Ulcerative colitis
Ulcerative colitis is an idiopathic bowel disease. It is the inflammatory condition of the digestive tract. Along with Crohn’s disease, it
is included commonly in Inflammatory Bowel Disease (IBD). Marked by inflammation in the mucosa and sub mucosa of large intestine (colon) and
the rectum.
Incidence rate:
Age: It can occur at any age but it is more common in 2nd and 3rd decades of life.
Sex: Females are affected slightly more often.
Classically, it begins in the rectum and in continuity extends upwards and sometimes it may involve the entire colon.
SYMPTOMS
Symptoms produced by ulcerative colitis depend upon the area in which it affects. If only rectum then there will be rectal bleeding.
- Loose stool mixed with blood is the characterstic symptom of ulcerative colitis.
- Weakness caused by recurrent bloody diarrhea.
- Some develop constant desire to pass stool.
- When whole of the colon is affected there is extensive bloody diarrhea, fatigue, abdominal cramps, weakness and night swetting.
- Dehydration and shock due to loss of vital fluids.
- Anemia due to severe blood loss.
- Tenesmus is felt in the rectum.
POSSIBLE CAUSES
While the cause of ulcerative colitis is still unknown, several, possibly interrelated, causes have been suggested. Some think that the smallest illness
could spark the disease.
Genetic factors:
There is a genetic component to the etiology of ulcerative colitis.
• Aggregation of ulcerative colitis in families.
• In identical twins and dizygotic twins.
Environmental factors:
Many environmental factors contribute to the pathogenesis of ulcerative colitis. They include the following:
• Diet: as the colon is exposed to many dietary substances which may encourage inflammation, dietary factors play an important role in the pathogenesis
of both ulcerative colitis.
• A diet low in fermentable dietary fiber may affect ulcerative colitis incidence.
• Breastfeeding: There have been conflicting reports of the protection of breastfeeding in the development of inflammatory bowel disease.
• There are several other factors too which contribute yo it.
Autoimmune disease:
Some of the studies held also list ulcerative colitis as an autoimmune disease, a disease in which the immune system malfunctions, attacking some part
of the body.
Alternative theories:
Symptoms of the disease may be caused by toxic effects of the hydrogen sulfide on the cells lining the intestine because levels of sulfate-reducing
bacteria are found to be higher in persons with ulcerative colitis which cause increase level of hydrogen sulfide in the intestine.
It may be caused by occlusions in the capillaries of the subepithelial linings, degenerated fibers beneath the mucosa and infiltration of the lamina propria
with plasma cells
FEATURES
(a) Macroscopic features: The characteristic feature is the continuous involvement of rectum and colon without any uninvolved skip areas. Its extent is
usually superficial and confined only to mucosal layers. There are present superficial mucosal ulcers without fissures. Pseudo polyps are usually
present. The muscle layer is thickened due to contraction, producing shortening and narrowing of affected colon with loss of normal haustral folds. There
are present alternate periods of exacerbation and remission.
(b) Microscopically:
1. There is crypt distortion, cryptitis and focal accumulation of neutrophils forming crypt abscesses.
2. There is marked congestion, dilatation and hemorrhages from mucosal capillaries.
3. Superficial mucosal ulcerations are present, which usually doesn’t penetrate into muscle coat and mucosal and sub mucosal layers get inflamed.
4. Width of sub mucosa is reduced.
COMPLICATIONS
1. Toxic mega colon (Fulminant colitis): It is the acute fulminating colitis in which the affected colon is thin walled and dilated and is prone to
perforation and faecal peritonitis. There is deep penetration of the inflammatory cell infiltrate into muscle layer which is disrupted.
2. Perianal fistula formation may occur rarely
3. Carcinoma may develop in long standing cases of ulcerative colitis of more than 10 yrs of duration.
4. Stricture formation almost never occurs in ulcerative colitis.
5. Hemorrhage with melena and exudation with diarrhea is seen occasionally. This causes anemia and loss of plasma protein (Hypoproteinaemia).
6. Fever and leucocytosis are common, due to toxic absorption.
HOMOEOPATHIC REMEDIES
Merc sol., merc cor., sulphur, ferrum phos, nux vomica, phosphorus, hamemalis, ferrum met