Ulcerative colitis: Symptoms, Treatment
Overview
Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that leads to long-lasting inflammation and sores called ulcers on the inner lining of the large intestine. Symptoms of this condition usually develop gradually and can become worse over time.
Many people with ulcerative colitis may have periods of remission. That means they may have times when no symptoms occur. Treatment for ulcerative colitis can significantly reduce symptoms and help keep patients in long-term remission though no cure is currently available.
In the United States, ulcerative colitis affects about 1 million people. And the prevalence rate is 35 to 100 cases per 100,000 people.
Symptoms
Due to the difference in the severity and the location of ulcerative colitis, symptoms can vary. They usually involve:
- Diarrhea, often with blood or pus
- Abdominal pain and cramping
- Rectal pain
- Rectal bleeding — passing a small amount of blood with stool
- Urgency to defecate
- Inability to defecate despite urgency
- Weight loss
- Fatigue
- Fever
- Failure to grow in children
In addition to these, people with ulcerative colitis may have less common symptoms such as:
- Joint pain or soreness
- Eye irritation
- Certain rashes
In most cases, people suffering from this condition have mild to moderate symptoms.
Types
According to its location, ulcerative colitis can be divided into the following types:
- Ulcerative proctitis
In this condition, inflammation is confined to the area closest to the anus. It tends to be the mildest type. People with it may only have rectal bleeding.
- Proctosigmoiditis
Proctosigmoiditis affects the rectum and the lower end of the colon, causing bloody diarrhea, abdominal cramps and pain, and an inability to move the bowels.
- Left-sided colitis
Inflammation extending from the rectum up through the sigmoid and descending colon is called left-sided colitis. Bloody diarrhea, abdominal cramping and pain on the left as well as unintended weight loss are common symptoms.
- Pancolitis
Pancolitis refers to the condition in which the entire colon is affected. Bouts of bloody diarrhea, abdominal cramps and pain, fatigue and significant weight loss may occur.
- Acute severe ulcerative colitis
Acute severe ulcerative colitis is a rare type. Similar to pancolitis, it affects the entire colon. It may result in severe pain, profuse diarrhea, bleeding, fever, and inability to eat.
Causes
The exact cause of ulcerative colitis hasn’t been identified. But it is believed that three factors may play a role in the development of this condition, including:
- Immune system malfunction
The immune system normally functions to protect you from viruses or bacteria. However, viruses or bacteria sometimes may cause your immune system to mistakenly attack the inner lining of the large intestine. This abnormal response leads to inflammation.
- Genes
It seems that ulcerative colitis is more common in people with a family history of this condition. But more studies are needed to figure out the link between genes and ulcerative colitis.
- Environment
According to some studies, environmental factors may increase the risk of ulcerative colitis, including medications such as anti-inflammatory drugs, antibiotics, a high-fat diet, certain foods, and stress.
Risk factors
Some risk factors may make you more likely to have ulcerative colitis. They may include:
- Age
People who are between 15 and 30 or older than 60 have a higher risk.
- Race
People of Jewish descent are more likely to develop ulcerative colitis.
- Family history
People who have a family member with IBD are at higher risk.
Complications
Possible complications that may be caused by ulcerative colitis involve:
- Severe bleeding
- A hole in the colon (perforated colon)
- Severe dehydration
- Liver disease (rare)
- Bone loss (osteoporosis)
- Inflammation of your skin, joints, and eyes
- An increased risk of colon cancer
- A rapidly swelling colon (toxic megacolon)
- Increased risk of blood clots in veins and arteries
Diagnosis
Your doctor may order one or more of the following tests and procedures to diagnose ulcerative colitis:
- Blood tests
- Stool sample
- Colonoscopy
- Flexible sigmoidoscopy
- X-ray
- CT scan
- Computerized tomography (CT) enterography and magnetic resonance (MR) enterography
Treatment
Doctors usually treat ulcerative colitis with medications and surgery.
Medications that will be used include anti-inflammatory drugs, immune system suppressors and other medications.
Anti-inflammatory drugs
These drugs are often first used to treat the condition. They include:
- 5-aminosalicylates, including sulfasalazine (Azulfidine), mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum).
- Corticosteroids, including prednisone and hydrocortisone.
Immune system suppressors
By suppressing the immune system response that contributes to the inflammation, immune system suppressors can reduce inflammation. In order to receive a better effect, sometimes a combination of these drugs will be used.
Drugs include:
- Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan)
- Cyclosporine (Gengraf, Neoral, Sandimmune)
- Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi)
- Vedolizumab (Entyvio)
Other medications
Other medications may be necessary to manage your symptoms. Your doctor may recommend:
- Antibiotics
- Anti-diarrheal medications
- Pain relievers
- Iron supplements
Surgery
Having surgery to remove your entire colon and rectum can often eliminate ulcerative colitis. It usually involves a procedure called ileal pouch anal anastomosis, in which a pouch is attached directly to your anus to enable you to expel waste relatively normally. However, this procedure may be not available sometimes. And you have to wear a bag to collect stool.
Home remedy
Aug 12， 2019
Researchers at UConn Health and Texas A&M University found in a mice model that eating walnuts shows protection against ulcerative colitis.
Walnuts contain a complex array of natural compounds and phytochemicals, they provide a multitude of health benefits. In this study, researchers have noticed adding walnuts into diet help the process of reparing of colonic mucosa.
In the study, walnuts account for 14% of the daily diet in mice, which is equivalent of 20-25 walnuts for a human.
Keyword: ulcerative colitis.
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