Ulcerative colitis is one of the chronic inflammatory bowel diseases characterized by inflammation of the colon. Characteristic are frequent, often bloody diarrhea and cramping pain on the left side of the abdomen. Ulcerative colitis occurs in flares and can cause symptoms that necessitate a hospital stay.
Causes and risk factors
Ulcerative colitis is caused by inflammation of the intestinal mucosa, in contrast to Crohn's disease, in which the entire intestinal wall becomes inflamed. As with Crohn's disease, it is still not known what exactly causes the inflammation. The scientists assume the interaction of genetic predisposition and environmental factors. They have discovered more than 30 risk genes that are different in ulcerative colitis patients. This seems to lead to a malfunction of the immune system in the intestinal cells and possibly to an overreaction of the body's own immune system.
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| Ulcerative colitis |
Like Crohn's disease, ulcerative colitis is more common in countries with high standards of hygiene, especially during childhood, than in poorer parts of the world. The researchers do not yet know the reasons for this. At least it seems clear that an "incorrect" diet with, for example, refined sugar does not play a major role in the onset of the disease. Scientists are still researching what part the psyche plays. It is also not considered certain that bacteria or viruses can trigger chronic inflammatory bowel disease.
Risk factors
Risk factors are hardly known. Although there is an accumulation of chronic inflammatory bowel diseases in certain families, only a quarter of the carriers of the risk genes develop the disease. Even smoking, which is known to trigger relapses in Crohn's disease, has a protective effect in ulcerative colitis.
Ulcerative Colitis Symptoms
Do you have cramping pains on the left side of your abdomen?
Do you suffer from severe diarrhea with blood and mucus at the same time?
These symptoms are typical of ulcerative colitis. The disease often begins with diarrhea a few times a day and mild pain. There is also the feeling that the bowel is never completely empty. As the inflammation spreads, the pain increases and the number of bowel movements increases, both during the day and at night. Blood is often found in the stool.
Ulcerative colitis is the most common chronic inflammatory bowel disease alongside Crohn's disease. While Crohn's disease can affect all parts of the gastrointestinal tract, ulcerative colitis only affects the large intestine (colon). The disease usually begins in the final section, the rectum. From there it can continue to spread and migrate upwards. Only the intestinal mucosa becomes inflamed.
Common symptoms of ulcerative colitis are:
- Liquid to thin diarrhea with blood, pus and mucus up to 40 times in 24 hours
- Frequent nocturnal bowel movements and constant urge to defecate (tenesmus)
- Cramping pains, often on the left side of the abdomen
- Flatulence, possibly associated with fecal incontinence
- Ulcers (ulcerations)
- Weight loss and deficiencies in electrolytes, iron and vitamins
- Tiredness and exhaustion, fever and feeling sick
When doctors speak of proctitis, ulcerative colitis is limited to the rectum. In proctosigmoiditis, the inflammation has spread to the sigmoid, a higher part of the intestine. Left-sided colitis refers to an attack on the left curvature of the large intestine, and experts speak of pancolitis for the entire large intestine.
Children and young people
Many sufferers have symptoms before the age of 20, even infants can develop ulcerative colitis. In children and adolescents, the entire colon is usually inflamed. Ulcerative colitis often manifests itself there in growth disorders.
Ulcerative Colitis Treatment
If ulcerative colitis is suspected, gastroenterologists are the right specialists. These gastrointestinal specialists carry out various examinations. To diagnose ulcerative colitis, other diseases must be ruled out. These include other chronic inflammatory diseases such as Crohn's disease. If it is not possible to clarify exactly whether Crohn's disease or ulcerative colitis is present, doctors speak of indeterminate colitis or an unclassified inflammatory bowel disease (IBDU). Gastroenterologists must also rule out bacterial or viral intestinal inflammation or food intolerance or food allergies, as well as irritable bowel syndrome.
- Questioning and physical examination: First, the specialist asks the person concerned about their symptoms and family history of the disease. In a physical examination, he feels the abdomen and inspects the anus.
- Blood tests: signs of inflammation in the blood count (increase in C-reactive protein, blood sedimentation rate, number of white blood cells) and other values that indicate anemia, lack of nutrients such as folic acid, vitamin D and B12.
- Stool examination: To rule out bacterial or viral infections.
- Ultrasound: Shows which parts of the intestine are affected and also complications such as toxic megacolon.
- Endoscopies: Colonoscopy (colonoscopy) shows whether the intestinal mucosa is swollen and reddened, whether bleeding and ulcers are present and is often repeated to monitor therapy or to prevent colon cancer; The small intestine can also be examined by means of capsule endoscopy (camera capsule that can be swallowed) in order to rule out Crohn's disease.
- X-ray: Used to confirm or rule out a suspicion of toxic megacolon.
- Biopsy: Tissue samples show the extent to which the intestinal mucosa is inflamed.
- Food allergy and intolerance tests: to rule out allergies and intolerances that cause symptoms on the one hand and to ensure that these do not aggravate the symptoms.
The treatment a gastroenterologist recommends for people with ulcerative colitis depends on factors such as the symptoms, their severity and how the inflammation is spreading. Since ulcerative colitis cannot be cured, the treatment for an acute flare-up aims to relieve the symptoms and slow down the inflammatory process. In the long term, the treatment should avoid complications and delay operations. Doctors distinguish between the treatment of an acute flare-up and therapy to reduce the flare-ups, known as maintenance of remission.
Drug treatment for an acute attack
The use of drugs to treat ulcerative colitis depends on the severity of the flare-up. Doctors often follow a step-by-step plan. First, sufferers are given aminosalicylates as anti-inflammatory agents locally (topically) as foams and enemas. In addition, these active ingredients can also be administered orally in tablet form. If those affected do not respond to the treatment, glucocorticoids are the next step – also first locally. In the case of a severe attack, also known as a fulminant attack, immunosuppressants and biologicals are used in addition to glucocorticoids. If an attack lasts for a long time (chronic-active course), those affected have to take immunosuppressants over a longer period of time.
The means in detail:
- Aminosalicylates: Anti-inflammatory drugs such as 5-aminosalicylic acid (5-ASA) mesalazine are the cornerstone of any colitis therapy. The active substance is first administered rectally as a so-called topical therapy with suppositories, foams and/or enemas. If the inflammation also affects higher sections of the colon, those affected are given tablets or both in combination.
- Glucocorticoids: If there is no improvement with mesalazine, the next treatment step is called glucocorticoid preparation Budesonide rectally as capsules or foam. If the symptoms do not improve, glucocorticoids (e.g. prednisone) can be taken systemically, i.e. as tablets orally, or intravenously in the case of severe flare-ups.
- Immunosuppressants: If glucocorticoids do not work or if the person concerned cannot tolerate these drugs, immunosuppressants such as azathioprine or ciclosporin A can help. However, these active ingredients increase the risk of other infections.
- Biologicals (e.g. TNF-alpha blockers): If glucocorticoids do not help, e.g. in the case of an acute attack with high inflammatory activity, the doctor can administer TNF blockers. In Switzerland, infliximab, adalimumab and certolizumab are approved.
- Antibiotics: If additional bacteria were found during the stool examination, these are combated with antibiotics.
- Antidiarrheal drugs (antidiarrheals): Drugs such as loperamide relieve diarrhea, but do not inhibit inflammation. However, they can be suitable for reducing the urge to defecate on the go in those affected, such as commuters.
- Painkillers: Certain painkillers, such as diclofenac or other nonsteroidal anti-inflammatory drugs (NSAIDs), can trigger an flare-up. Paracetamol or metamizol are considered harmless.
- Proton pump inhibitors (PPI): If systemic glucocorticoid preparations are taken for a long time, doctors recommend that you also take proton pump inhibitors, which reduce the production of gastric acid and prevent stomach burning and pain.
Surgery
Surgery may be necessary when ulcerative colitis becomes uncontrolled with medication. Persistent bleeding, a toxic megacolon (see "course, complications, special features"), colon cancer precursors and colon cancer often make an operation unavoidable. The entire large intestine of the affected person is removed (proctocolectomy) and a kind of replacement large intestine is formed from a piece of small intestine and connected to the anus (ileoanal pouch system).
Nutrition
Scientists are still unable to say to what extent diet triggers a flare-up of colitis. There is also no special diet recommendation. Many sufferers suffer from a lack of electrolytes, iron and vitamins due to loss of appetite and diarrhea, which can be compensated for with dietary supplements in tablet form. If those affected are underweight, nutritional advice is recommended to clarify which foods are digestible for them and which are not. For example, a diet with a lot of roughage such as whole grain products or legumes tends to increase the symptoms because they stimulate bowel movements.
Other therapies
Those affected with chronic diseases such as ulcerative colitis are often mentally stressed. In addition to the acute symptoms, waiting for the next flare-up can also lead to severe psychological strain. Some of those affected withdraw from their social environment, get depressive moods or suffer from anxiety. Patient organizations such as the Swiss Crohn's Disease / Ulcerative Colitis Association (SMCCV) offer good opportunities to exchange ideas with other sufferers and to obtain information. In addition, it can be helpful for those affected to seek psychological help in order to be better able to cope with the disease in everyday life.