Ulcerative colitis

OVERVIEW

Ulcerative colitis is a chronic inflammatory disease affecting the colon. Patients with ulcerative colitis have a relapsing and remitting disease course with periodic flares. There is relapsing and remitting mucosal inflammation, starting in the rectum and extending to proximal segments of the colon. Ulcerative colitis usually presents with bloody diarrhoea and is diagnosed by colonoscopy and histological findings.

In ulcerative colitis there is a pattern of flare-ups (active disease). Symptoms are worse during flare ups. During times of remission there are little to no symptoms. The goal of therapy is to remain in remission as long as possible.

Treatments for ulcerative colitis include 5-aminosalicylic acid drugs, steroids, and immunomodulators. Some patients can require colectomy for medically refractory disease or to treat colonic neoplasia.

DISCUSSION

At what age does ulcerative colitis occur?

Ulcerative colitis usually occurs before 30 but it can occur at any age

What are the different types of ulcerative colitis?

Proctitis - When the inflammation occurs in  rectum and lower part of colon, it’s called ulcerative proctitis

Left sided colitis - If only the left side of your colon is affected, it’s called left sided colitis

Pancolitis - If your entire large intestine is affected, it’s called pancolitis

What are the symptoms of active disease?

Diarrhoea mixed with blood or pus

Abdominal cramping

Anemia

Weight loss

What extra intestinal manifestations can occur in patients having ulcerative colitis?

Peripheral arthritis

Primary sclerosing cholangitis

Pyoderma gangrenosum

What causes ulcerative colitis?

Ulcerative colitis is  probably the result of an overactive immune response. The immune system mistakenly attacks the body, which causes inflammation and tissue damage

Is there any risk for venous thromboembolism in patients having ulcerative colitis?

Yes, there is. The risk is greater in patients admitted with a flare or being treated with corticosteroids. Venous thromboembolism prophylaxis should be prescribed in patients hospitalized with ulcerative colitis

Toxic megacolon is a possible complication of ulcerative colitis. What is toxic megacolon?

Toxic megacolon is nonobstructive dilation of colon. Toxic megacolon can be total or segmental. Toxic megacolon usually occurs as a complication of inflammatory bowel disease, mostly ulcerative colitis. But it can occur as a result of any disease causing colonic inflammation.

How do you diagnose ulcerative colitis?

Endoscopy with biopsy is the only way to establish the diagnosis of ulcerative colitis. 

Endoscopic procedures

1. Colonoscopy

Colonoscopy allows to view the entire colon. During colonoscopy, tissue samples are taken for biopsy.

2. Flexible sigmoidoscopy

Flexible sigmoidoscopy allows to examine the sigmoid colon and rectum. If the colon is severely inflamed flexible sigmoidoscopy is preferred instead of a full colonoscopy.

How is ulcerative colitis treated?

Ulcerative colitis treatment usually involves either medication therapy or surgery

Medications

1. Aminosalicylates - Used for mild to moderate ulcerative colitis

Sulfasalazine

Mesalamine

2. Corticosteroids - Used for severe form of ulcerative colitis

Prednisone 

Budesonide 

Because corticosteroids have serious side effects, healthcare providers only recommend them for short-term use

3. Immunomodulators

6-mercaptopurine

Azathioprine 

Methotrexate 

These medications help calm an overactive immune system

4. Biologics - Biologics treat moderate to severe ulcerative colitis by targeting parts of the immune system to quiet it down

Infliximab 

Adalimumab

Golimumab

Surgery is an option if medications aren’t working or there are complications, such as bleeding or abnormal growths.

There are two kinds of surgery for ulcerative colitis

1. Proctocolectomy and ileoanal pouch

Proctocolectomy is a procedure that removes colon and rectum

Then ileoanal pouch is made surgically. The ileoanal pouch is made from a part of the small intestine to create a new rectum

2. Proctocolectomy and ileostomy

After surgically removing colon and rectum, permanent ileostomy is done

What is the role of immunomodulators in treatment of ulcerative colitis?

Immunomodulators reduce inflammation by suppressing the immune system response that starts the process of inflammation

Below is the link to the video on Ulcerative Colitis

https://youtu.be/U08MlCXal-8