What happens in the colon
In ulcerative colitis, the immune system attacks the lining of the colon. The inflammation is superficial, but continuous: it begins in the rectum and rises upward without healthy intervals. The mucous membrane becomes swollen, bleeding, erosions and ulcers appear on it. The intestine absorbs water worse, hence frequent loose stools; irritation of the rectum causes constant urge.
- Ulcerative proctitis - only the rectum is affected
- Left-sided colitis - up to the flexure of the splenic angle
- Total (widespread) colitis - the entire colon
- Activity level: light, moderate, heavy
Causes and risk factors
As with Crohn's disease, the cause is due to a combination of genetic predisposition, immune disorders and changes in intestinal microflora. The disease often begins at a young age. Interestingly, smoking, unlike Crohn's disease, does not increase the risk of ulcerative colitis, but this is not a reason to smoke: the health benefits of quitting smoking are incomparably higher.
- IBD in close relatives
- Past intestinal infections
- Stress can trigger exacerbations
- Taking NSAIDs and interrupting treatment are common causes of attacks
Symptoms
The severity of manifestations depends on the extent of inflammation. With proctitis, a person may only notice blood in the stool and urge; with total colitis, frequent bowel movements, fever and anemia. Blood in the stool is often mistaken for hemorrhoids and examination is delayed, wasting time.
- Frequent loose stools with blood and mucus
- False urge to defecate, feeling of incomplete evacuation
- Cramping pain in the left side of the abdomen
- Weakness, weight loss, fever
- Joint pain, skin and eye damage
Diagnostics
The basis of diagnosis is colonoscopy with biopsy: it confirms the diagnosis and determines the extent and activity of inflammation. In case of a severe attack, they are limited to examining the rectum and sigmoid colon, so as not to damage the wall. Be sure to exclude intestinal infections, including clostridial infections. Fecal calprotectin is used to monitor activity without repeat endoscopies.
- Colonoscopy or sigmoidoscopy with biopsy
- Fecal calprotectin
- Stool tests for C. difficile infections and toxins
- Complete blood count, CRP, albumin, iron
- Plain radiography of the abdomen during a severe attack
Treatment and observation
Basic drugs for mild and moderate cases are derivatives of 5-aminosalicylic acid in tablets and in the form of suppositories or enemas. In case of exacerbation, glucocorticoids are added; in case of frequent relapses and hormone dependence, immunosuppressants and biological drugs are added. A severe attack is treated in hospital. If drug therapy does not help or complications develop, surgery is performed. Patients with a long course undergo regular colonoscopy for early detection of precancerous changes.
- Do not interrupt maintenance therapy even if you feel well
- Check calprotectin and blood tests regularly
- Screening colonoscopy 8 years after the onset of the disease
- In case of exacerbation - a gentle diet, sufficient drinking
- Avoid self-administration of NSAIDs