Ulcerative colitis is a disease that causes abdominal pain, diarrhea and bloody diarrhea in patients after the development of inflammation that holds the inner surface of the large bowel. .It has approximately equally frequency in men and women. Although it is usually 30-40 years old, it can also be seen in early and late ages.
There is another disease commonly common with ulcerative colitis: Crohn disease. These two diseases can be frequently confused clinically and laboratoryly. The biggest differentiator point is that Crohn disease can hold the entire gastrointestinal tract from the esophagus to the anus. Ulcerative colitis, on the other hand, only holds the large bowel, starts at the near end of the large bowel (rectum) and heads towards its beginning. Treatment is basically medical. Surgery is unthinkable without obligation.
Ulcerative ColitisThe reason for today is not clearly known. No infection agents have been clearly identified. It is not contagious.
In the formation of the disease, the immune system (our body’s defense system) occurs as a result of exaggerated and chronic activation. In other words, our defense system attacks our own bowel tissue as if it were a foreign tissue. This lack of control in the defense system can occur over time and can be seen with other similar autoimmune diseases. There is a genetic base in susceptibility to the disease. For this reason, inflammatory bowel disease is more common in relatives of patients.
The complaints and symptoms you may see in the patients are:
- Bloody diarrhea,
- Abdominal pain,
- Emergency flushing,
- Tenesmus -a feeling of whining and contraction in the anus,
- Abdominal distention,
- Gas and bloating,
- Fever, sweating, slimming in severe cases,
- Joint pains,
- Sacroiliitis -low back pain,
- Weakness, fatigue – iron deficiency anemia
Complications are generally seen in 10% of patients.
Toxic mega-colon;
It can progress during the periods of acute fire. With the severity of inflammation, the bowel expands and the wall thins. The patient may have fever, extreme exhaustion, anemia, and shock. If there is no quick recovery with intravenous drugs, surgery should be performed before it can be late.
Is the risk of cancer increased in ulcerative colitis?
If the left side of bowel is kept after 10-15 years, or if the entire bowel is kept after 8 years, the risk of cancer increases 10-20 times. Therefore, after these period, the bowels should be tested annually by colonoscope, and if precancerous changes are detected, they should be operated without waiting.
Arthritis:
It will occur in joint inflammation, lower back pain, sacroiliac joint involvement.
Erythema nodosum:
There may be small red swellings that are painful on the front of the leg more.
Uveitis, episcleritis:
There may be painful and red eye lesions. It can cause permanent damage to vision.
Primary sclerosant cholangitis:
It is a condition that can cause problems leading up to liver transplantation, which can be caused by puckering and narrowing of the bile ducts in patients, disrupting the flow of bile to the liver in the advanced period.
Laboratory tests
Diagnosis of the disease should be considered primarily in people with abdominal pain and bloody diarrhea.
Stool tests
Examination is necessary for some bacterias and ameba (parasites) Because some bacterias such as shigella and parasites such as entemoba histolytic share similarities with ulserative colitis. In mild cases and cases of simple diarrhea, fecal calprotectin can be useful in separating from irritable bowel syndrome.
Blood tests
Anemia and elevated white blood cell count can be seen by full blood count test. The elevation of CRP and sedimentation indicates that the disease is in the active rotation. Anemia (hemoglobin miscaemia-anemia) is caused by bleeding. The elevation of the white sphere and sedimentation reflects the severity of the fire (inflammation-inflammation) event. p-ANCA serological testing may be useful in separating of the diagnosis with crohn disease. If they are p-ANCA positive, both ASCA Ig G and ASCA Ig A negative, this supports ulcerative colitis in the patient.
Radiological findings
Bowel x-graphs with bariumare bowel films taken by giving metic fluid (barium) from the anus to the bowels. It can indicate the area of involvement and ulcers. However, it is less valuable than this can be, because it has not the process of taking parts for microscopic diagnosis.
Endoscopic findings
Colonoscopy: The main diagnosis is the examination of the bowel surface by colonoscopy and pathologically (examination under the microscope) after biopsy. With the colonoscope, the length of the area with involvement will also be understood.
Other diseases that make villous atrophy in small intestine biopsy
- Tropical sprue
- Collagenous sprue (refractory state, 50% respond to steroids)
- Autoimmune enteropathy
- AIDS enteropathy
- Acute malnutrition
- Food protein hypersensitivity
- Whipple disease
- Crohn disease
- Hypogamaglobulinemia
- Abetalipoproteinemia
- Intestinal lymphoma
- Intestinal tuberculosis
- Excessive proliferation of bacteria in the small intestine
- Small bowel ischemia
- Eosinophilic gastroenteritis
- Infectious enteritis
- Giardiasis
- Parasitic infestation
- Graft-versus-host disease
- Drug-dependent enteropathy (e.g. olmesartan)
- Allergic enterocolitis (allergic to milk protein, soy and rice allergy)
- Other causes of nutritional deficiency
- Lactose intolerance
- Fructose intolerance
- Tropical sprue
- Pancreatic insufficiency
- Crohn disease
- Pernicious anemia
- Infectious gastroenteritis
- Microscopic colitis
General Recommendations
In order to properly attitude and protect the bowel flora, foods with pro-biotic and prebiotic content and products such as yogurt can be used in patients. Those who can’t tolerable the yogurt can take it in pill and powder to add to other foods.
Aspirin derivatives and other NSAII painkillers may inflame ulcerative colitis disease.
I don’t recommend fizzy drinks and alcohol in my own patients.
Drug Treatment of Ulcerative Colitis
Our goals in drug treatment are:
- Soothing the disease (providing remission)
- Maintaining a state of well-being – maintenance treatment
- Keeping side effects of drugs under control
- To improve the quality of life.
Drug groups used in treatment
anti-inflammatory drugs
- 5-ASA preparates
- Asacol – eudragit-s coated agent.
- pentasa
- salofalk
- salozopyrin EN-tab
- Steroids– enema or oral
Immune modular drugs
- Azothiopurin
- 6- mercaptopurin
- Cyclosporin
- Methotrexate
Biological agents
- infiliximab
- adalilumab
- vedoluzimab
These drugs are usually used in the form of subcutaneous or intravenous injections.
Surgical treatment of ulcerative colitis
Surgical treatment should not be performed without compulsive. Surgical indication arises in these cases:
- Active colitis patients who do not respond to medical treatment
- Progress of colon cancer
- Toxic mega-colon that did not respond to treatment
- Presence of chronic ameba infestation that does not respond to treatment
Are ulcerative colitis patients stranded in conceptive pregnancy?
Ulcerative colitis is considered to be due to the activity of the course at the time of pregnancy. If activation occurs when pregnancy occurs, the disease will continue actively. If the disease is in remission, it will continue to be calm throughout pregnancy. Therefore, if the pregnancy is planned, it would be appropriate to try to ensure that the disease is in remission during the period of pregnancy.
Ulcerative colitis and medications used in pregnancy
Many of the ulcerative colitis drugs can be used safely during pregnancy and lactation. Medications that can be used safely or continue to be used:
- metronidazol – Category B
- 5-ASA preparations – Asacol is not recommended due to the additive in it but there is no problem with other drugs with the same content
- azathioprin
- Cyclosporine
- biological agents – some drugs should pay attention to the postpartum below.
- corticosteroids- It is recommended to use without exceeding a certain dose, if possible, after 12 weeks
Insecure:
- Methotrexate
- rifaximin
You can read the detailed description of drug treatment in pregnant patients with ulcerative colitis, pregnancy planners and lactating in our article “Use of ulcerative colitis drugs pregnancy and lactation “.