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Ulcerative Colitis

Considered as one of the two major inflammatory bowel diseases, ulcerative colitis (UC) manifests itself in the large intestine. It is a multifactorial and polygenic disease, which can also include a genetic predisposition. UC is a lifelong illness and has a significant impact on an individual s emotional and social quotients. The inflammation starts at the rectum and spreads upwards with tiny ulcers forming in the lining of the colon. Contents of the bowel move and empty rapidly. There is a discharge of pus and mucus from the ulcers. The disease rarely affects the small intestine. UC can affect people of all ages but tend to develop between 15 years and 30 years of age.

Causes

Genetics: individuals with a family history of ulcerative colitis

Immune system reactions: the intestinal epithelial barrier is compromised leading to UC

Sulfate-reducing bacteria

Use of NSAIDs

Low levels of vitamin A and E

Signs and symptoms

Frequent stools

Rectal bleeding

Discharge of mucus from the rectum

Occasional tenesmus

Severe dehydration

Lower abdominal pain

Diarrhoea and cramps

Fever

Leukocytosis

Abdominal distention

Diagnosis

Physical examination:

Tachycardia

Fever

Abdominal tenderness

Significant weight loss

Grading ulcerative colitis:

Severe: > 4 bowel motions per day; hypoalbuminemia < 30g/L, rectal bleeding

Moderate: > 4 bowel motions per day; rectal bleeding

Mild: < 4 bowel motions per day; rectal bleeding

Serologic markers: Antineutrophil cytoplasmic antibodies (ANCA); perinucelar ANCA (pANCA)

Laboratory studies:

CBC for anaemia and thrombocytosis

Comprehensive metabolic panel for hypoalbuminaemia; hypokalaemia; hypomagnesaemia; alkaline phosphate

Inflammatory markers: to check for erythrocyte sedimentation rates

Stool assays: culture for bacterial pathogens

Endoscopy and biopsy

Plain abdominal radiographs

Cross-sectional imaging studies

Radionuclide studies

Treatment

Most of the ulcerative colitis patients can be treated with medications. Surgery is a definitive therapy for ulcerative colitis. Predominant indications for surgery are non-responsiveness to medical treatment, uncontrolled colonic bleeding, dysplasia, adenocarcinoma , complications of ulcerative colitis like toxic megacolon or perforation. Such complications require emergency surgery as these are life-threatening situations.

Dr. Deepak Varma prescribes long-term monitoring for individuals diagnosed with ulcerative colitis. He drafts a careful treatment plan, which has to be followed by the patient throughout their lives.