ulcerative colitis

Ulcerative colitis can occur at any age, but most often starts between the ages of 15 and 30.
It occurs with equal frequency in women and men, and in some families it is cumulative.
There are 5 new cases per 10,000 inhabitants per year.
People living in developed countries with urban lifestyles are more at risk, and dietary differences may play a role.

There are many theories about the origin of the disease, but none is proven.
The most widely held view is that the immune system reacts badly to bacteria living in the intestinal wall.
Familial accumulation also raises the possibility of a genetic predisposition.
The disease is thought by many to be immune-mediated, but it may also have psychosomatic causes.

The disease lasts a lifetime, with periods of asymptomatic illness followed by acute flare-ups at unpredictable intervals.
In severe flare-ups, the number of bowel movements per day can be up to 30, and the movements and attempts (tenesmus) are painful.
However, the symptoms of proctitis ulcerosa, which is confined to the rectum, are much milder.

The most severe form in ulcerative colitis is toxic megacolon (megacolon), when the colon dilates and the muscle movement of its walls (peristalsis) is lost.
The patient also develops septicaemia, followed by a collapse of the peripheral circulation (shock).
The patient’s life can be saved by complete removal of the colon and intensive therapy.
Well-managed forms do not affect the outlook for life, but the quality of life certainly does.

Ulcerative colitis can be treated with medicines and surgery.
The aim of treatment is to prolong symptom-free periods and to reduce symptoms in acute flare-ups.

MEDICATION:

• Aminosalicylates are medicines containing 5-aminosalicylic acid (5-ASA), which are used to reduce inflammation.
• Sulfasalazine, a combination of 5-ASA and sulfapyridine, has been shown to be effective in achieving and maintaining an asymptomatic period.
• Steroidal anti-inflammatory drugs are considered if the former are not sufficiently effective.
  Their long-term use is not recommended because of their side effects.
• Immunosuppressive medicines are used when all other medicines have proved ineffective.
  They have the disadvantage of increasing the body’s susceptibility to other diseases, such as infections.
• Hospitalisation becomes necessary when the patient has lost significant amounts of blood, fluid and salt and is at risk of developing toxic megacolon syndrome.

The faeces are evacuated through an opening in the abdominal wall (stoma), but in lucky cases it is also possible to connect the small intestine and the anus.
In this case, the storage function of the large intestine is lost and the patient initially defecates 4-6 times a day.
Later on, the lower part of the small intestine may dilate into a reservoir and the patient’s quality of life improves.
Removal of the large bowel may be necessary if the patient does not respond to medication, if a “toxic megacolon” develops, and if malignant degeneration, perforation or life-threatening bleeding develops.
Surgery will be required in 25-40% of patients in their lifetime.

SURGICAL TREATMENT:

In most cases, ulcerative colitis is well managed.
The life-threatening condition is rare, so the disease has a favourable prognosis in terms of life expectancy.
Surgery is a permanent solution, although it is a long-lasting and relatively risky procedure.

ADDITIONAL TREATMENTS:

When choosing the right diet, the patient should be aware of what aggravates their symptoms and avoid these foods in the future.
As a general rule, protein-rich and fibre-rich foods should be eaten, while avoiding bloating foods and vegetables.
During flare-ups of inflammatory bowel disease, fibre should be spared.
This is because the intestinal mucosa is particularly sensitive to the indigestible parts of food.
In severe cases, the dietitian will prepare a special diet of only easily digestible and nutrient-rich foods, with intravenous feeding being the last resort.

In addition to reducing inflammation, the patient’s distress and the consequences of the underlying disease need to be addressed.

• Anti-diarrhoeal medicines such as methylcellulose or other medicines that inhibit bowel movements can significantly reduce the number of bowel movements per day and the amount of bowel movements.
• Paracetamol preparations are used for pain relief.
  Salicylates and similar non-steroidal anti-inflammatory drugs should be avoided as they may increase symptoms.
• Iron, folic acid and vitamin B12 are given to clear the blood, because regular blood loss can lead to significant anaemia.
• Non-steroidal anti-inflammatory drugs are sometimes given to prevent periods of inflammation.
  An unpleasant side effect of their use can be gastric or duodenal ulcers and the resulting bleeding, which can be life-threatening.