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IBD: Ulcerative colitis

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Professor Lovat
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Stomach wallIBD: Ulcerative Colitis

Inflammatory Bowel disease (IBD) is an inflammatory condition of the gastrointestinal tract. There are two main types: ulcerative colitis and Crohn’s disease.

Let’s talk about ulcerative colitis.

What is Ulcerative Colitis?

Ulcerative colitis is a non-infective inflammatory condition which affects the last part of the gastrointestinal tract, the large bowel which is also called the colon. Unlike Crohn’s disease, the inflammation is continuous and it only affects one area of the gut.

The gut wall is composed of several layers. From the central, hollow tube (the lumen) outwards, the layers are: mucosa; submucosa; muscularis and serosa. Ulcerative colitis only affects the innermost layer of the gut – the mucosa.

Disease Extent

The disease always starts in the bottom of the colon, the rectum. It can then spread upwards. Some people only have disease in the rectum, this is called proctitis. If the disease is a little more extensive, and affects the side of the colon on the left side of the body, this is called left sided colitis. If it is more extensive still, and affects the transverse colon or goes all the way round to the right side (beginning) of the colon, it is called pan-colitis (which means it is affecting the whole large bowel).

Symptoms

Ulcerative colitis suffers frequently experience the following signs and symptoms when the disease is active:

  • Diarrhoea containing blood or mucus
  • Going to the toilet to open bowels more frequently, both during the day and at night
  • Abdominal pain  
  • Weight loss
  • Loss of appetite
  • Tiredness
  • Ulcers

Ulcerative Colitis is also associated with symptoms that are not related to the gut, including:

  • Arthritis
  • Red eyes
  • Swollen skin

Causes and exacerbating factors

The immune system is the body’s defence system: it works to eliminate foreign invaders such as bacteria, fungi and viruses that cause illness. Sometimes, however, the immune system develops a fault and mistakes the body’s own tissue and bacteria as being foreign. There are currently two main theories relating to the cause of ulcerative colitis, although no-one really understands what the underlying problem is:

  • The gut wall is lined with antibodies, chemicals of the immune system that help prevent disease. It is also lined with many friendly bacteria that help with digestion. They primarily do this by competing for resources with non-friendly bacteria, preventing them from growing. In ulcerative colitis, the antibodies of the body “attack” the body’s friendly bacteria. This results in inflammation within the colon – IBD
  • Sometimes foreign invaders enter the gut and the body’s immune system try to fight them off. Normally, after they have been eliminated, the body would return back to its normal state with the immune system monitoring for disease, but in an inactive state. However, in ulcerative colitis, it is believed that the immune system does not turn off after the foreign bacteria have been removed. This results in inflammation within the colon – IBD

Genetics also play a role in who will get IBD. For example 25% of IBD suffers have a family history of the condition. Additionally, IBD is more common in certain ethnic groups such as Mexican Americans and South Asians.

A number of environmental factors have been proposed although there is little evidence to support these. Interestingly, smoking is associated with a lower risk of ulcerative colitis. However, smoking is absolutely NOT recommended to ulcerative colitis suffers due to the wide-range of health issues associated with it.

Diagnosis

As with any medical assessment, the diagnosis pathway begins with your doctor taking a basic medical history. This involves them asking you a few questions, and perhaps performing a few physical examinations. If they are concerned that you have ulcerative colitis, they will refer you to a specialist. You may be offered a colonoscopy so they can have a look at the lining of your gut wall. They may also take a sample of tissue from your gut wall so it can be analysed by specialists – this is called a biopsy

Treatment

A variety of different treatment options are offered to individuals with ulcerative colitis.

  • 5-ASA drugs: these drugs are the mainstay of treatment as they both heal an ‘acute attack’ and prevent further attacks. They work by direct contact with the lining of the bowel. The two drugs in this class are called mesalazine, which is widely used in a number of formations, and sulphasalazine, which is no longer widely used because of the risks of side effects.
  • Corticosteroids: as ulcerative colitis is an inflammatory condition, your doctor may give you anti-inflammatory drugs such as prednisolone. However, because these drugs can cause problems if taken for a longer period of time, they are only prescribed short-term. A standard course lasts for less than 2 months.
  • Immunosupressants: as ulcerative colitis may be caused by the body’s immune system, your doctor may prescribe immunosupressants to weaken the immune system. Although it can help treat your symptoms within a few months, you will become more prone to acquiring infections. It is important, therefore that you report any signs of infection or fever to your doctor. It is now recognised that these drugs reduce the frequency of disease recurrence and may also lead to a better long term outcome, such as a reduction in the risk of developing colon cancer later in life. There are many drugs in this class, most notably, azathioprine, 6-mercaptopurine and a series of biologic monoclonal antibody agents such as infliximab, humira and vedolizumab.
  • Surgery: Sometimes ulcerative colitis does not respond to typical medication and quality of life can be significantly affected. In these circumstances, the patient may be offered surgery to remove the large bowel. This is a highly specialist procedure.

If you are worried that you have inflammatory bowel disease, or any other gastrointestinal condition, why not contact the London Gastroenterology centre. Our doctors are experts and will be happy to help you! Call us now to book an appointment on 020 7183 7965.

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