Ulcerative colitis
Ulcerative Colitis is a chronic inflammatory, immunologic and gastrointestinal disease characterized by acute seizures and alternately remissions. It manifests itself within the entire colon itself or only in parts of it.
In most cases, the rectum is involved. Occasionally, a wound occurs in the final part of the small intestine. The disease is limited to the colon and its sub-mucous. Unlike Crohn's, in Colitis the inflammation is restricted to the superficial mucous layer without any involvement of the deeper layers of the intestinal wall.
There is still no cure for the disease, but proper adjustment of the medication is needed, taking it on a regular basis, combined with adjusting the diet and maintaining a healthy and relaxed lifestyle, can help most patients go into remission from the disease and can lead to a normal and good quality of life.
Causes
The exact causes of Colitis are not certainly known yet, but it has been strongly linked to psychosomatic causes such as stress or trauma. Other possible causes include nutritional deficiencies, genetics, bacterial or parasitic infections, food allergies, antibiotics and NSAIDS (Nonsteroidal anti-inflammatory drugs).
The cause of the disease
Colitis manifests in wave patterns - from seizures to full state of remission. The symptoms of the flair appear to depend on the location of the inflammation inside the colon. For example: Proctitis(inflammation that is focused only on the rectum), is more pronounced in bleeding and tenesmus (a constant need to visit the bathroom but without stool), and less in diarrhea.
Pancolitis: a form of Ulcerative Colitis which affects the entire large intestine and whose symptoms include diarrhea, abdominal pain, fever, weight loss, and anemia.
The inflammation that forms along the colon is continuous and mainly involves the lining of the intestine. Most often, it begins with the anus (known as "Proctitis"), which spreads deeper into the colon.
Symptoms
The main symptoms of Colitis are blood in the stool, diarrhea (sometimes with mucous), pain, and cramps in the lower abdomen. In some cases, the patient can develop fever and experience a loss of appetite and weight. If the rectum is involved, the patient may suffer from Tenesmus. Other symptoms include fatigue and weakness (as a result of anemia), hemorrhoids, fluid and electrolyte loss, eye infections, arthritis, and various skin problems.)
In a state of remission, there are no symptoms at all and people feel normal. About 50% of patients have a relatively mild illness, but about 15% experience quite a severe illness. Most sick people will go into remission, although there is a small percentage, 5% to 10% of patients, who will suffer from chronic disease. There is a minority of patients who will undergo colon surgery, usually in the early years of the onset. It is found that after 10 years of having the disease, the risk of surgery is significantly reduced. In some cases, the onset of the disease will be rapid and acute. Sometimes the disease erupts in turmoil. Sometimes a bacterial or parasitic infection of the digestive system (for example, returning from a trip to the Far East or South America) can trigger a colitis attack.
External symptoms
In addition to intestinal disease, other organs and body systems may also be involved:
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Involvement of the liver and bile tract:
1. Slight increase in liver enzymes: Possible causes include inflammation of the small bile ducts, fatty liver, or as a side effect of drug therapy.
2. PSC - Primary Sclerosing Cholangitis- It is important to check and rule out the disease in case of an increase in liver enzymes.
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Musculoskeletal system:
1. Arthritis: In 5% -20% of patients, arthritis or joint pain develops. It is found that the greater the inflamed area of the colon, the greater the risk of arthritis. 2. Osteoporosis: Bone mass depletion is common in 30% -60% of patients. The greater the duration and severity of the inflammation, the more bone-depleting materials are activated. Other causes include Prolonged steroid therapy, inadequate calcium and vitamin D intake in the diet, and a lack of the needed minerals and vitamins, such as vitamin K. Vitamin K affects osteocalcin activation, and therefore its level affects osteoporosis development. Lack of other vitamins and minerals such as vitamin C, boron, magnesium and copper also affect osteoporosis.
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Skin diseases:
Pyoderma Gangrenosum appears in 1% -2% of patients regardless of the stage of the disease.
Erythema nodosum: appears in 2% -4% of patients. This is more common in women. There is a connection between the involvement of the joints and the activity of the inflammation in the bowel.
Other cutaneous effects: Sweet's syndrome apical ulcers in the oral cavity and angular stomatitis.
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Eye infections
Uveitis - appears in 5% to 8% of patients, manifested by eye pain and headaches, secretion of excess tears, blurred vision, and light sensitivity (photophobia). Other eye diseases such as scleritis and episcleritis: There seems to be a connection between their appearance and the inflammation of the colon.
Other possible complications:
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Bleeding
A common complication that can cause anemia due to iron deficiency.
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Toxic colitis
A severe complication in which the intestinal wall is damaged and can cause obstruction and cessation of the bowel, a condition that causes colon swelling and an increase in white blood count. This can cause death and therefore requires immediate treatment.
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Colorectal Cancer
This is the most dangerous complication of ulcerative colitis. Having prolonged inflammation in large areas of the colon increases the risk of tumor progression. Therefore, the risk increases as the duration of the active disease last and the intestinal area affected by the disease is more extensive. However, since most patients are undergoing medical surveillance including early detection of colonoscopy, the disease can be diagnosed at its earliest stages (pre-cancerous changes = mucosal dysplasia).
Conventional treatment
Drug therapy is based on the control of the inflammatory process in the intestinal wall. The first drugs which are given are called - 5 aminosalicylates such as (Mesalazine (Pentasa, Rafassal, Asacol)). If they do not help, or in more severe cases, corticosteroids such as Prednisone or immunosuppressive drugs such as (Sulfasalazine (Salazopyrin), Azathioprine (Imuran, Azopi or Methotrexate) are used. In those cases where the wounds are contaminated, antibiotics are given depending on the contaminant. In addition, there are newer drugs such as (Infliximab (Remicade, Adalimumab, or Humira) based on the anti-TNF component - a protein substance that is secreted in the inflammatory areas and increases tissue damage.
Also, during severe flare-ups of the disease, "intestinal rest" is sometimes applied as part of the treatment while being hospitalized. That includes fasting, intravenous feeding, intravenous medication, and Zonda that drains the gastric acid from the stomach. When the disease is persistent and severe and there no relief is attained using full drug treatment, the option of surgery to remove the patient's intestinal segment and induce drainage of contaminated abdominal wounds (abscesses) should be considered.
Natural treatment
The purpose of natural therapy is first of all to control the symptoms and prevent seizures. Many clinical studies show the importance of nutrition and treatment options using herbs and supplements.
It is known that certain foods can worsen and even cause Colitis. For example, animal protein has a huge impact on inflammation of the gut. During the therapy sessions, I preform adjustment of the diet of each patient according to their specific stage of the disease, while focusing on increasing anti-inflammatory foods and removing allergenic and aggravating ones.
In addition, Colitis can cause poor absorption of essential food ingredients. Therefore, alongside the rich and varied diet that my patients are getting, they are also provided with nutritional supplements to fill up any deficiencies, if needed.
It is important to note that the course of the illness is directly affected by the patient's mental state and therefore mental support and stress reduction are necessary as part of the treatment. During the therapy sessions, I provide the patient with relaxation techniques that are meant to help reduce stress and support thier mental state of mind (such as breathing exercises, guided imagery, meditations, etc).
Nutrition for Ulcerative Colitis
Ulcerative Colitis cannot be cured, but symptoms can be relieved and seizures can be prevented through dietary guidelines that include a balanced menu. Nutritional therapy focuses on strengthening and improving the function of the immune and digestive systems. Intake of foods containing essential omega-3 fatty acids, fruits, and vegetables as sources of antioxidants, vitamins and minerals, and prebiotic foods that may contribute to reducing inflammation, affect the cells' health, reduce oxidation stress and maintain normal bowel activity.
It is also important to adhere to eating habits that include eating small meals at small intervals, prolonged chewing of the food, and avoiding heavy meals. In many cases, there is a direct connection between an allergy or food intolerance and Crohn's. Therefore, it is recommended to perform an elimination diet to identify the allergenic food. In any case, it is recommended to avoid foods that are considered allergic as they may exacerbate the disease.
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