Ulcerative Colitis

Ulcerative colitis is a disease characterized by inflammation of the part lining the inner surface of the large intestine with the effect of environmental factors.

Approximately 95% of cases have involvement of the rectum, the last part of the large intestine.

Ulcerative colitis often spreads from the anus up through the large intestine. It is frequently seen between the ages of 15-40, but 5% of the cases occur after the age of 60.

What Complaints Are Observed in Ulcerative Colitis?

Bleeding from the rectum: Frequent episodes of bloody diarrhea, mucus may also be present. Persistent straining (tenesmus) abdominal pain, constipation, biliary tract stenosis Fever (above 37.5o C) High pulse rate (tachycardia), Weight loss, Continuous weakness, Cramp-like abdominal pain Sometimes constipation in the elderly

Extra-intestinal symptoms: arthralgia, oral aphthae, some eye diseases, biliary tract stenosis (primary sclerosing cholangitis), kidney stones, vein occlusions

Are There Medicines That Cause Exacerbation Of The Disease?

Painkillers, aspirin, some antibiotics, birth control pills cause exacerbation of the disease. It is known that 5-10% of cases apply to the doctor for the first time with a severe exacerbation of the disease. It was determined that, in case of response to treatment in this patient group, 50% of them required surgical intervention within one year and 75% of them within five years with a new attack.

How is Ulcerative Colitis Diagnosed?

Colonoscopic evaluation is essential. In colonoscopy, the degree of inflammation in the intestinal wall, ulcers formed and how much the intestine is involved can be determined. The definitive diagnosis is made with the pathological evaluation of the biopsies taken at this time.

2. Blood tests Anemia: Hb level below 10.5 g, present in 35-75% of cases. Platelet increase High sedimentation rate (more than 30 mm/hour) Low albumin Low potassium Low magnesium Low alkaline phosphatase can also be detected.

How is Ulcerative Colitis Disease Classified?

The severity of disease activity is often made according to the Montreal (Truelove-Witts criteria) classification. Remission (quiescent period): less than 3-4 stools per day Mild: bloodless or bloody stools up to 4 times a day Moderate: bloody stools at least 4-6 times a day Severe: more than 6 bloody stools per day

With Which Diseases Can Ulcerative Colitis Be Confused?

• Bowel cancer
• Rectal cancer
• Inflammatory colitis
• Ischemic colitis
• Radiation colitis
• lymphocytic colitis

Which Drugs Are Used in the Treatment of Ulcerative Colitis

5-ASA (mesalamine): 2.4-4.8 g/day dose and is an important drug in the maintenance of the disease in the quiescent period (remission). Tablets and enema forms are available for use in types with rectal involvement near the anus.

Sulfasalazine: It is used as 4-6 g/day and is effective in mild to moderate disease and disease in the quiescent period (remission).

Biologic agents(Infliximab/Adalinumab vs ): It is a tumor necrosis factor inhibitor and is used in moderate to severe ulcerative colitis cases.

Azathioprine: 2.5 mg/kg/day is given and is an immune system stabilizer.

Cyclosporine: important to prevent surgery.

6-Mercaptopurine: 1.5 mg/kg/day is given, it is a drug that reduces the amount of cortisone.

Ciprofloxacin: antibiotic that inhibits bacteria

Metronidazole: It is an antibiotic used to destroy bacteria that are effective in an anaerobic environment.

Cortisone: In mild and moderate cases, budesonide (2-8 mg/day) and hydrocortisone (100 mg/day) are used as enemas. In severe cases, intravenous (IV) 60mg/day methylprednisolone or hydrocortisone 400mg/day is given.

Fecal Transplantation: After passing a stool sample from a healthy person through a microfiltration system; It is given to people with intestinal problems via enema, colonoscopy, tablets, nasal gastric tube. This method, called fecal microbiota transplantation (FMT), was first used in the treatment of Clostridium difficile infection (CDE), which is caused by the decrease or disappearance of beneficial bacteria in the intestine after heavy antibiotic use. CDE is responsible for 15-25% of diarrheas that develop after heavy antibiotic use.

Later, it was used in the treatment of irritable bowel syndrome (IBS) and inflammatory bowel disease. Such treatments are carried out by Gastroenterology Specialists. Since it is a relatively new treatment method, there is not enough information about its long-term results. With this treatment method, there are reservations about the transmission of viruses such as jaundice (hepatitis), AIDS disease (HIV) to the transplant recipient.

What Are the Types of Ulcerative Colitis?

Ulcerative colitis is limited to the large intestine (colon) and rectum. Inflammation only occurs in the innermost layer of the intestinal lining. It usually starts in the rectum and lower colon, but can spread to the entire colon.

The varieties are;

• Ulcerative Proctitis: Inflammation is limited to the area closest to the anus (rectum) region and rectal bleeding may be the only symptom of the disease.
• Proctosigmoiditis: Inflammation involves the rectum, which is the lower end of the colon, and the sigmoid colon.
• Left-sided colitis.
• pancolitis

What are the Causes of Ulcerative Colitis?

Experts believe that bacteria or viruses can accidentally trigger the immune system to attack the inner lining of the large intestine. This immune system response causes inflammation, leading to symptoms. Some people find that eating certain foods, stress, or emotional distress can cause ulcerative colitis. The exact cause of the disease is unknown. Factors causing ulcerative colitis;

• Overactive intestinal immune system
• Genetic factors
• Environment
• Overactive intestinal immune system.

What Are the Symptoms of Ulcerative Colitis?

Ulcerative colitis symptoms can range from mild to severe and vary from person to person. It also varies over time, with periods of remission when you’re in good health and you have no symptoms, your symptoms recur when they’re bothersome, or they can change with flare-ups.

It can vary in how inflamed the colon is and how severe the inflammation is, but the most common symptoms during a flare-up are:

• Diarrhea. This is usually with blood and mucus and an urgent need to go to the toilet.
• Cramping pains in the abdomen (these can be very severe and often occur before defecation)
• Fatigue and exhaustion. This may be due to the disease itself, anemia (see below), or at night.
• If you have to get up with pain or diarrhea, it can be caused by insomnia
• You generally do not feel well. Some people may have a fever and a fever with a rapid heartbeat.
• Anorexia and weight loss.
• Anemia (decreased red blood cell count)

How is Ulcerative Colitis Treated?

Tests and physical examinations are needed to confirm the diagnosis. It may include:

Blood and Stool Tests

Simple blood tests can show if you have inflammation somewhere in your body and whether you are anaemic. Your stools may also be tested for signs of bleeding or inflammation and to check if your diarrhea is due to an Infection. If inflammation is confirmed, examination such as endoscopy, x-ray or scanning is done.

Endoscopies

In an endoscopy, a doctor or specialist endoscopist uses an endoscope (a long, thin, flexible tube with a camera at the end) to examine your digestive tract. There are several types of endoscopy, each with a different name depending on the part of the intestine being examined. The type of endoscope used will also vary.

Colonoscopy or Sigmoidoscopy

These types of endoscopies are often used to help diagnose and monitor ulcerative colitis. In these tests, a short endoscope called a SIGMOIDOSCOP or a longer and more flexible colonoscope is inserted through the anus to examine the rectum and colon.

MRI and CT Scans

Other tests that can sometimes be used to help diagnose colitis include MRI (Magnetic Resonance Imaging) and CT (Computed Tomography) scans. MRI scans use magnets and radio waves, and CT scans use a special type of x-ray to create a ‘3D’ image of the body. Some justifys also use ultrasound to find areas of inflammation.

Is Ulcerative Colitis Dangerous?

Ulcerative colitis can pose a risk if left untreated. This risk increases with the extent of the colitis-affected colon and is therefore greater if you have extensive colitis than left-sided colitis.

People with proctitis do not have an increased risk. It shows that the risk of developing cancer usually begins to increase about 8-10 years after the onset of symptoms.

This should be diagnosed before it is much later than when your symptoms started.

How should patients with ulcerative colitis be fed?

Ulcerative colitis So far there is little evidence that any food or additive can cause or improve colitis. The most important thing in general is to maintain your weight and strength

Eating a nutritious and balanced diet and drinking enough fluids to keep you hydrated is because you may find certain foods affect your symptoms.

For example, when you have a flare-up, bland, bland foods may cause less discomfort than raw vegetables or non-seasoned foods. The urge to open the bowels is usually caused by inflammation in the lower colon, but because fiber adds bulk to stool, it can act as a trigger and make urgency worse.

Therefore, it may be helpful to reduce the amount of fiber you eat during flare-ups and perhaps switch to a low-fiber diet. It’s important to get your doctor’s advice on a healthy safe diet so it doesn’t get triggered again.

What Triggers Ulcerative Colitis?

A leading theory in ulcerative colitis is that certain food products specifically trigger inflammation in the immune system.

Milk, eggs, fruit juices, dried fruits, dates, wheat, bread, pasta, alcohol, red meat, especially fatty meat should not be consumed. In the psychological sense, it is necessary to stay away from stress and anger from the environment where your emotions are destroyed.

Who Gets Ulcerative Colitis?

Ulcerative colitis can be seen in a 2-year-old child, and it can also be seen in 15-year-olds. Ulcerative colitis can occur at any age, but most people are diagnosed in their mid-30s.

Men and women are equally likely to be affected, but older men are more likely to be diagnosed than older women.

What Happens If Ulcerative Colitis Is Untreated?

When ulcerative colic is not treated, it triggers anemia. Anemia begins in the body, symptoms such as abdominal swelling and vomiting may occur during the exacerbation period.

Stones form in the urinary tract and kidneys. It causes constipation in people over 60 years of age. In advanced cases, it can lead to bowel cancer.

What Causes Ulcerative Colitis Pain?

Ulcerative colitis signs and symptoms include bloody diarrhea, abdominal cramps and left-sided pain and urgent defecation. It usually affects the entire colon and causes bouts of bloody diarrhea that can be severe, abdominal cramps and pain, fatigue and significant weight loss.

Abdominal pain from ulcerative colitis can create a cramping sensation in the intestines. It can happen before a bowel movement or as you go. Other parts of your body may also be damaged. Some people with the disease have joint pain.

How Do Ulcerative Colitis Attacks Occur?

Ulcerative colitis attacks vary from person to person, in some patients it is seen as widespread diarrhea, while in some patients it manifests itself as constipation. Attacks can generally be treated on an outpatient basis. One of the most important reasons that trigger attacks is stress and the other is the ready-made fatty foods consumed.