Ulcerative Colitis

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Ulcerative colitis is one of the forms of irritable bowel disease (IBD) as like Crohn’s disease. Ulcerative colitis is an inflammation of the colon, in which there is inflammation of the mucosa of the colon leading to ulcer formation and open sores.

Ulcerative colitis is one of the forms of irritable bowel disease (IBD) as like Crohn’s disease. Ulcerative colitis is an inflammation of the colon, in which there is inflammation of the mucosa of the colon leading to ulcer formation and open sores.

The most indicating feature of the ulcerative colitis is diarrhoea mixed with blood.

Ulcerative colitis does not show a regular form of symptoms it is an intermittent kind of disease. There are some periods where the patient is absolutely free from symptoms and some periods where there are exacerbated symptoms.

Ulcerative colitis involves only large intestine compared to the second form of irritable bowel disease i.e. Crohn’s disease which involves any part of intestines.
It is rare that ulcerative colitis involves the terminal ileum part; it affects terminal ileum only when there is a defect in the ileocecal valve.

PATHOPHYSIOLOGY
T cells play a very important role in the path physiology of ulcerative colitis. In ulcerative colitis, lamina propria is the attacking structure of the colon where T cells accumulate. These T cells play a cytotoxic role against the epithelium of colon. Along with T cells, there is infiltration of B cells and plasma cells on the colonic epithelium.

In, ulcerative colitis there is acute and chronic infiltration of the lamina propria, crypt branching and atrophy of villous. Findings also show abscesses in the colon walls and inflammation of the crypts of Lieber Kuhn. The goblet cells release mucus. In chronic stages, the ulcerated areas are covered with granulated tissue.

Due to this, there is the formation of pseudopolyps.
Cases of ulcerative colitis show increased the amount of the colonic sulfate-reducing bacteria in the colon. These colonic bacteria’s are responsible for producing hydrogen sulphide gas in the colon which can be a cause for the formation of ulcerative colitis but not confirmed till now.Classification of Ulcerative Colitis

The extent of disease tells the severity of symptoms. Extent of disease classifies the disease in two forms and are as follows
• Extensive colitis; there is involvement of entire colon. There are very severe symptoms at this stage.
• Distal colitis; when involvement is limited up to rectum then it is termed as proctitis.
• When involvement includes rectum as well as sigmoid colon then it is termed as proctosigmoiditis.

Races affected by Ulcerative Colitis

Prevalence of ulcerative colitis is seen more in northern countries and northern areas of individual countries.
Prevalence is present in all type of races of the world.

Age / Sex groups affected by Ulcerative Colitis

Can occur or affect an individual of any age group but people with low immunity are more prone to suffer from ulcerative colitis.
Females and males are equally affected.
Individuals having the family history of irritable bowel disease are at higher risk of suffering from ulcerative colitis.

Causes of Ulcerative Colitis

Ulcerative colitis can occur due to number of causes as follows
• Genetic causes; in cases of ulcerative colitis, there is seen chromosomal instability. If there is a family history of irritable bowel disease then the patient is at higher risk of a developing ulcerative colitis. On chromosomes, there are multiple regions which are responsible for the development of ulcerative colitis and Crohn’s disease. Such genes are also involved in the development of cancer of colon and rectum.

The individuals who possess genetically susceptible genes for development of ulcerative colitis show derangement in the cell mediated immunity against the normal commensal bacteria’s of the intestine. This lead to the inflammation of the mucosal layer of the colon forming the disease named as ulcerative colitis.

• An auto immune response of the body; in patients where the auto immune response of the immunity is active, the colon can be one of the organs to be attacked by the auto antibodies. In such cases, no sure cause of development of ulcerative colitis is found only there is present increased amount of auto antibodies in the blood leading to the destruction of body’s own healthy cells.

• Environmental factors; as the colon is in contact with many dietary products as the colon is a major part of the digestive tract. When these dietary products enter the colon and come in contact with the mucosa these dietary products contain the certain type of substances in them to which some individuals are reactive and this reaction leads to inflammation of the mucosa of the colon. Some common dietary products  which are associated with the formation of ulcerative colitis are as follows
• Vitamin B 6
•  Meat protein
•  Alcoholic beverages
• Sulphur restricted diets
• Accutane
•  Unsaturated fatty acids

• Breast feeding; breast feeding can reduce the risk of developing ulcerative colitis.
• Psychological stress is a great factor involved in the development of ulcerative colitis.
• Milk intake can lead to increase in the formation of ulcerative colitis.
• The smoking cause is involved in Crohn’s disease the comparatively to ulcerative colitis play no role.

Ulcerative Colitis Signs and Symptoms

Ulcerative colitis symptoms depend on the severity of the disease and the area of colon and rectum involved by disease.
• Loose stools mixed with blood and mucus.
• Regular loss of blood leads to the anaemic condition.
• Pain in the abdomen before and after passing stools.
• There are painful abdominal cramps.
• Fever may be an additional symptom.
• Weight loss.
• Nausea and vomiting.
• Some other associated symptoms are knee pains.
• Ulcers on skin and mucosa of the mouth.
• Pain in joints with swelling.

Ulcerative colitis also involves extra intestinal features and that is as follows depending upon the organs involved
• In mouth; ulcers on tongue, lips or buccal mucosa.
• Eyes; inflammation of iris termed as iritis, another inflammation is episcleritis (inflammation of sclera).
• On skin; erythema nodosum ( inflammation of the subcutaneous tissue of the extremities ), painful ulcers ( pyoderma gangrenosum )
• Clubbing feature is seen on the ends of a finger.
• Inflammation of the bile duct is also seen with ulcerative colitis known as primary sclerosing cholangitis.
• On musculoskeletal system; sacroiliitis (inflammation of the lower spine region), ankylosing spondylitis.

Differential diagnosis of Ulcerative Colitis

• Crohn’s disease.
• Colon polyposis syndrome.
• Colon polyps.
• Diverticulitis of colon.
• Adenocarcinoma of a colon.
• Gastroenteritis due to bacteria.
• Infectious colitis.
• Rectal cancers and carcinomas.
• Trauma to the intestines.
• Toxicity of mega colon.
• Ischemia of mesenteries.
• Tuberculosis of gastrointestinal tract.

Homeopathic treatment for Ulcerative Colitis

Arsenic album
• Well indicated medicine for ulcerative colitis.
• Stools are small, offensive, and dark with marked prostration.
• The patient complains of dysentery which is offensive, dark and bloody.
• Patients complain of the urge to pass stools immediately after eating, drinking and stools are worse at night.
• There is cholera with marked prostration, intense agony and present with burning thirst.
• Diarrhoea worse after eating spoiled meat and alcoholic abuse.

Ferrum metallicum
• There is the passage of undigested stools at night.
• The patient complains of the ineffectual urging of stools which are hard followed by a backache and cramping like pain in the rectum.
• Well indicated medicine for prolapsed and.
• Children complain of itching of anus.
• The patient is intolerant to eggs.
• There is pressure and distension in the stomach after eating.
• When patient just attempted to eat diarrhoea sets in.

Mercurius corrosiveness
• The patient complains of dysentery and tenesmus not relieved by stool.
• Stools are hot, bloody, slimy, and offensive, with cutting pains in rectum and shredding of mucus membranes of the intestinal canal.
• The abdomen is bloated and very painful to touch.
• The patient suffers from ulcerative colitis. There is bruised sensation at the caecal region, and transverse colon is painful.

Nitricum Acidum
• The patient complains of violent cutting pain after stools.
• There are haemorrhages from the bowels which are profuse and bright red in colour.
• The patient complains of haemorrhoids which bleed easily.
• Diarrhoea is slimy and offensive.
• Colic in the abdomen is relieved by binding tight cloth on the abdomen.
• The patient complains of violent cutting pain in rectum after stools and the lasting for hours.

Nux vomica
• Urge for stool is felt throughout the abdomen.
• Diarrhoea occurs after a debauch, worse morning time.
• The patient complains of frequent small evacuation.
• The patient complains of a long history of dysentery, stools relieve pain for some time.
• The patient feels constant uneasiness in the rectum.
• Diarrhoea occurs with jaundice.

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