ulcerative colitis (ibd)
TRANSCRIPT
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
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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
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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 %
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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
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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
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