Brief description of ulcerative colitis

Chronic inflammatory disease of the colon lining (large intestine), the ulcerative colitis (or chronic ulcerative colitis) is progressive, generally starting from the rectum, then spreading throughout the colon. Although its symptoms are very similar to those of Crohn’s disease, ulcerative colitis shows a clear difference as it does not extend to another part of the digestive tract, thus affecting the colonic mucosa only superficially, unlike Crohn’s disease which may affect the tissues very seriously. Note that this is an autoimmune disease that primarily affects young adults aged 20 to 40, regardless of their gender. Canada is largely affected by this disease, the statistics showing 2 inhabitants out of 1.000 inhabitants are affected by this disease. There are several types of ulcerative colitis, depending on the area of ​​the large intestine that is affected:

• Ulcerative proctitis, the disease develops exclusively in the rectum
• Proctosigmoiditis, the disease affects the rectum and then spreads to the sigmoid colon
• The distal colitis from the rectum to the top of the descending colon
• Pancolitis, is where it spreads to the entire colon

The causes of this autoimmune disease

Ulcerative colitis is due to the immune system dysregulation, the latter produces antibodies or autoantibodies that directly attack the patient’s own body. In this case the intestinal lining of the latter, targeting especially the good bacteria in the intestine (intestinal flora). Although poorly identified nowadays, the causes are more a body of evidence that tip the balance one way rather than the other. Therefore, there are several factors that seem to favor the occurrence of this disease:

• Hereditary factors and genetic predisposition, including family history
• Environmental factors are also highlighted: air pollution, high-fat, high-sugar diet, the habit of eating more than twice a week at fast-food restaurants. Conversely, individuals living in rural areas and consuming plenty of fruits and vegetables are much less at risk. Food intolerance does not impact on the occurrence of the disease.
• The genetic factor can also be a cause, the% of patients being higher in Caucasians and people with Jewish backgrounds (especially of Ashkenazi origin)
• The psychological factor (stress …) does not seem to be involved

Symptoms very similar to those of Crohn’s disease

Chronic and causing life-long flare-ups, symptoms can completely disappear for several months or even for several years. The predominant symptom of the disease is a frequent and bloody diarrhea, the blood resulting from inflammation of the bowel, inflammation that can lead to bloody or purulent ulcers. The symptoms are experienced differently by each individual, with some patients feeling the effects of the disease less. The most common symptoms are:

• The presence of blood in the stool
• Abdominal pain (cramps)
• Frequent and false urge to defecate (even at night and sometimes more than 15 times per day) even if the released stool is minimal (it is the rectal tenesmus, a result of the rectum inflammation)
• Chronic diarrhea
• Significant weight loss due to malfunctioning of the intestine that cannot optimally absorb nutrients from food
• Fatigue due to anemia in the patient. Anemia (iron deficiency) due to blood loss in the stool
• Fever

More or less serious complications can occur:

• Rash
• Internal bleeding
• Inflammation of the eyes
• Arthritis
• Other organs can also be affected (e.g. the liver)
• An increased risk of colorectal cancer which requires the patient’s regular monitoring
• Children affected by the disease may have developmental delays
• Toxic megacolon (severe but rare) can occur causing a perforation of the colon. The vital urgency is of absolute priority.

A reliable diagnosis

The doctor will perform an anamnesis in order to list all the symptoms the patient has noticed, remembering to review the family history from the point of view of the damage caused to the digestive system. Therefore, he/she can push further diagnosis by performing specific analyses:

• A stool analysis to look for the presence of parasites and bacteria
• A blood test to identify an immune system reaction through an increase in the number of white blood cells, evidence that the inflammation has already appeared.
• Colonoscopy with removal of mucosa (biopsies) to have it analyzed by a laboratory
• Barium enema, i.e. a radiological examination performed by a contrast medium; the barium.

All these tests will then allow for the implementation of an appropriate treatment.

Existing treatments and prevention

Treatment of ulcerative colitis

First, it must be emphasized that there is no cure for ulcerative colitis, the purpose of all the treatments is primarily to control the disease, especially in terms of symptoms and flare-ups. The drugs will thus act on inflammation. There are:

• Anti-inflammatory drugs (aminosalicylates: olsalazine, sulfasalazine …) that allow to suppress the symptoms of the disease.
• Cortisone (corticosteroid: budesonide, hydrocortisone …) that is administered during flare-ups.
• Immunosuppressants (azathioprine, methotrexate …) that are prescribed when symptoms are not controlled by the usual drugs or in cases of serious flare-ups. The patient will then carry out regular blood tests.
• Biological therapy or blockers of tumor necrosis factor (infliximab or anti-TNF alpha agents) as injections represent the interesting new solutions when conventional treatments are ineffective
• Probiotics (to restore the intestinal flora), iron, vitamin D, calcium
• Anti-diarrheal and antispasmodics (against abdominal pain)

Please note that the use of these drugs cause more or less severe side effects:

• nausea
• vomiting
• weight gain
• acne…
• Surgery acne remains the most effective treatment leading to a cure for ulcerative colitis with the surgeon performing resection of the entire large intestine; it is called colectomy. As a consequence of this resection, the patient then collects all the stools in an outer pouch which he/she empties by himself/herself. The consequences of such a procedure are not innocuous.

The progress of medicine through a new intervention, the ileal pouch-anal anastomosis, now allows the patient to have the same pouch but internally, the patient can then go to the toilet almost normally.

Prevention of ulcerative colitis

Preventing the onset of the disease remains impossible given that its causes are still very unclear, however, the patient with ulcerative colitis will have to follow some tips: During flare-ups, he/she will:

• avoid certain foods, such as spicy foods, bran, some vegetables such as cabbage, beans … but also raw vegetables and fruits
• avoid too sugary and high-fiber foods
• avoid certain beverages such as alcohol, sugary drinks and caffeine
• give up drinking milk and eating dairy products which are often considered to be the cause of diarrhea
• avoid overeating (separating meals during the day, make 4-5 smaller ones rather than 2 or 3)
• stay well hydrated when diarrhea is severe
• give up smoking

Apart from flare-ups, precisely in order to prevent them, he/she will:

• avoid bad fats
• eat more lean meats (poultry …) and high-fiber foods