Ulcerative colitis - Wikipedia. Ulcerative colitis (UC) is a long- term condition that results in inflammation and ulcers of the colon and rectum. Weight loss, fever, and anemia may also occur.
Often symptoms come on slowly and can range from mild to severe. Symptoms typically occur intermittently with periods of no symptoms between flares. It is a kind of inflammatory bowel disease (IBD) along with Crohn's disease and microscopic colitis. Just Diagnosed with Left-Side Colitis and. Several medications are used to treat symptoms and bring about and maintain remission, including aminosalicylates such as sulfasalazine, steroids, immunosuppressants such as azathioprine, and biological therapy. Removal of the colon by surgery may be necessary if the disease is severe, does not respond to treatment, or if complications such as colon cancer develop. Patients usually present with diarrhea mixed with blood and mucus, of gradual onset that persists for an extended period (weeks). They may also have weight loss and blood on rectal examination. The inflammation caused by the disease along with the chronic bleeding from the GI tract leads to increased rates of anemia. The disease may be accompanied by different degrees of abdominal pain, from mild discomfort to painful bowel movements or painful abdominal cramping with bowel movements. Ulcerative colitis is associated with a general inflammatory process that can affect many parts of the body. Sometimes these associated extra- intestinal symptoms are the initial signs of the disease, such as painful arthritic knees in teenagers, which also may be seen in adults. A diagnosis of ulcerative colitis may not occur until the onset of intestinal manifestations, however. Extent of involvement. Mine progressed from Ulcerative Proctitis to Left sided colitis. Ulcerative colitis is classified according to how much of your colon is affected. (ulcerative proctitis). The Mayo Clinic Diet Online. The disease is classified by the extent of involvement, depending on how far the disease extends: Distal colitis, potentially treatable with enemas. Colectomy specimen. In addition to the extent of involvement, people may also be characterized by the severity of their disease. Mild abdominal pain or cramping may occur. Patients may believe they are constipated when in fact they are experiencing tenesmus, which is a constant feeling of the need to empty the bowel accompanied by involuntary straining efforts, pain, and cramping with little or no fecal output. Rectal pain is uncommon. Moderate disease correlates with more than four stools daily, but with minimal signs of toxicity. Patients may display anemia (not requiring transfusions), moderate abdominal pain, and low grade fever, 3. Patients in this category may have inflammation extending beyond just the mucosal layer, causing impaired colonic motility and leading to toxic megacolon. If the serous membrane is involved, a colonic perforation may ensue. Unless treated, the fulminant disease will soon lead to death. As ulcerative colitis is believed to have a systemic (i. The frequency of such extraintestinal manifestations has been reported as anywhere between 6 and 4. For example, chromosome band 1p. Other potential regions involve cell scaffolding proteins such as the MAGUK family. There may even be human leukocyte antigen associations at work. In fact, this linkage on chromosome 6 may be the most convincing and consistent of the genetic candidates. Physicians should be on high alert for porphyrias in families with autoimmune disorders and care must be taken with the use of potential porphyrinogenic drugs, including sulfasalazine. Environmental factors. They include the following: Diet: as the colon is exposed to many dietary substances which may encourage inflammation, dietary factors have been hypothesized to play a role in the pathogenesis of both ulcerative colitis and Crohn's disease. Few studies have investigated such an association; one study showed no association of refined sugar on the prevalence of ulcerative colitis. The theory of sulfur as an etiological factor is related to the gut microbiota and mucosal sulfide detoxification in addition to the diet. One Italian study showed a potential protective effect. Surgical removal of the large intestine often cures the disease. An alternative theory suggests that the symptoms of the disease may be caused by toxic effects of the hydrogen sulfide on the cells lining the intestine. Human colonic mucosa is maintained by the colonic epithelial barrier and immune cells in the lamina propria (see intestinal mucosal barrier). N- butyrate, a short- chain fatty acid, gets oxidized through the beta oxidation pathway into carbon dioxide and ketone bodies. It has been shown that N- butyrate helps supply nutrients to this epithelial barrier. Studies have proposed that hydrogen sulfide plays a role in impairing this beta- oxidation pathway by interrupting the short chain acetyl- Co. A dehydrogenase, an enzyme within the pathway. Ulcerative colitis symptoms can include: Abdominal pain/discomfort. Symptoms include bloody diarrhea, pain in the lower left side of the abdomen.Furthermore, it has been suggested that the protective benefit of smoking in ulcerative colitis is due to the hydrogen cyanide from cigarette smoke reacting with hydrogen sulfide to produce the non- toxic isothiocyanate, thereby inhibiting sulfides from interrupting the pathway. The severity of disease at clinical presentation is important in determining the appropriate therapy. Patients with mildly active disease will have fewer than 4 bowel movements daily and no signs of toxicity. Individuals with moderate- severity UC have more frequent bowel movements with bleeding. Approximately 7. 0% of patients with ulcerative colitis will have moderately active disease at presentation. Patients with severely active disease will have signs of toxicity with fever, tachycardia, and anemia. Patients with fulminant or toxic colitis or toxic megacolon often have more than 1. These people most often require immediate colectomy because 1. Diagnosis. Full colonoscopy to the cecum and entry into the terminal ileum is attempted only if the diagnosis of UC is unclear. Otherwise, a flexible sigmoidoscopy is sufficient to support the diagnosis. The physician may elect to limit the extent of the exam if severe colitis is encountered to minimize the risk of perforation of the colon. Endoscopic findings in ulcerative colitis include the following: Loss of the vascular appearance of the colon. Erythema (or redness of the mucosa) and friability of the mucosa. Superficial ulceration, which may be confluent, and. Pseudopolyps. Ulcerative colitis is usually continuous from the rectum, with the rectum almost universally being involved. Perianal disease is rare. The degree of involvement endoscopically ranges from proctitis or inflammation of the rectum, to left sided colitis, to pancolitis, which is inflammation involving the ascending colon. Histologic. Microbiological samples are typically taken at the time of endoscopy. The pathology in ulcerative colitis typically involves distortion of crypt architecture, inflammation of crypts (cryptitis), frank crypt abscesses, and hemorrhage or inflammatory cells in the lamina propria. In cases where the clinical picture is unclear, the histomorphologic analysis often plays a pivotal role in determining the diagnosis and thus the management. By contrast, a biopsy analysis may be indeterminate, and thus the clinical progression of the disease must inform its treatment. Differential diagnosis. The image shows confluent superficial ulceration and loss of mucosal architecture. Crohn's disease may be similar in appearance, a fact that can make diagnosing UC a challenge. The following conditions may present in a similar manner as ulcerative colitis, and should be excluded: The most common disease that mimics the symptoms of ulcerative colitis is Crohn's disease, as both are inflammatory bowel diseases that can affect the colon with similar symptoms. It is important to differentiate these diseases since their courses and treatments may differ. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis. Management. The goal is to induce remission initially with medications, followed by the administration of maintenance medications to prevent a relapse. The concept of induction of remission and maintenance of remission is very important. The medications used to induce and maintain a remission somewhat overlap, but the treatments are different. Physicians first direct treatment to inducing remission, which involves relief of symptoms and mucosal healing of the colon's lining, and then longer term treatment to maintain remission and prevent complications. Acute severe ulcerative colitis requires hospitalisation, exclusion of infections, and corticosteroids. Corticosteroids such as prednisone can also be used due to their immunosuppressive and short- term healing properties, but because their risks outweigh their benefits, they are not used long- term in treatment. Immunosuppressive medications such as azathioprine and biological agents such as infliximab and adalimumab are given only if people cannot achieve remission with 5- ASA and corticosteroids. Such treatments are used less commonly due to their possible risk factors, including but not limited to increased risk of cancers in teenagers and adults. A formulation of budesonide was approved by the FDA for treatment of active ulcerative colitis in January 2. Thus, the drug may locally decrease histamine secretion by involved gastrointestinal mast cells and alleviate the inflammation. Aminosalicylates. Tofacitinib, vedolizumab, and etrolizumab can also produce good clinical remission and response rates in UC. For this reason, patients on these treatments are closely monitored and are often given tests for hepatitis and tuberculosis at least once a year. Nicotine. Another randomized, double- blind, placebo- controlled, single- center clinical trial conducted in the United States showed that 3. The form in which treatment is administered depends both on the severity of the anemia and on the guidelines that are followed.
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