"Ulcerative colitis is a chronic inflammatory bowel disease with no definitive cure, but various treatment approaches are implemented to alleviate its symptoms."
What is ulcerative colitis?
Ulcerative colitis is a chronic inflammatory bowel disease like Crohn's disease. Unlike Crohn's disease, it is limited to the colon, the rectum is often involved. Small intestine involvement is not observed. Unlike Crohn's disease, involvement is continuous and inflammation is mucosal and does not go deeper. In mild cases, inflammation is seen only in the rectum, while in severe cases it is seen in the whole colon. As the disease progresses, ulcers formed with the contribution of bacterial infection become persistent and localized.
Who are at risk?
Although the exact causative factors of ulcerative colitis are unknown, the immune system, genetic predisposition and environmental factors (including diet) play a role in the development and progression of the disease. As dietary habits, environmental and social factors have changed worldwide, the incidence has increased at an alarming rate. High sugar and soft drink consumption and low vegetable consumption have been associated with an increased risk of ulcerative colitis. Decreased consumption of omega-3 polyunsaturated fatty acids and increased dietary intake of omega-6 polyunsaturated fatty acids are associated with an increased risk of ulcerative colitis. In addition, Crohn's disease is more common in women than men, whereas in ulcerative colitis, the ratio of women to men is similar in all age groups and no gender difference was observed.
How is it diagnosed?
The diagnosis of ulcerative colitis is based on anamnesis (history), clinical findings, endoscopic imaging and histologic results. Markers of inflammation such as sedimentation and C-reactive protein (CRP) may be elevated. Fecal calprotectin is a protein associated with increased neutrophils in the intestine and can be detected in feces and is helpful in the diagnosis. CRP and fecal calprotectin levels are markers evaluated in response to treatment. The use of radiologic imaging in diagnosis is limited. In patients with acute severe ulcerative colitis, it is recommended that toxic megacolon should be evaluated by standing direct abdominal radiography. Magnetic resonance imaging and abdominal tomography can show the presence of thickening of the colon, but are not sensitive enough to be diagnostic tools. Colonoscopy is considered the gold standard for diagnosis and follow-up of the disease. In patients with ulcerative colitis, it is important for the examination of dysplasia (the presence of abnormal cells that may be precursors of cancer).
What are the symptoms?
The symptoms of ulcerative colitis are often insidious. The most prominent symptom is bloody diarrhea, often accompanied by a feeling of urgency or difficulty passing stools. Inflammation in the rectum leads to mucous bleeding. Diarrhea can occur 10-12 or more times a day. However, in patients in whom the disease is confined to the rectum, bleeding or even constipation may occur without a change in bowel habits. There is cramping pain in the lower abdomen, but it is usually mild. There is also nausea, vomiting, discomfort in the upper stomach, loss of appetite, fever and weight loss. Intolerance to milk and dairy products may occur. Anemia due to bleeding, low protein and electrolyte balance disorder as a result of severe diarrhea. In ulcerative colitis; malnutrition is also seen as patients cannot get enough nutrition as a result of loss of appetite, diarrhea, nausea and vomiting.
What are the complications?
Systemic complications include liver, gallbladder and biliary tract disease, fatty liver, arthritis, eye, skin and mucous membrane lesions, anemia and vascular inflammation. Most lower gastrointestinal bleeding stops on its own, but some cases may require emergency colectomy (surgical removal of part or all of the colon). Perforation is most common in the sigmoid colon and corticosteroid treatment increases the risk of perforation. Patients may experience weakness, tachycardia (increased heart rate), hypotension, decreased/loss of bowel sounds, abdominal tenderness and free air under the diaphragm. The most common complication leading to hospitalization is toxic megacolon (rapid enlargement and swelling of the colon). Local complications of ulcerative colitis include abscesses, fistulas (abnormal connections), stenosis of the colon and rectum and heavy bleeding. Cracks in the anus, abscesses around the anus or hemorrhoids rarely develop in ulcerative colitis. In addition, depending on the duration of the disease, increased inflammation and nutritional factors may increase the risk of malignancy (malignant tumor).
What are the therapeutic approaches?
Since the cause of the disease is unknown, there is no definitive treatment. Therapeutic approaches are aimed at alleviating inflammation and symptoms. Sulfasalazine or mesalazine and, when necessary, corticosteroids are among the preferred treatment options in ulcerative colitis. Sulfasalazine is used to treat active ulcerative colitis and to achieve remission (disappearance or alleviation of symptoms). Antibiotics are often preferred in complications such as fistula and abscess. Food supplements containing probiotic and prebiotic cultures can be used to regulate both the immune response in the gut and the microflora of the digestive tract. Approximately 20% of patients with ulcerative colitis recover with colectomy. Whether a colectomy is necessary is determined by the severity of the disease and indicators of increased cancer risk.
Conclusion
Ulcerative colitis is a common disease with an increasing prevalence worldwide. Although the exact cause is unknown, genetic and environmental factors are associated with the development of the disease. Ulcerative colitis, which has a global impact on the healthcare system with its recurrent and incurable features, affects the quality of life of patients. Therefore, it is necessary to reduce the symptoms of the disease and/or develop effective treatments.
Gülada, B.Ö., et al. (2024). Gilaburu (Viburnum opulus L.) fruit extract has potential therapeutic and prophylactic role in a rat model of acetic acid-induced oxidant colonic damage. Journal of Ethnopharmacology, 322, 117624.
https://pubmed.ncbi.nlm.nih.gov/38128893/
Ömeroğlu Yel B. (2018). Sıçanlarda deneysel kolit modelinde Gilaburu’nun (Viburnum opulus L.) olası tedavi edici ve koruyucu etkilerinin araştırılması. Marmara Üniversitesi, Sağlık Bilimleri Enstitüsü, Beslenme ve Diyetetik Anabilim Dalı, Yüksek Lisans Tezi. (Danışman: Doç. Dr. Berna Karakoyun Laçin)
https://tez.yok.gov.tr/UlusalTezMerkezi/tezDetay.jsp?id=dY5OvP0v47SYeLN_q7B3mw&no=CXJjq2ryteUAWRBH6ZezLw
Buzcu H. (2024). Sıçanlarda asetik asit ile oluşturulan deneysel kolit modelinde phoenixin-14'ün olası tedavi edici etkilerinin araştırılması. Sağlık Bilimleri Üniversitesi, Sağlık Bilimleri Enstitüsü, Tıbbi Fizyoloji Anabilim Dalı, Doktora Tezi. (Danışman: Prof. Dr. Berna Karakoyun Laçin) https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYeni.jsp
Ashique, S., et al. (2023). Recent updates on correlation between reactive oxygen species and synbiotics for effective management of ulcerative colitis. Frontiers in Nutrition, 10, 1126579. https://pubmed.ncbi.nlm.nih.gov/37545572/
