- Ulcerative colitis: description
- Ulcerative colitis: symptoms
- Ulcerative colitis: causes and risk factors
- Ulcerative colitis: examinations and diagnosis
- Ulcerative colitis: treatment
- Ulcerative colitis: disease course and prognosis
Ulcerative colitis is a chronic, usually bumpy inflammation of the colon. It is characterized by frequent diarrhea with blood and mucus admixtures. There is also pain, often in the left upper abdomen. During the symptom-free period, a normal everyday life is possible, during a push even a hospital stay may be necessary. Read more about symptoms, therapies and nutrition in ulcerative colitis.
ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. K50K51
Dr. med. Mira Seidel
Because of the poorer food use in ulcerative colitis to ensure a balanced whole foods to prevent the risk of malnutrition.
Causes and risk factors
Examinations and diagnosis
Disease course and prognosis
Ulcerative colitis: description
Ulcerative colitis, as well as Crohn's disease, is one of the chronic inflammatory bowel diseases (IBD). Often it is difficult to keep the two diseases apart.
What happens with ulcerative colitis?
In ulcerative colitis, the colon and the rectum are mainly inflamed - this is also the great difference to the other chronic enteritis Crohn's disease. Here, the inflammatory foci are found mainly in the small intestine, but also parallel to the stomach or large intestine. Colitis, on the other hand, has localized but extensive inflammation. The inflammation itself is limited to the uppermost Daumschleimhaut and does not stretch through all skin layers as in Crohn's disease. It often ulcers (ulcers), which can quickly start to bleed.
In all affected the rectum (rectum) is infested. From here the inflammation spreads differently.
The onset of ulcerative colitis is often insidious and is perceived late by those affected. The more the inflammation spreads in the intestine, the stronger the symptoms become. In about five percent of all cases, the disease starts out of prime health all of a sudden. This is especially dangerous, because then most complications can be expected.
facts and figures
Ulcerative colitis usually affects young people between the ages of 16 and 25 years. Men are affected more frequently than women; even children can get sick.
In Germany, around six people per 100,000 new inhabitants per year develop ulcerative colitis. Healing is not possible. However, a boost can often take many years to come - in the symptom-free split times affected people can thus lead a completely normal life. Acute ulcerative colitis may cause severe pain, so hospitalization is often unavoidable.
Patients with ulcerative colitis have a higher risk of colon cancer. Therefore, regular check-ups should be carried out during the course of the disease.
Ulcerative colitis: symptoms
Depending on the severity and course of the disease, symptoms of varying severity occur. This includes:
- bloody diarrhea (up to 40 times within 24 hours) as well as pus and mucus in the stool.
- permanently painful stool urgency (Tenesmen)
- spasmodic pelvic pain, especially before bowel movements
- nocturnal stool urge
- Flatulence that can lead to fecal incontinence
- colicky abdominal pain mostly in the left lower abdomen, possibly associated with mild fever
- Weight loss, fatigue and loss of performance
- Anemia (due to the bleeding intestinal ulcers)
- Rarely, inflammation of the joints (arthritis), skin or eyes (uveitis) occur.
In addition, ulcerative colitis can lead to certain complications. In periods of relapse, massive bleeding often occurs. Patients must then be hospitalized in hospital. The megacolon is also feared. It is caused by a intestinal paralysis. Due to the lack of intestinal movement, the stool can no longer be transported and accumulates in the intestine. As a result, it expands painfully. Often it comes in the episode to an inflammation of the peritoneum (peritonitis) and a bowel perforation (perforation). Both complications are life threatening.
Possible sequelae of ulcerative colitis are colon cancer and primary sclerosing cholangitis (inflammation and constriction of the biliary tract). In children, it can lead to growth disorders. Associated with malnutrition in ulcerative colitis these complications can be exacerbated.
Ulcerative colitis: causes and risk factors
As with most chronic inflammatory bowel disease, ulcerative colitis also applies: causes and risk factors are poorly understood. Scientists suspect that a familial predisposition (genetic predisposition) is associated with certain risk factors.To date, several genes have been discovered that are present in altered form in patients with ulcerative colitis. Diet and environmental factors also play a role. Patients often do not tolerate lactose (lactose intolerance). The diet for ulcerative colitis must then be changed immediately.
The immune system also plays a role. Researchers suggest that certain intestinal bacteria and malfunction of the immune system can also lead to ulcerative colitis.
In general, the illness is not caused by mental factors (it is not psychosomatic). However, with existing illness stress states and psychological loads can trigger an active ulcerative colitis thrust.
If the cecum has been removed, there is a lower risk of ulcerative colitis. Tobacco disclaimer has a similar effect. The causes are so far unclear.
Ulcerative colitis: examinations and diagnosis
The examination and diagnosis consists of two components. First, the history of the disease (anamnesis) is collected. Thereafter, a physical examination takes place.
The safest method of examination is colonoscopy. A long, flexible instrument (endoscope) is inserted through the anus. The doctor can thus see the mucosal conditions on a camera and detect inflammation. Also pus deposits can become so visible. In addition, tissue samples (biopsies) are taken. These are later examined in the laboratory.
To confirm the diagnosis, if colon ulcerative colitis is suspected, a second colonoscopy is performed to compare the results. The distance between the two colonoscopies depends on the individual course of the disease. If there are no complaints, there may be several weeks between the two examination dates. In acute complaints, the second examination usually takes place a few days after the first one.
In addition, ulcerative colitis patients are treated with blood. Of particular importance here is the C-reactive protein (CRP). This value is greatly increased in the blood in inflammation. Also during the course of the disease, the level of CRP and hemoglobin levels are measured time and again. They provide information about how severe the inflammation is and how high the blood loss is due to the ulcerative colitis. Therapy and further examinations then depend on the results.
For further confirmation also liver values can be determined. In ulcerative colitis, two enzyme levels are typically elevated - the gamma GT and the alkaline phosphatase (AP). In about 70 percent of the cases, it is also possible to detect antibodies that are directed against one's own tissue and destroy it (autoantibodies).
The abdomen is examined by ultrasound (ultrasound) at both the initial and the follow-up examination. For example, intestinal dilation (megacolon) can be detected.
To rule out infection with bacteria, the stool is also examined in the laboratory. Such an infection may appear to cause colitis-ulcerative symptoms, but is easily treated with antibiotics.
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Chronic intestinal inflammation - the most important facts
Everyone knows diarrhea and abdominal discomfort. In some cases, these sufferings no longer disappear or return again and again. This is due to so-called chronic inflammatory bowel disease, CED for short. Eleven fast facts!
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Crohn's disease and ulcerative colitis
Basically, one differentiates between two forms of chronic enteritis: crohn's disease and ulcerative colitis. In ulcerative colitis especially the colon is affected. That is, starting from the rectum, the inflammation spreads to the small intestine. In Crohn's disease, on the other hand, very different areas can be inflamed. In about 25 percent of patients, the colon is affected, in 30 percent of the last section of the small intestine - but also the esophagus and stomach can be inflamed.
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Often in young adults
Both forms of inflammatory bowel disease occur for the first time in relatively young years. Those affected are between 20 and 40 years old at the time of initial diagnosis. However, there is a second peak of disease between 60 and 70 years old. About 160 to 250 out of 100,000 people in Germany are affected by ulcerative colitis. In Crohn's disease, there are between 120 to 200 per 100,000 inhabitants.
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Thrust digestive problems
Both intestinal diseases have in common that they occur mainly in batches. That is, after periods of relative calm suddenly severe symptoms occur: painful stool urgency, spasmodic pelvic pain, flatulence, nocturnal stool urgency, fatigue or mild fever. Some patients lose their appetite and unwanted weight. Above all, sufferers suffer from diarrhea, ulcerative colitis, he is even often bloody with mucus secretions.
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Similar and yet different
A ulcerative colitis thrust often starts very suddenly, the inflammation affecting large areas of the intestinal wall.The changes caused by the inflammation, however, affect only the upper (mucus) skin layers. Crohn's disease thrust, by contrast, tends to develop gradually. Unlike ulcerative colitis, the inflammation is "discontinuous", it looks rather spotty. And: In Crohn's disease, the changes in the intestinal membrane go much deeper.
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Despite intensive research, the causes of inflammatory bowel disease (IBD) have yet to be clarified. It is believed that an unfavorable interaction of hereditary, psychological, but especially immunological factors leads to the disease. However, several risk factors have been identified, for example, for Crohn's disease, smoking. In both CEDs, stress or heavy stress can fuel a relapse.
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Derailed immune response
Researchers suspect that the immune system's function against intestinal bacteria is disturbed, and the body reacts with an inflammatory response. In ulcerative colitis, the protective mucous membrane is apparently not thick enough, and the germs can attack the intestinal wall. In Crohn's disease, the protective layer does not contain enough antibodies to prevent the bacteria from entering. Both result in local inflammation.
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Colonoscopy provides security
Those affected by chronic intestinal inflammation often have a longer history of suffering. Whether the cause is to be found in the intestine is determined by a colonoscopy. At endoscopy, the doctor visually looks at the intestinal wall (is it flat or only red in places?) And takes samples that will later be examined in the laboratory. In addition, blood, stool and ultrasound examinations are made.
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Therapy for ulcerative colitis
Since the causes of colitis are not known, one can only alleviate the symptoms. For this purpose, anti-inflammatory drugs are used to alleviate the disease and prolong the period of rest between two episodes. Mostly aminosalicylic acid is the drug of choice, in severe relapses also cortisone. If the inflammation can not be controlled with medication, in extreme cases, a part of the intestine can be surgically removed.
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Therapy for Crohn's disease
Also in Crohn's disease, aminosalicylic acid is used to control local inflammation. In severe episodes, the doctor also administers cortisone. If there is a bacterial infection, antibiotics are used. In Crohn's disease, surgical interventions are more often required, for example, in which chronically constricted areas in the intestines are eliminated or severely affected intestinal sections are removed.
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Rest breaks, but no cure
Neither ulcerative colitis nor Crohn's disease are curable so far. The aim of the therapy is to extend the rest periods in which the patient has no discomfort as long as possible. These remission phases can sometimes last for years.
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Increased colorectal cancer risk
People with a chronic inflammatory bowel disease have an increased risk of colorectal cancer. That's why it's important for patients to be regularly screened for malignant changes in the gut.
Ulcerative colitis: treatment
Since the causes of ulcerative colitis are not yet known exactly, the disease can not be treated causally and heal. Anti-inflammatory drugs, however, can alleviate a colitis ulcerative spurt and extend the periods between bouts. The majority of patients can be treated on an outpatient basis. Only in severe cases, a hospital stay is necessary.
In ulcerative colitis, medications work best directly at the site of the inflammatory process in the intestine. The possible side effects are then least. If this is not possible, the preparations have to be used (systemically) via the bloodstream. According to the German Society for Digestive and Metabolic Diseases, the following medicines are currently in question:
5-ASA preparations (5-aminosalicylic acid)
These drugs, used to treat ulcerative colitis, are encapsulated. As a result, they dissolve after oral intake (as a capsule) specifically at the end of the small intestine or first in the colon. As a suppository or as an enema preparation, the active ingredients reach only the lower part of the colon. This treatment should be continued for at least two years after the inflammation subsides, in order to delay a new impulse or to maintain a symptom-free condition. Mesalazine is the drug of choice.
For severe relapses and failure of 5-ASA therapy, cortisone (for example, prednisolone) is used to treat ulcerative colitis. The active ingredient is administered in the form of tablets. If only the rectum is affected, cortisone can also be given as a suppository or enema.
Means that slow down the immune system (immunosuppressants)
Immunosuppressants (eg, azathioprine or cyclosporin A) are used in chronic ulcerative colitis, for example, when cortisone is not effective enough, causes too high side effects, or can not be used for any other reason.
Escherichia coli Nissle
In the case of mesalazine intolerance, the ingestion of non-pathogenic bacteria (Escherichia coli Nissle) may prolong the disease-free intervals.
Some drugs for the treatment of ulcerative colitis are still in the trial phase. Professional societies recommend not using these medicines outside of studies. These include the use of antibiotics in combination with anti-inflammatory drugs, the local application of growth factors (epidermal growth factor), various antibodies and extracts of frankincense, which have a newly discovered pathway anti-inflammatory and thus could be used in ulcerative colitis. Homeopathy is not very important in the treatment.
For ulcerative colitis diets, there are no specific requirements to maintain a resting phase of ulcerative colitis. However, many suffer from specific deficiencies such as anemia, iron deficiency, folic acid deficiency or reduced bone density (osteopenia). In case of deficiency symptoms, missing vitamins or trace elements must be supplemented in addition to normal food.
Therapy of an acute disease episode of ulcerative colitis is increased in stages - depending on how severe the episode is. The more frequently the bloody diarrhea occurs, the higher the body temperature rises and the more pronounced the malady is, the more massively must be treated. The following classification with the corresponding measures applies:
- Light thrust: 5-ASA preparation (5-aminosalicylic acid) as a capsule or suppository or enema
- Moderate push: additional cortisone tablets
- Heavy thrust: Drugs and nutrient solutions via an infusion solution (drip)
In some cases, ulcerative colitis is no longer controlled by medication. In this case, or if colon cancer or precancerous lesions have been proven, surgery is inevitable. This will remove the entire colon. New surgical techniques allow the small intestine to form a kind of artificial rectum, which later takes on the function of the distant rectum. This way you can avoid an artificial intestinal exit.
In certain emergency situations, which can not be controlled with the help of medication, ulcerative colitis must be operated on immediately. These may include extreme relapses, toxic megacolon, or persistent bleeding.
What you can do yourself
The occurrence of ulcerative colitis can not prevent the person affected. At the first sign of blood in the stool the doctor should be consulted. If you are already ill, a timely doctor's visit and appropriate therapy can shorten your relapses and reduce your severity. Bed rest should be maintained during a severe acute colitis ulcerative episode. Then the usual everyday life can be resumed. In addition, in the context of ulcerative colitis therapy, it often makes sense to seek psychological counseling. In it, the patient is shown ways to deal with the disease and to integrate it into everyday life.
Read more about the investigations
- stool examination
Ulcerative colitis: disease course and prognosis
Like the onset, the course of the disease in ulcerative colitis is unpredictable. Individually, different periods of rest (remission phases) can occur before a new ulcerative colitis occurs. The respective complaints can be different.
In about 85 percent of those affected, the disease is bumpy, that is, the ulcerative colitis symptoms are replaced at irregular intervals by symptom-free periods. The phases without discomfort can last for several years, and a new boost can then suddenly start again without any visible trigger. In about ten percent of all those affected no remission phases occur.
Scientifically, a distinction is made between four phases in the disease process:
- Acute push: Complaints such as bloody diarrhea or painful, but futile, bowel movements occur here.
- Fulminant thrustNot only is it characterized by bloody diarrhea, but it is also characterized by general malaise, fever, accelerated heartbeat, and weight loss.
- Chronically active course: persistent symptoms despite drug therapy; Although the drugs cause an improvement, but no complete and permanent (<2 relapses per year) normalization of the condition.
- Remission phases: Sections without complaints.
Depending on the spread of the inflammation, the prognosis for ulcerative colitis also decides. Curable, the disease is basically not. If it is confined to the end of the colon and the rectum, sufferers have a good prognosis with a normal life expectancy.
However, if it comes in the course of a colon cancer (cancer), the life expectancy is significantly limited, if this is not recognized in time. Therefore, from the tenth year of the disease regular (usually once a year) colonoscopies with tissue sampling (biopsies) should be performed. With a surgical or a drug therapy sufferers can lead an almost normal life. A therapy of Ulcerative colitis 5-ASA supplements can reduce cancer risk by almost 75 percent. Also, folic acid is currently being tested for this possibility.
Read more about the therapies
These laboratory values are important
- bile acid