Ulcerative colitis
Incidence/prevalence
Risk factors
Pathogenesis
Ulcerative Colitis involves defects in epithelial barrier, immune response, leukocyte, and microflora of the colon.
The epithelial barrier has a defect in colonic mucin, and possibly tight junctions, leading to increased uptake of luminal antigens. The lamina propria of the mucosa also has an increased number of activated and mature dendritic cells which include a large number of toll-like receptors, specifically TLR2 and TLR4.
There also seems to be an atypical T-helper cell response in patients with ulcerative colitis, specifically Th2, which exerts a cytotoxic response against epithelial cells.
Other immune-related factors that play a role in the pathophysiology of ulcerative colitis include tumor necrosis factor-alpha, interleukin 13, and natural killer T-cells. Levels of IgM, IgA, and IgG are elevated in inflammatory bowel disease; however, a disproportionate increase in IgG1 antibodies is found in patients diagnosed with ulcerative colitis.
Levels of IgM, IgA, and IgG are elevated in inflammatory bowel disease
Ulcerative colitis is a chronic disease of the large intestine, in which the lining of the colon becomes inflamed and develops liaisons and ulcers. The cause is unknown.
It usually happens due to the immune system's overactive response.
The first degree relative of a patient with ulcerative colitis has four times higher risk of developing the disease.
unknown
Age: it's mostly likely if your between 15 and 30 years old or older than 60.
Older men are at higher risk of developing ulcerative colitis.
Ethnicity: Jewish descent have higher risk of getting the disease.
Food and stress doesn't cause it, but can trigger symptoms.
Clinical Manifestations
Symptoms can vary depending on the severity of the inflammation.
Some of the symptoms include:
Diarrhea, often with blood.
Skin rashes
Occasional constipation
Rectal bleeding
Abdominal cramping and pain.
Rectal pain
Urgency to defecate
Weight loss, fatigue, fever, joint pain.
Failure to grow in children
Diagnostics
Flexible sigmoidoscopy is a type of endoscopic procedure that allows healthcare provider to examine part of the colon from the rectum. It examines lower colon and the rectum. During procedure:
Your colon must be clear of stools. Preparation may include a clear liquid diet, enema, and laxatives.
Sigmoidoscope, a thin flexible tube, through the rectum and into the anus and large intestine to view the area.
The procedure may cause some cramping or discomfort.
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Treatment
Imaging scans allow the health care provider to get detailed images of the affected areas [CT Scan, and Barium enema]
Colonoscopy
The doctor inserts the colonoscope through the rectum and into the anus and large intestine.
A biopsy may be inserted through the cope in order to remove a small sample of the tissue for further analysis.
The first line of treatment is sulfasalazine and 5 aminosalicylates, given orally or rectally.
Colectomy is curative in patients with ulcerative
colitis since the disease is restrictive in the colon
All patients need maintenance therapy to prevent relapse. Oral aminosalicylates are the drug of choice but some may respond to azathioprine and 6-mercaptopurine.
It’s important to maintain a healthy and soothing diet that helps reduce your symptoms, replace lost nutrients, and promote healing. Many people with ulcerative colitis find that soft, bland foods cause less discomfort than spicy or high-fiber foods.
Large bowel resection. It’s performed to remove diseased portions of your large intestine commonly referred to as the colon but includes both the colon and rectum.
Ostomy surgery of the bowel. During ostomy surgery of the bowel, surgeons connect the large or small intestine to the skin on the outside of your abdomen.
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9 to 20 cases per 100000 persons per year. Its prevalence is 156 to 291 cases per 100000 per year. Ulcerative colitis has a greater prevalence in adults compared to Crohn's disease.
Ulcerative colitis is less prevalent in pediatric patients.
The onset peak between the ages of 15 to 30 years.
There is an association between inflammatory bowel disease and the removal of an inflamed appendix.
In the US, about 1 million people are affected with ulcerative colitis.
Ulcerative colitis is a worldwide disorder, the highest prevalence rates have been reported in other and Western Europe and North America.
Refrences
Blanchaert, C., Strubbe, B., & Peeters, H. (2019). Fecal microbiota transplantation in ulcerative colitis. Acta gastro-enterologica Belgica, 82(4), 519–528.
Kucharzik, T., Koletzko, S., Kannengiesser, K., & Dignass, A. (2020). Ulcerative Colitis-Diagnostic and Therapeutic Algorithms. Deutsches Arzteblatt international, 117(33-34), 564–574. https://doi.org/10.3238/arztebl.2020.0564
Porter, R. J., Kalla, R., & Ho, G. T. (2020). Ulcerative colitis: Recent advances in the understanding of disease pathogenesis. F1000Research, 9, F1000 Faculty Rev-294. https://doi.org/10.12688/f1000research.20805.1