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Ulcerative colitis (UC)

Ulcerative Colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes long-lasting inflammation and sores (ulcers) in the lining of the colon and rectum. It is a type of autoimmune disorder in which the immune system mistakenly attacks the gastrointestinal (GI) tract, leading to symptoms such as abdominal pain, diarrhea, and rectal bleeding.

Ulcerative Colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes long-lasting inflammation and sores (ulcers) in the lining of the colon and rectum. It is a type of autoimmune disorder in which the immune system mistakenly attacks the gastrointestinal (GI) tract, leading to symptoms such as abdominal pain, diarrhea, and rectal bleeding.

Key Features of Ulcerative Colitis:

  • Chronic inflammation: The inflammation typically starts in the rectum and lower colon and can spread upwards through the colon.
  • Ulcers: Sores or ulcers form in the affected areas of the colon, which can lead to bleeding and discharge of mucus.
  • Autoimmune response: The body's immune system attacks the colon lining, though the exact cause is still not fully understood. Genetic and environmental factors likely contribute.

Symptoms of Ulcerative Colitis:

The severity of UC symptoms can vary from person to person, with some experiencing mild symptoms and others having severe episodes. Common symptoms include:

  • Diarrhea: Often with blood or mucus.
  • Abdominal pain and cramping: Usually in the lower abdomen.
  • Rectal bleeding: Blood in the stool or on toilet paper.
  • Urgency: A strong, urgent need to have a bowel movement.
  • Fatigue: Persistent tiredness due to inflammation and blood loss.
  • Weight loss: Caused by poor absorption of nutrients.
  • Fever: In severe flare-ups or complications.
  • Dehydration: Due to persistent diarrhea.

During flare-ups, symptoms tend to worsen, while in periods of remission, the symptoms may subside or disappear entirely.

Causes of Ulcerative Colitis:

The exact cause of UC is not fully known, but several factors are believed to contribute:

  1. Immune system dysfunction: In UC, the immune system mistakenly attacks the colon, causing chronic inflammation.
  2. Genetics: A family history of IBD or UC increases the risk of developing the disease. Certain gene mutations are linked to UC.
  3. Environmental factors: Infections, diet, and stress may trigger or worsen symptoms in individuals predisposed to UC.

Diagnosis of Ulcerative Colitis:

Diagnosing UC typically involves a combination of:

  1. Medical history and physical examination: A doctor will ask about symptoms, family history, and conduct a physical exam.
  2. Blood tests: To check for anemia (due to blood loss) and signs of inflammation.
  3. Stool tests: To rule out infections or other conditions.
  4. Colonoscopy: A procedure that allows the doctor to examine the colon and rectum directly and take tissue samples (biopsy) to look for characteristic signs of UC.
  5. Imaging tests: Such as CT or MRI scans, may be used to assess the extent of inflammation or complications.

Treatment of Ulcerative Colitis:

There is no cure for UC, but treatments aim to control inflammation, manage symptoms, and improve quality of life. Treatment options include:

  1. Medications:
    • Aminosalicylates (5-ASA): Anti-inflammatory drugs that help reduce symptoms and inflammation in mild to moderate cases.
    • Corticosteroids: Used for flare-ups to reduce inflammation. However, they are not suitable for long-term use due to side effects.
    • Immunosuppressive drugs: Medications like azathioprine or methotrexate to suppress the immune system and prevent flare-ups.
    • Biologics: Target specific components of the immune system, such as tumor necrosis factor (TNF) inhibitors (e.g., infliximab, adalimumab), to reduce inflammation.
    • Antibiotics: Sometimes used to treat infections or complications in UC patients.
  2. Surgery:
    • Colectomy: In severe cases of UC, where medications are ineffective, surgery may be necessary to remove the colon (total colectomy). This can often cure UC, though the patient may need an ostomy (a surgically created opening in the abdomen for waste elimination) or an ileoanal pouch for bowel movements.
  3. Lifestyle and dietary changes:
    • Diet: Although there is no specific diet for UC, individuals may benefit from eating low-fiber, easy-to-digest foods during flare-ups. Supplements may also be needed if nutrient absorption is impaired.
    • Stress management: Stress can trigger or worsen UC, so relaxation techniques and counseling may help.
  4. Vitamin and mineral supplements: UC can interfere with nutrient absorption, so patients may need supplements for vitamins (e.g., B12, vitamin D) and minerals (e.g., iron).

Complications of Ulcerative Colitis:

If UC is not controlled, it can lead to serious complications, including:

  • Colon perforation: A hole or tear in the colon wall, which can lead to infection.
  • Toxic megacolon: A severe and life-threatening complication where the colon becomes dangerously dilated and cannot function properly.
  • Colon cancer: Chronic inflammation in the colon increases the risk of developing colorectal cancer over time, especially after 8–10 years of having the disease.
  • Nutritional deficiencies: Chronic diarrhea and inflammation can impair nutrient absorption, leading to deficiencies in vitamins and minerals.
  • Fistulas: Abnormal connections between the colon and other organs, such as the bladder, vagina, or skin.

Prognosis

UC is a lifelong condition that requires ongoing management. With proper treatment, many people with UC can manage their symptoms and lead normal lives, but flare-ups can occur unpredictably. Early diagnosis and treatment are important to prevent complications and improve the quality of life for those with UC.

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