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Ulcerative Colitis: Causes, Symptoms, Diagnosis, Treatment, and Prevention

A type of inflammatory bowel disease (IBD), ulcerative colitis (UC) causes inflammation and ulcers (sores) in the lining of the large intestine (colon) and rectum. It affects people of all ages, but it usually develops between 15 and 30 years old. As well as abdominal pain, bloody diarrhea, weight loss, and fatigue, UC may also increase the risk of colon cancer, bowel obstructions, and anemia.

Causes of Ulcerative Colitis

Although the exact cause of UC is unknown, an abnormal immune response has been linked to it. In general, the immune system protects the body from harmful substances, such as bacteria and viruses. However, in UC, the immune system incorrectly attacks the colon and rectum cells, resulting in inflammation and ulcers. There are several factors that may trigger or worsen the immune system response in UC, including:

• Genetics. Some people may inherit genes that make them more susceptible to UC.

• Environmental factors. Some bacteria, viruses, or antigens may trigger or aggravate the inflammation in UC.

• Medications. Some drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, or oral contraceptives, may increase the risk or severity of UC.

• Stress. Stress may not cause UC, but it may worsen the symptoms or trigger a flare-up.

Symptoms of Ulcerative Colitis

The symptoms of UC vary depending on the extent and severity of the inflammation. Some people may have mild or no symptoms, while others may have severe or frequent symptoms. There may also be periods of remission (no symptoms) and flare-ups (worsening symptoms) over time. Some of the most common symptoms of UC include:

• Diarrhea, often with blood or pus

• Rectal bleeding or pain

• Abdominal pain or cramping

• Urgency or difficulty to defecate

• Weight loss or malnutrition

• Fatigue or fever

Some people with UC may also experience other symptoms, such as:

• Joint pain or swelling

• Skin problems or mouth sores

• Eye inflammation or vision problems

• Liver or kidney problems

• Growth delay or failure in children

Diagnosis of Ulcerative Colitis

UC is diagnosed by asking about the patient's medical history, symptoms, and family history. A physical examination, including a rectal exam, is conducted by the doctor to check for signs of inflammation or bleeding.

• Blood tests. Blood tests can help detect anemia, inflammation, infection, or liver or kidney problems.

• Stool tests. Stool tests can help identify blood, pus, bacteria, or parasites in the stool.

• Colonoscopy. Colonoscopy is a procedure that uses a flexible tube with a camera and a light to examine the inside of the colon and rectum. The doctor can also take tissue samples (biopsies) for further analysis.

• Sigmoidoscopy. Sigmoidoscopy is similar to colonoscopy, but it only examines the lower part of the colon and rectum.

• X-rays or CT scans. X-rays or CT scans can help detect complications, such as perforation, obstruction, or abscesses, in the colon or abdomen.

Treatment of Ulcerative Colitis

It is not possible to cure UC, but it can be treated to reduce inflammation, heal ulcers, relieve symptoms, prevent complications, and induce and maintain remission. As well as the type, extent, and severity of UC, the treatment may vary depending on the patient's response and tolerance. Treatment may include:

• Medications. Medications can help reduce the inflammation, suppress the immune system, control the infection, or relieve the pain or diarrhea. Some of the medications used for UC include:

  • Aminosalicylates. These are anti-inflammatory drugs that can help reduce the inflammation and prevent flare-ups. They can be taken orally or rectally.

  • Corticosteroids. These are potent anti-inflammatory drugs that can help reduce the inflammation and induce remission. They are usually used for short-term treatment or for severe cases. They can cause serious side effects, such as weight gain, osteoporosis, diabetes, or infections, if used for a long time or in high doses.

  • Immunomodulators. These are drugs that can help suppress the immune system and reduce the inflammation. They are usually used for moderate to severe cases or for those who do not respond to other medications. They can take several weeks or months to work and can increase the risk of infections or cancers.

  • Biologics. These are drugs that can help block specific proteins or cells that are involved in the inflammation. They are usually used for moderate to severe cases or for those who do not respond to other medications. They are given by injection or infusion and can cause allergic reactions or infections.

• Surgery. Surgery may be an option for some people with UC who have severe symptoms, complications, or a high risk of colon cancer. Surgery involves removing part or all of the colon and rectum. There are different types of surgery for UC, such as:

  • During a protocolectomy, the entire colon and rectum are removed. A stoma is made in the abdomen, and the small intestine is attached to it. Stool passes through the stoma and is carried outside the body in an ostomy bag.

  • As an alternative to proctocolectomy, ileal pouch-anal anastomosis (IPAA) allows patients to have normal bowel movements. The surgeon removes most of the colon and the rectum, leaving a small portion intact. A pouch will be created from the small intestine and attached to the remaining rectum by the surgeon. The stool will then pass through the pouch and the rectum to the anus.

  • The continental ileostomy does not require an ostomy bag. The surgeon removes the colon and rectum and creates a pouch from the small intestine, an alternative to proctocolectomy. The surgeon will then create an opening (stoma) in the abdomen and attach the pouch to it. Using a catheter, the stool can be drained from the pouch through the stoma.

Prevention of Ulcerative Colitis

There is no known way to prevent UC, but some lifestyle changes may help reduce the risk of flare-ups or complications. Some of the preventive measures include:

• It is important to eat a balanced diet that contains fruits, vegetables, whole grains, lean proteins, and healthy fats, which will provide the nutrients and fiber necessary for colon and immune health. Foods that may trigger or worsen the symptoms of UC include spicy, fatty, fried, or dairy foods, alcohol, caffeine, or carbonated drinks. These foods should be avoided or limited.

• It is important to drink plenty of fluids, especially during diarrhea. Water is the best choice, but broth, juice, and herbal tea can also be helpful. Avoid or limit fluids that may irritate the colon, such as alcohol, caffeine, or carbonated drinks.

• There is no evidence that stress causes UC, but it can worsen the symptoms or trigger a flare-up. Stress management techniques, such as relaxation, meditation, yoga, or exercise, can be helpful in reducing stress and improving the patient's mood and health.

• Quitting smoking can improve the health of the colon and the immune system as well as improve the overall health of the patient. Smokers are more likely to develop UC, as well as complications, such as colon cancer.

• If medications are taken as prescribed, they can control inflammation, heal ulcers, relieve symptoms, prevent complications, and induce and maintain remission. Follow the doctor's instructions carefully and take the medications as prescribed. Symptoms may worsen or recur if the patient stops, changes, or skips the medications without consulting his or her doctor.

Outlook for Ulcerative Colitis

UC is a chronic condition that has no cure, but it can be managed with proper treatment and care. Most people can lead normal and productive lives, with periods of remission and occasional flare-ups. If a person has severe or frequent symptoms of UC, complications, or a high risk of colon cancer, their quality of life may be adversely affected or surgery may be required. It is important to remember that the outcome of UC depends on several factors, including the type, extent, and severity of the disease, the response and tolerance to treatment, the presence of complications and comorbidities, and the patient's lifestyle and coping skills.