicade. To be administered by infusion. Affects the immune system. Very expensive (tens of thousands of euros per year).
• Interleukin-10: Experimental agent.

Operation
In some cases it is necessary to carry out an intestinal operation. This may for instance be the case of a severe narrowing of the intestine or when it does not respond to medication. The approach to the Crohn's disease and ulcerative colitis is hereby clearly different. In ulcerative colitis, one will, in general, take away the whole large intestine and then to make a connection between the small intestine and the anus. Nowadays, in ulcerative colitis often chosen for the construction of a so-called "pouch". This creates a reservoir of small intestine which ensures that the stool can be collected again temporarily. In Crohn's disease, one operates as sparingly as possible. If there is an operation, one often takes the last part of the small intestine and the beginning of the large intestine road. One can also remove a narrowing (stenosis), carry out a fistula surgery or an incision abscess. In some people with Crohn's disease or ulcerative colitis is sometimes necessary to apply a temporary or permanent artificial intestine exit: a stoma.

The course
A problem with ulcerative colitis is the uncertainty about the future course. Sometimes the inflammation is restricted to a small part of the intestine. In other cases, the ignition covers a much larger portion of the intestine. There are major differences in severity and nature of the complaints and the outcome of treatment. Most patients after treatment can lead a normal life. They have relatively few complaints. The quality of their life is comparable to that of people without IBD. However, a number of patients with IBD has a very hard to control inflammation. This requires extensive drug therapy. Sometimes hospitalization is necessary and surgery. Also, most patients should be regularly checked by a specialist. This is a general internist, a gastroenterologist, a pediatrician and / or a surgeon. Especially when drug use is regulated blood tests. In patients who do not respond well to treatment is sometimes needed again an endoscopic examination.

• Pregnancy

In general, women with IBD as much chance of a normal pregnancy as women without IBD. The course of the disease during pregnancy is sometimes better, sometimes worse. but usually equals the course without pregnancy. Most drugs can be used without problems. When in doubt, it is however advisable to consult with your doctor. The accompaniment of the pregnancy, which will be especially given the growth of the child is usually done by a gynecologist.

• Complications

Most people with chronic bowel disease respond favorably to treatment. If not reduce the discomfort after treatment, or even worsen, or if the ignition spreads outside the intestinal tract which is considered as a complication of IBD. Complications are seen at around 10 to 20% of the patients. Extension of the disease outside the colon relates mainly to inflammations of the joints, skin, eyes, and the liver. Flare joint pain often runs parallel with a revival of intestinal inflammation.

• Malignant degeneration

This is one of the most common, but often unspoken anxiety of the patient. With long-term and extensive inflammation of the colon is an increased risk of developing colon cancer light. This is the reason why after approximately ten years, often a so-called "screening colonoscopy 'is performed. Then many pieces of tissue are removed for examination under the microscope. It has become clear that the chances of getting cancer is much smaller than had been assumed in IBD patients.