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Ulcerative colitis: Treatment, symptoms, advice and help

About ulcerative colitis

Ulcerative colitis chronic inflammatory bowel diseases which pursue a protracted relapsing and remitting course, usually extending over years.

Ulcerative colitis: Incidence, age and sex

The incidence of ulcerative colitis is 10 – 20 per 100 000, with a prevalence of 100-200 per 100000. It most commonly starts in young adults, with a second incidence peak in the seventh decade.

Signs and symptoms of ulcerative colitis

The major symptom is bloody diarrhea with relapses and remissions. Fever, lethargy and abdominal discomfort are often present.In severe cases anorexia, malaise, weight loss and abdominal pain occur.

Causes and prevention of ulcerative colitis

Factors associated with the condition include genetic & environmental factors-

Genetic : More common in Ashkenazi Jews.10% have a first-degree relative or at least one close relative with IBD.Associated with autoimmune thyroiditis and SLE. HLA-DR 103 associated with severe ulcerative colitis. Ulcerative colitis patients with HLA-B27 commonly develop ankylosing spondylitis.

Environmental : Ulcerative colitis – more common in non-smokers and ex-smokers. Associated with low-residue, high refined sugar diet. Appendicectomy protects against ulcerative colitis.

Ulcerative colitis: Complications

Intestinal

Severe, life-threatening inflammation of the colon,perforation of the small intestine or colon, life-threatening acute haemorrhage,fistulae and perianal disease and cancer may develop.

Extra intestinal

Aphthous ulcers of the mouth , iritis or uveitis, which is inflammation of the iris, episcleritis, seronegative arthritis, Ankylosing spondylitis, arthritis of the spine. Sacroiliitis, arthritis of the lower spine, erythema nodosum, which is a panniculitis, or inflammation of subcutaneous tissue involving the lower extremities , pyoderma gangrenosum, which is a painful ulcerating lesion involving the skin, deep venous thrombosis and pulmonary embolism, autoimmune hemolytic anemia.

Ulcerative colitis: Treatment

Treatment depends upon the extent and activity of colitis as determined by the following investigations Sigmoidoscopy with biopsies is essential to define disease extent.In mild to moderate active proctitis ,measalazine enemas or suppositories combined with oral measalazine are effective first-line therapy.Topical corticosteroids are reserved for patients who are intolerant of topical mesalazine. Patients who fail to respond are treated with oral prednisolone 40mg daily.In midly active left-sided or extensive ulcerative colitis , high-dose aminosalicylates combined with topical aminosalicylate and corticosteroids are effective.

Severe ulcerative colitis is best managed in hospital jointly by a physician and surgeon.Supportive treatment includes intravenous fluid to correct dehydration along with nutritional support.Patients who do not respond after 7 – 10 days’ maximal medical treatment usually proceed to urgent colectomy.

Life-long maintenance therapy is recommended for all patients with exctensive disease and patients with distal disease who relapse more than once a year. Oral aminosalicylates – either mesalazine or balsalazide – are first – line agents (Box 22.71).Sulfasalaazine has a higher in incidence of side-effects, but should be considered in patients with co-existent arthropathy.

Patient who frequently relapse despite aminosalicylate drugs are treated with thiopurines.