Update: December 2018
Ulcerative colitis (NUC) is chronic.
gastrointestinal tract disease of recurrent nature, in which inflammation
the mucous membrane of the large intestine, on which ulcers and
areas of necrosis.
Clinically, ulcerative colitis is manifested by bloody diarrhea,
arthritis, weight loss, general weakness, abdominal pain,
This disease increases the risk of developing colorectal cancer.
More on ulcerative colitis of the intestines – symptoms and treatment
diseases we will tell in this article.
Causes of Ulcerative Colitis
The etiology of the disease is not fully understood, scientists
are still intensely searching for the true causes
ulcerative colitis. However, the main factors are known.
risk for the disease, which include:
factors. If a person in the family suffered from a relative
ulcerative colitis, the risk of its occurrence increases.
- The effect of infection. The intestine is a place where they constantly live
various microorganisms that can lead to inflammation
in the intestinal mucosa.
- Аутоиммунные factors. Inflammation caused by mass death
cells containing antigens.
- Influence of inflammatory factors (released during immune
response, when the complex is formed antigen – antibody).
- Among the causes of ulcerative colitis, scientists also highlight
stressful factors and malnutrition.
American experts conducted a large-scale study and
found that the fungi in the intestines of a person are associated with
inflammatory bowel disease (Crohn’s disease and ulcerative
colitis), reports the Los Angeles Times. Experiments on
rodents, allowed scientists to prove the connection between those in their
intestine over 100 species of various fungi and ulcerative colitis
The presence of fungi in mammals activates
leukocyte production of dectin-1 protein. In the case when the mice
the body could not produce it, the mice become more
susceptible to the development of ulcerative colitis than healthy them
brethren. Moreover, the use of antifungal drugs allows
soften the course of this disease in rodents.
In humans, dektin-1 is encoded by the gene CLEC7A, based on these
research revealed that in the presence of the mutant form of this gene
the patient had ulcerative colitis that is not amenable to traditional
methods of treatment (diet, NSAIDs, corticosteroids).
Mutations in the CLEC7A gene contribute to the emergence of more severe
forms of colitis, since this gene is associated with other factors
affecting inflammation, and antifungal treatment
in this case helps to improve the patient’s condition.
Symptoms of ulcerative colitis
There are major symptoms of ulcerative colitis associated with the gastrointestinal tract.
(intestinal manifestations) and extra-intestinal symptoms.
The main intestinal symptoms of NUC are:
- Diarrhea with blood
Diarrhea with blood and mucus (and sometimes even with pus) is
the main diagnostic sign of the disease. Sometimes highlighting
blood, mucus and pus occurs spontaneously (not during
defecation). The frequency of bowel movements in patients with NUC is different – from
several times a day up to 15 – 20 times (severe cases). Frequency
stools worse morning and night.
- Abdominal pain
Pain can also have varying degrees of intensity – from weak
to sharp pronounced, accompanied by extreme discomfort. More often
total pain is localized in the left half of the abdomen. Strong
abdominal pains that are not controlled by the use of analgesics,
are a sign of the onset of complications of the disease.
- Temperature rise to subfebrile indicators.
- Other signs of intoxication: weakness, weight loss,
poor appetite, frequent dizziness.
- False urge to act of defecation (tenesmus). Sometimes a patient
it is possible to extract instead of feces only a fragment of mucus or mucus from
pus (a symptom of “rectal spitting”).
- Bloating (flatulence).
- Possible fecal incontinence.
- Sometimes a patient вместо диареи появляется запор, который
is a sign of pronounced inflammation of the mucous membrane
- The likelihood of rapid (fulminant, lightning)
development of ulcerative colitis.
This form develops in just a few days, its manifestation
is toxic megacolon (dilation or dilatation of the lumen
large intestine). In this case, the patient rises sharply
temperature, reaching rates above 38 ° C. The patient is weak
is adynamic, rapidly loses weight, he has pains in
abdominal pain, frequent loose stools with copious mucus,
blood and pus, pain in the abdomen. In the terminal stage of NUC
tachycardia occurs, blood pressure decreases,
oliguria. The patient has bloating and soreness in the abdomen,
intestinal noise is not heard. Neutrophil is noted in the blood.
leukocytosis, on the radiograph visible enlarged colon (her
diameter greater than 6 cm). Dilatation of the colon due to
an increase in nitric oxide, which increases contractile
функцию гладких мышц intestine. Excessive expansion of the thick
intestine dangerous perforation of its wall (rupture).
Extraintestinal manifestations of NUC
They occur infrequently – just 10 – 20% of patients. To them
- Skin lesions in the form of erythema nodosum and gangrenous
pyoderma, which is associated with the presence in the blood of elevated concentrations
bacterial antigens, immune complexes, cryoproteins.
- Symptoms of oropharyngeal lesions. Occur in 10% of patients. They
associated with the emergence of aphtha-specific lesions on the mucous
the oral cavity, the number of which decreases as the transition
disease in remission.
- Damage to the eyes (occur even less often – only 5–8% of cases),
they appear: uveitis, episcleritis, conjunctivitis,
retrobulbar neuritis, keratitis, choroiditis.
- Articular lesions. Inflammatory processes in the joints are
nature of arthritis (most common), sacroiliitis,
spondylitis. These lesions can be combined with pathology.
intestinal or precede the main symptoms of ulcerative
- Pathology of the bone system in the form of: osteoporosis (increase
bone fragility), osteomalacia (softening of the bones), aseptic
and ischemic necrosis.
- The defeat of the pulmonary system (occurs in 35% of patients
- The defeat of the pancreas, liver and biliary tract.
These changes are due to endocrine disruption.
- The rarest extraintestinal symptoms of ulcerative colitis
The intestines are: vasculitis, myositis and glomerulonephritis.
Ulcerative colitis has an acute phase and a remission phase. Begins
the disease first gradually but quickly gaining momentum when
signs of ulcerative colitis become more pronounced.
Sometimes the symptoms subside, but then re-intensify. With
the ongoing treatment of the disease takes on the character of a recurrent
chronic ulcerative colitis, whose symptoms subside with
prolonged remission. Frequency рецидивов у больных неспецифическим
ulcerative colitis often does not depend on the degree of damage
bowel, and from maintenance treatment (nonsteroidal
anti-inflammatory drugs, antibacterial, antiviral
During the acute phase of the disease, the large intestine looks like this:
there are hyperemia and swelling of his mucous membrane, intestinal appear
bleeding and ulcers. The remission process on the contrary is accompanied by
atrophic changes in the mucous membrane – it becomes thinner,
its function is disturbed, lymphatic infiltrates appear.
Diagnosis of the disease
The diagnosis and treatment of ulcerative colitis is handled by a specialist.
therapeutic profile or gastroenterologist. Suspicion
the disease causes a complex of relevant symptoms:
- diarrhea with blood, mucus and pus
- abdominal pain; arthritis
- eye disorders against the background of general intoxication
of the body
- In general, the blood test in a patient with ulcerative colitis is noted.
anemia (decreases the number of red blood cells and hemoglobin), there is
leukocytosis. In the blood test for biochemistry, an increase
blood levels of C – reactive protein, which is
indicator of the presence of inflammation in the human body. Besides,
the concentration of albumin, magnesium, calcium decreases, increases
the number of gamaglobulin, which is associated with active development
- In the immunological analysis of blood in most patients
there is an increase in cytoplasmic concentration
anti-neutrophil antibodies (they appear due to abnormal
- In the analysis of the patient’s feces of ulcerative colitis, blood is noted, pus
and mucus. Pathogenic microflora is seeded in feces.
Instrumental diagnostics NUC.
Endoscopy (rectosigmoidoscopy, colonoscopy (preparation)
reveals in the patient a complex characteristic of the disease
- swelling and hyperemia, granular nature of the mucous membrane
- contact bleeding
- the presence of pus, blood and mucus in the intestinal lumen
- in the remission phase marked atrophy of the mucous
оболочки толстого intestine.
Colonoscopy may be partially replaced by capsular endoscopy.
(“video videos”) in the near future, it will be conducted by
patients who, because of the painfulness of the procedure and discomfort
refuse to perform colonoscopy. However capsular
endoscopy will not replace traditional endoscopic examination,
since the image quality is inferior to direct visualization.
Withмерная стоимость такой капсулы будет составлять порядка 500
X-ray examination is also effective.
методом диагностики язвенного colitis. With этом в качестве контраста
used barium mixture. On the x-ray of the patient NUC
marked expansion of the intestinal lumen, the presence of polyps, ulcers,
shortening the gut. This type of examination allows you to prevent
Ulcerative Colitis Treatment
Etiological treatment that can affect the cause
ulcerative colitis does not exist. Disease treatment wears
symptomatic, it is aimed at: elimination of the process
inflammations maintaining remission and preventing occurrence
complications. If drug therapy does not give effect, the patient
Surgical treatment is indicated.
Among the conservative methods of treatment of NUC emit:
Diet therapy. During periods of exacerbation the patient is recommended
refrain from meals. You can drink only water. During the period
remission patient is recommended to reduce the amount of diet
fat and increase the protein content (lean fish and meat, cottage cheese,
eggs). It is recommended to abandon coarse fiber,
которая может травмировать нежную слизистую intestine. As
Carbohydrates are recommended: cereals, honey, jellies, jellies,
berry and fruit compotes and decoctions. Patient is recommended
vitamins: A, K, C, as well as calcium. In severe cases
artificial food is recommended – parenteral and
NSAIDs (nonsteroidal anti-inflammatory drugs) salofalk,
mesalazine, sulfasalazine and corticosteroids – prednisone,
metiprednisolone. The dosage of drugs is selected by a doctor in
Antibiotics. With обострении заболевания также рекомендованы
antibiotics: ciprofloxacin, cyfran, ceftriaxone, thienam.
Surgical treatment of ulcerative colitis is indicated for patients
conservative methods don’t help. Indications for surgery at
ulcerative colitis are:
- perforation (perforation of the intestinal wall);
- signs of intestinal obstruction;
- the presence of toxic megacolon;
- profuse bleeding;
- рак intestine.
The main types of surgery are:
- Colectomy (excision of the colon).
- Proctocollectomy (removal of rectum and colon) with
preservation of the anus.
- Proctocolectomy followed by ileostomy. With этом
rectum and colon are excised and then superimposed
Ileostomy (permanent or temporary) through which
удаление естественных отходов из of the body человека. Further
the patient is undergoing reconstructive surgery, ileostomy
remove and restore the natural path of defecation.