Ulcerative Colitis

Agenda

Revising the digestive system

Understanding Inflammatory Bowel Disease (IBD)

Learning about Ulcerative Colitis

Digestive system

IBD affects the digestive system. Before we learn about the disease lets revise the parts of the digestive system

Large intestine

One form of IBD, ulcerative colitis affects only the large intestine

The parts of the large intestine are important to remember

In order these are parts of the large intestine

Ascending colon

Transverse colon

Descending colon

Sigmoid colon

Rectum

Inflammatory Bowel Disease(IBD)

IBD refers to recurrent chronic diseases that cause inflammation of the intestines

There are two main types of IBD

Ulcerative colitis (UC)

Crohn’s disease (CD)

Normal Colon Inflamed Colon

Difference between CD and UC

UC affects only the large intestine

CD can affect any part of the gastrointestinal tract. But most frequently attacks terminal ileum and colon

Approx. 15% of patients have signs that falls between UC and CD (indeterminate colitis)

Ulcerative colitis (UC)

It is a type of IBD

Affects only the large intestine

Rectum is always involved in ulcerative colitis

Always starts in rectum

The inflammation is in a continuous stretch

For instance if ulcerates colitis affects the descending colon, then there will be inflammation in the descending colon, sigmoid colon and rectum

7

Ulcerative colitis (UC)

Out of the four layers in the wall of the large intestine, the inflammation involves the mucosa and submucosa

The mucosa look ulcerated and granular

With a severe attack, the mucosa becomes hemorrhagic (bleeds easily) & ulcerated

8

UC can be divided into 5 types based on the how of the large intestine is affected

Proctitis

Proctosigmoiditis

Distal colitis

Extensive colitis

Pancolitis

Distribution of the subtypes of UC in India

In patients with UC have

Pancolitis (entire colon) 42.8%

Left sided colitis 38.8 %

Proctitis alone in 18.3 %

10

What is the cause of UC? (Pathophysiology)

UC is an autoimmune diseaseMeaning that the immune system is attacking the

body

The exact cause is not yet known

It is known that three factors interact to cause UC They include the immune system, certain genes and

some environmental factors

11

What are the symptoms of UC?

Bloody diarrhea with or without mucus is the hallmark of ulcerative colitis

Diarrhea

Rectal bleeding

Tenesmus

Passage of mucus

Abdominal pain

How is ulcerative colitis diagnosed?

Ulcerative colitis cannot be diagnosed by a single tests

The diagnosis of UC involves the following

History of the patient

Physical examination

Laboratory tests

Endoscopy

Tissue biopsy

Based on the findings of all these investigations a diagnosis of UC can be made

How is ulcerative colitis classified based on severity?

Ulcerative colitis can be classified on the basis of how severe the symptoms are

Based on this the severity is as follows;

Mild

Moderate

Severe

Fulminant

The severity of UC is determined by certain clinical scores

Clinical Score to Determine Severity

>30>30< 30ESR

Transfusion required<75% of normalNormalHemoglobin

>90>90NormalPulse

>37.5> 37.5NormalTemperature (C)

ContinuousFrequentIntermittentBlood in Stool

>10>6 - <10<4Stools (per day)

ESR :Erythrocyte sedimentation rate

MODERATE

>4

Intermittent

Normal

Normal

Normal

< 30

SEVERE FULMINANTMILD

Truelove and Witts Criteria

Depending on the criteria that are fulfilled in the table above, the severity can be determined

Clinical Score to Determine Severity

There are numerous clinical scores to determine the severity of UC

It includes the

Truelove and Witts Criteria

Disease Activity Index

Clinical Activity Index

Endoscopic Index

Histology Index

Research papers often use one of these criteria's to determine the severity of UC

ESR :Erythrocyte sedimentation rate

What is the pattern of UC

UC follows a pattern of remission and flares

Remission is a period in which there are no or few symptoms. In the period the patient free from the disease.

Flare is a period when the symptoms are presents. In the period the disease is active and affects the patient

Goals of Therapy for Ulcerative Colitis

Ulcerative Colitis cannot be cured by medicine

Thus the goals of therapy includes

Inducing remission (Reducing the symptoms of the disease)

Maintaining remission (Maintaining a long symptoms free period)

Restoring and maintaining nutrition

Maintaining patient’s quality of life

What is used to treat UC?

Clinical therapy

Mesalazine/Mesalamine

Corticosteroids

Immunomodulators

Ciclosporin

Infliximab

Surgery

What is the first line of treatment for UC?

Flares

In a flare the goal is to get the symptoms under control as soon as possible

Hence corticosteroids are used along with mesalamine

Remission

In remission safe and effective drugs are used.

Here, mesalamine is preferred and is used in most UC patients

A patient will use other drugs only if they are not responding well to mesalamine

What are the formulations of mesalamine?

Oral Mesalamine

Used for all types of UC

Suppositories

Used for proctitis

Foam enema

Used for proctitis and proctosigmoiditis

Liquid enema

Used for proctitis, proctosigmoiditis and left sided colitis

Learn through videos…

Click play to start