Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) chronic non-contagious in which there is inflammation and ulcers in the large intestine (colon) and rectum on its most superficial layer of the mucosa. This process causes symptoms such as diarrhea, bleeding, cramps and fever.

Unlike Crohn's disease, ulcerative colitis usually not affect the full thickness of the intestinal wall and almost never affects the small intestine. The disease typically affects the rectum and sigmoid colon (large intestine order) may extend partially or completely over the remaining large intestine.

Ulcerative colitis usually appears between 15 and 30 years. A minority of those affected suffer their first attack between 50 and 70 years.

Classified according to the extent of affected intestine, ulcerative colitis may be limited to the rectum (ulcerative proctitis) or may affect additional parts of the colon, often with pronounced symptoms. People who develop ulcerative colitis at younger age are more likely to have severe symptoms. The disease can also be classified according to the intensity that affects the segments and can be mild, moderate or severe.

ulcerative colitis

The exact cause of ulcerative colitis is unknown. Previously, it was believed that diet and stress could be among the causes of disease, but now it is known that this can only aggravate the problem, but not cause ulcerative colitis.

One possible cause is a disorder of the immune system. Similarly when the immune system tries to fight an invading virus or bacteria, in this case an abnormal immune response causes it to attack the body's own cells. In this case, the cells of the colonic mucosa and rectum. It is as if the body understand that the large intestine were a foreign body, trying to fight it persistently.

Heredity also appears to play a role in the incidence of ulcerative colitis, since the disease occurs in people who have family members with the disease. However, most people with ulcerative colitis do not have this family history.

Symptoms appear at different times, depending on the patient's body and may never appear, and of a sudden arise, causing concern.

The RCU is presented in three different ways:

It is the most prevalent form of manifestation, which affects approximately 60% of patients.

It occurs in two ways: segmental, affecting mainly the rectum and distal colon (80% of cases), and overall, affecting the entire colon.

It characterized by basic symptoms such as diarrhea and rectal bleeding and less intense and rare systemic manifestations.

During the outbreak or during periods of exacerbation, diarrhea predominant signal is 3 to 5 bowel movements per day.

In the mild form, signs and symptoms of RCU clearly characterize an inflammatory bowel disease with predominant diarrhea, mucus, pus and rectal bleeding.

You can follow abdominal pain with colic, which can be relieved with defecation and sometimes wakes the patient at night. It affects approximately 30% of patients.

Generally, patients with this moderately do not perform all of its activities due to fatigue. They may also have intermittent and moderate fever and periods of anorexia and weight loss.

Usually respond well to treatment.

It is the form lower incidence (10%), characterized by a high number of stools (20 to 30 times) for 24 hours.

There may be intense rectal bleeding and constant high fever. Usually the clinical picture accompanies anorexia, asthenia, paleness and rapid weight loss.

Often the patient must be hospitalized.

Some patients are refractory to medical treatment, requiring sometimes surgical intervention.

The symptoms of ulcerative colitis can be:

Other conditions with symptoms similar to those of ulcerative colitis include Crohn's disease, diverticulitis, irritable bowel syndrome (IBS), colonic cancer and other colitis.

Check a doctor's appointment if you experience a persistent change in your bowel habits or if you have symptoms such as:

Although ulcerative colitis is not fatal in most cases, it is a disease that can be severe and, in some cases, can cause complications.

Experts who can diagnose ulcerative colitis are:

Be prepared for the consultation can facilitate diagnosis and optimize time. This way, you can now get to the consultation with some information:

The doctor will likely make a series of questions such as:

It is also important to take your questions for written consultation, starting with the most important. This ensures that you get answers to all relevant questions before the end query. For ulcerative colitis, some basic questions include:

Do not hesitate to ask other questions, if they occur at the time of consultation.

The diagnosis of UC is based on the evaluation of the patient's medical history, family history and clinical and laboratory specific and non-specific.

There is no specific test to identify assertively if a person suffers or not RCU.

To make the diagnosis, the doctor needs to consider and investigate all symptoms, know the patient's history, do physical exams and order testsclinicians. After assessing all these elements together, the doctor can evaluate and reach a conclusion.

Understand each of the pillars that make up the diagnosis of ulcerative colitis:

Through history will be possible to detail and even experience symptoms that have not yet been realized, and the age of onset and to the severity of symptoms.

Family history can also help in the diagnosis, although not proven heredity disease.

The next step is the physical examination of the patient.

The general health of the patient and malnutrition signs are vital to thediagnosis and therapeutic management of UC.

Through blood tests, can detect changes of the elements ofpresence of inflammation and blood.

Blood tests help to detect the presence of anemia, low red blood cell counts, and the elements (white) of immune defense ..

These blood tests look for the antibodies that are produced by the systemimmune, combating intestinal microbes as part of the processinflammatory.

These markers include perinuclear anti-neutrophil cytoplasmic(PANCA) and anti-Saccharomyces cerevisiae (ASCA). These antibodies are calledbiomarkers.

Many patients with ulcerative colitis have the pANCA antibody in their blood, whilepatients with Crohn's disease have a positive pattern forASCA. However, these antibody tests are not specific.

The survey of fecal calprotectin is an important complementary examinationfurther the diagnosis and monitoring of the RCU. It is a proteinfound in cytoplasmic granules of neutrophils. High concentrations ofcalprotectin in feces are observed in inflammatory bowel diseases (IBD),as Crohn's disease and ulcerative colitis.

high calprotectin levels are also observed in infectious andneoplastic bowel.

Several types of drugs may be effective in treating ulcerative colitis. The type you will take depends on the severity of the disease. Drugs that work well for some people may not work for others, so it may take some time to find a medication that helps you.

The antiinflammatory drugs are often the first step in the treatment of inflammatory bowel disease. But beware, not all anti-inflammatory drugs may be used. Those that can be used, we quote:

These drugs also reduce inflammation, but do so by suppressing the immune system response that begins the process of inflammation. For some people, a combination of these drugs works better than one drug alone. Corticosteroids may also be used in conjunction with a suppressor of the immune system. Immunosuppressive drugs include:

Surgery can eliminate ulcerative colitis. But this usually means removing the colon and rectum, placing the ileum (small intestine) in the abdominal wall, which is coupled to an ileostomy pouch. There is a procedure called ileoanal anastomosis with ileal pouch that eliminates the need to wear a bag to collect feces. The surgeon constructs a bag from the end of his small intestine. The bag is then connected directly to your anus, allowing you to expel waste. The latter, although aesthetically better, presents the risk that there is inflammation in the small intestine (pouchitis), and there are a large number of liquid.

Many people with digestive disorders can benefit from an alternative and complementary therapy. However, they can not replace the use of traditional treatments. Some therapies used include:

Only a doctor can tell what the most appropriate medicine for your case as well as the correct dosage and duration of treatment. Always follow strictly the guidelines of your doctor and NEVER automedique. Do not stop the drug without consulting a doctor before and, taking it more than once or in much larger quantities than prescribed, follow the instructions on the label.

It may be helpful to keep a food diary to have control of what you are eating and what foods make you feel better or worse. If you find that some foods are worsening symptoms, you can try to eliminate them. Here are some suggestions that may help:

Although stress is not a cause of inflammatory bowel disease, it can make your signs and symptoms worse, and trigger crises. To help control stress, try:

Possible complications of ulcerative colitis include:

Most people with ulcerative colitis have remission periods (when the condition is not active) that can last several years. These periods are interrupted by occasional mild symptoms outbreaks. However, some people have the symptoms of ulcerative colitis all the time.

Children can have the same symptoms in adults. In addition, children with the disease may grow more slowly than normal and go through puberty later than expected.

You can not prevent ulcerative colitis, since the causes of the disease are not known.

Reviewed by: João Duda, coloproctologista the Brazilian Society of Coloproctology and specialist My Life Portal - CRM 22961 / PR

Brazilian Association of Ulcerative Colitis and Crohn's Disease

National Institute of Diabetes and Digestive and Kidney Diseases

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