The life expectancy of patients with ulcerative is usually the same as the general population. Ulcerative colitis (UC) is a lifelong disease with periods of flare-ups and remissions. The longer the periods of remission, the better will be the general condition of the patient and the lower will be the risk of complications. About 10% of patients improve after one attack, and the rest may have multiple flares throughout life. Appropriate treatment, diet, and lifestyle modifications are necessary to prevent complications some of which could be life-threatening. The doctor would advise a treatment plan even during the periods of remission. Regular screening with colonoscopy is required, the frequency of which would be planned by the doctor. It may be done once every 1-3 years.
What are the causes of ulcerative colitis?
Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) affecting the inner lining of the large intestine (large bowel) leading to erosion and ulcers. It is a lifelong illness with no specific cause or cure. Patients have repeated cycles of flare-ups and remission with potential manifestations beyond the gut (extraintestinal manifestations). There is a profound emotional and social impact on the affected patients.
What are the causes of ulcerative colitis?
The exact cause of ulcerative colitis (UC) is unknown, and the possible causes are as follows:
- Immune reactions
- The body’s immune system attacks the inner lining of the large intestine (an autoimmune disorder).
- Environmental factors
- Diet rich in fat, sulfur, and meat
- Alcohol and substance abuse
- Psychological stress
- Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), increase the risk of UC.
- Milk consumption may exacerbate the disease.
What are 14 signs and symptoms of ulcerative colitis?
Patients commonly develop the following signs and symptoms:
- Rectal bleeding
- Frequent stools
- Mucous discharge from the rectum
- Tenesmus (constant feeling of needing to empty the bowels)
- Lower abdominal pain and cramps
- Severe diarrhea
- Abdominal distention/bloating
- Increased heart rate
- Severe abdominal pain
- Weight loss
- Pus discharge through the anus
- Extracolonic manifestations (inflammation of the eyes, joints, skin, and lungs)
What are the types of ulcerative colitis?
Ulcerative proctitis: Inflammation limited to the area close to the anus (rectum). Symptoms are usually mild, and rectal bleeding may be the only sign.
- Proctosigmoiditis: Inflammation involves the lower end of the colon.
- Left-sided colitis: Inflammation extends from the rectum up through the sigmoid and descending colon.
- Pancolitis: Involves the entire colon
- Acute severe ulcerative colitis (UC): This rare form of colitis affects the entire colon and causes severe pain, profuse diarrhea, bleeding, fever, and inability to eat.
The severity of UC can be graded as follows:
- Mild: Bleeding per rectum and fewer than four bowel motions per day
- Moderate: Bleeding per rectum with more than four bowel motions per day
- Severe: Bleeding per rectum more than four bowel motions per day and systemic illness with protein loss from the body
What is the treatment of ulcerative colitis?
The physician would do a complete physical assessment, and advise a series of blood and radiological investigations (X-ray, computed tomography (CT) scan, etc.). Colonoscopy, endoscopy, biopsy, stool examination, and other tests would be required.
Ulcerative colitis (UC) is a lifelong disease with constant periods of flare-ups and remissions (periods without symptoms, which may last for weeks or years). Presently, there is no permanent medical cure for it, but there are various medications that can provide symptomatic relief, reduce inflammation, and manage flare-ups.
Treatment involves medical and surgical management, depending on the severity of the disease. Patients would also require dietary and lifestyle changes.
Medical treatment includes the following:
- Medication to suppress and/or modulate the immune system
- Anti-diarrhea medication
Surgical treatment includes the following:
- Colectomy (surgical removal of part of the colon or whole colon) may be required in severe cases.
- Diet low in fat, meat, sulfur, and milk
- Management of psychological stress and emotional support
What are the complications of ulcerative colitis?
The possible complications of ulcerative colitis are as follows:
- Bleeding: The ulcers and erosions in the inner lining of the large intestine can perforate through the layers of the intestine causing bleeding.
- Nutrition loss and dehydration: Chronic diarrhea and inflammation lead to dehydration, nutrition loss, and a decrease in the absorption of nutrients.
- Inflammation of other organs: Inflammation of the eyes, joints, skin, liver, and lungs
- Toxic megacolon: A rare complication that causes swelling and ballooning of the colon manifesting as:
- Swollen and painful abdomen
- Colon cancer and ulcerative colitis: The chances of colon cancer increase if the patient has had ulcerative colitis (UC) for over 8 years. Appropriate treatment and the availability of new treatment options have lowered the risk of colon cancer.
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Hendriksen, C., et al. "Long term prognosis in ulcerative colitis--based on results from a regional patient group from the county of Copenhagen." Gut 26.2 February 1985: 158–163. doi: 10.1136/gut.26.2.158 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1432417/>.
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