Ulcerative colitis

Ulcerative colitis is one as Crohn's disease to the chronic inflammatory bowel disease (IBD). According to the definition, it is a chronic, life-accompanying inflammation of the intestine, which is accompanied by ulcers on the intestinal mucosa - the Latin word "ulcus" means "ulcer". In contrast to Crohn's disease, chronic intestinal inflammation is limited to inflammation of the lining of the large intestine , which is called “colon” ​​in Latin.

Crohn's disease is a spread of inflammation, while ulcerative colitis begins in the rectum, i.e. at the end of the large intestine, and spreads from there towards the small intestine . This is rarely affected - the disease usually "stops" at the transition from the large to the small intestine. If it is well advanced, the entire colon is often involved. All layers of the intestinal walls can become inflamed.

In Germany around 168,000 people are affected by ulcerative colitis, men and women alike. The disease usually occurs for the first time between the ages of 25 and 35. Ulcerative colitis is not curable. Thanks to modern drugs, many patients can live largely symptom-free with the inflammation in the intestine. Doctors speak of "remission" when the disease stops. In the course of the disease, depending on the severity, complications can still arise in the long run.

Like Crohn's disease, ulcerative colitis is relapsing. This means that after a symptom-free phase , a flare-up can suddenly occur, in which the symptoms worsen massively.

Ulcerative colitis: the symptoms

Ulcerative colitis causes symptoms typical of chronic intestinal inflammation . For example, the following symptoms are common:

• Cramp-like pain mostly in the left lower abdomen
• Painful bowel movements
• frequent urge to defecate, including at night
• bloody slimy diarrhea
• Flatulence with feces (fecal incontinence)
• fever
• Tiredness, exhaustion
• Weight loss
• Anemia (from loss of blood from the stool)

Concomitant diseases such as changes in the skin, for example in the form of nodular, blue-reddish, sometimes encrusted areas, as well as inflammation of the joints or eyes - unlike Crohn's disease - only rarely occur. How severe the symptoms are is different for each patient. Sometimes ulcerative colitis is so mild that the person concerned does not even notice the disease. Nausea and constipation are not typical symptoms, but they do happen sometimes.

Important: If you notice blood in your stool , you should definitely consult a doctor! Bloody stools can indicate not only ulcerative colitis, but colon cancer as well . Both should be dealt with as quick as possible.

Ulcerative colitis: the causes

As with all IBDs, the causes of ulcerative colitis are unclear. Because intestinal inflammation is more common in some families, there is a genetic cause . However, ulcerative colitis is not directly inherited - it is not a hereditary disease. Several factors will likely have to come together to trigger the outbreak. I nfektionen and disruption of the immune system seem to favor ulcerative colitis. The psyche also obviously has an influence on the intestinal inflammation.

 

Ulcerative colitis: this is how the doctor makes the diagnosis

With the typical symptoms of ulcerative colitis, those affected should consult a doctor. This first clarifies the medical history, as experts call the first conversation, in the anamnesis. He asks what symptoms appear when and how long they last. The doctor will also inquire about the family background, medication to be taken and stress factors.

• The blood values then provide information about the inflammation in the intestine . Sometimes they already show nutrient deficiencies caused by frequent diarrhea.
• A stool examination is also part of the diagnosis of ulcerative colitis . This allows the doctor to check which bacteria are in the intestines.
• A colonoscopy finally shows how severely the intestinal mucosa has already been attacked and where the inflammation is. It enables tissue samples to be taken and helps doctors differentiate the disease from another IBD, such as Crohn's disease.
• Capsule endoscopy is particularly suitable for viewing the small intestine . To do this, the patient swallows a small camera that is no larger than a tablet and films the inside of the intestine.
• Other imaging methods that can be used for diagnosis are magnetic resonance imaging ( MRT ) and computed tomography (CT) .

Ulcerative Colitis: The Therapy

There is no cure for ulcerative colitis, but it is possible to treat the bowel disease in such a way that the symptoms hardly occur. Todays there are a number of drugs that effectively slow down inflammation, noticeably relieve symptoms and lengthen the symptom-free phases between two attacks. Doctors differentiate between drugs that are used locally in the intestine and those that work systemically, i.e. throughout the body. As a rule, the following means are used:

• Mesalazine, which is anti-inflammatory in the form of suppositories, enemas or tablets.
• “Cortisone”, which also inhibits inflammation locally (as a suppository) or systemically (as a tablet).
• Immunosupressants that dampen the immune system and thus slow down the inflammatory process. The doctor prescribes them when other medications are no longer sufficient.
• Genetically engineered drugs (biologics) such as TNF antibodies help in severe cases when other drugs do not work.

The composition of the medication depends on the severity of the illness and on whether an acute flare-up is to be treated or the illness is currently dormant. The treatment of ulcerative colitis is very individual and has to be adapted to the current status again and again if necessary.

More than 80 percent of patients with ulcerative colitis are in pain. However, you should be careful with painkillers : Active ingredients such as acetylsalicylic acid, diclofenac and ibuprofen can trigger relapses and are therefore not suitable. Doctors are more likely to recommend acetaminophen for IBD patients if they are in pain.

Because stress increases relapses, patients diagnosed with ulcerative colitis should avoid psychological stress as much as possible or learn to deal with them better. Autogenic training or meditation exercises, for example, are helpful for this.

Ulcerative colitis: surgery

If medication no longer helps, the doctor and patient have to think about an operation . Surgically removing the severely inflamed sections of the intestine - often the entire colon - is the last option to treat ulcerative colitis. Sometimes, however, it is the only option before serious complications occur. After the operation, patients temporarily have to live with an artificial anus, later part of the small intestine serves as the rectum.

Diet in ulcerative colitis

Patients with a special diet cannot particularly influence their ulcerative colitis. In the event of an acute attack, however , you should avoid dietary fiber so as not to put additional stress on the digestive tract. Coffee and spicy food should also be avoided during flare-ups because they irritate the intestinal lining. Some nutritionists recommend consuming potassium and magnesium for ulcerative colitis , because the body loses both in large quantities due to frequent diarrhea. The minerals are contained in bananas, for example.

In ulcerative colitis, however, it is more important to eat a nutritious diet overall than to eat individual foods in order to avoid a deficiency. Sometimes dietary supplements should be taken after consulting a doctor.

Complications of ulcerative colitis

In the course of ulcerative colitis, complications can arise that are more or less dangerous and should be treated. For example, flat ulcers form on the lining of the colon, which can break open and bleed profusely. In severe cases, life-threatening blood loss occurs.

If children already have ulcerative colitis, the disease can cause stunted growth due to a lack of nutrients.

Sometimes severe inflammation can lead to overinflation of the colon . Sufferers have severe abdominal pain , a bloated stomach (in technical jargon: "acute abdomen") and a high fever. The situation is life-threatening and should be treated as soon as possible, otherwise an intestinal rupture may occur.

If the large intestine had to be surgically removed, there is a risk that the end of the small intestine, which then serves as the anus, becomes inflamed. Within the first two years after the operation, almost every third patient develops such a "pouchitis", after that even every second one. Regular check-ups are necessary in order to identify changes in good time.

The risk of developing colon cancer is increased in people with ulcerative colitis. Experts estimate that after 15 to 20 years of illness, eight percent of those affected develop colon cancer. Because the risk is significantly greater than with healthy people, people with ulcerative colitis should definitely take advantage of appropriate preventive medical check-ups.

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