Treatment of ulcerative colitis abroad
Ulcerative colitis corresponds to the diffuse inflammatory process in the large intestine that doesn’t go beyond its mucous membrane. North America, Northern Europe and Australia are those places where colitis has the mostincidences.
The pathology is peculiar with a high mortality level. One of the most harmful complications is large intestine cancer arise because of inflammation.
Causes of ulcerative colitis
Etiology of the disease is still poorly known and exact causes are not yet identified. However, several theories exist as for the illness background. Viral origin of ulcerative colitis is considered to be the leading cause.
Risk factors are:
- Genetic predisposition
- Oral contraceptives administration
Protective factors (those that decrease the risk of ulcerative colitis) are:
- Removal of the appendicitis at a young age
- Daily use of oleic acid (for example, as part of olive oil)
Symptoms of ulcerative colitis
Ulcerative colitis symptoms are differentiated into two groups: intestinal (enteric) and extra-intestinal (abenteric). Intestinal group of symptoms is observed in all patients without any exception.
Key ones are:
- Mixture of mucus and blood in the feces. Sometimes there may be pus.
- Diarrhea, frequency of the stool can reach 20 times a day.
- In elderly patients constipation is more common symptom than diarrhea.
- Mild pain in the abdomen that weakens after stool.
- False desire to defecate.
60% of patients have also extra-intestinal signs of ulcerative colitis that are manifested differently in every patient.
Intoxication syndrome makes body temperature rise. There is a headache and muscle ache, weakness and drowsiness.
Dystrophic syndrome is peculiar with progression of weight loss, deterioration of nutrients absorption, primarily proteins, as it exits with feces.
Ulcerative colitis is able to damage almost all the internal organs and pathogenesis of some of these disorders remains unclear.
Following organs may be involved into the process:
Rarely, an autoimmune damage of blood vessels or kidney smay happen. Some patients can suffer from systemic vasculitis or glomerulonephritis.
Clinical course of the illness can be acute, chronic or cyclical (recurrent). Great danger is coming from the acute form as symptoms are growing rapidly in this case.
Complications of ulcerative colitis
Ulcerative colitis is a dangerous disease with high mortality with following possible complications:
- Perforation of the large intestine (colon) occurs as a result of the inflammatory process when a through hole appears in the abdominal cavity. Complication develops in every fifth patient with a severe course of ulcerative colitis.
- Megacolon is a toxic expansion of colon cavity that occurs in 5% of patients. Mortalitydue to this condition reaches 30%. Mega colon makes the frequency of the stool decrease, the symptoms of intoxication and pain in the abdomen become worse.
- Intestinal bleeding can be very massive, with the release of blood clots through the anus.
- Colon strictures develop during chronic ulcerative colitis and is clinically manifested by intestinal obstruction.
- Polyps in the colon (large intestine) are diagnosed in each third patient with ulcerative colitis. They carry the threat of malignancy (degeneration into cancer).
- Colon cancer often occurs in patients who got sick before the age of 30. The risk of cancer is higher for people with long-term ulcerative colitis, and when a large part of intestinal tract is involved in the pathological process.
Diagnostics of ulcerative colitis
Obvious signs of the illness and also laboratory tests help to suspect ulcerative colitis:
- Anemia, inflammatory markers, reduction in the amount of total protein in the blood
- Released protein and blood (in severe cases) in the urine
- Red blood cells, leukocytes, intestinal epithelium in the feces
Next techniques are applied to confirm the diagnosis:
- Irrigoscopy which is an X-ray examination of the intestine with the introduction of a contrasting agent.
- Colonoscopy is an endoscopic study involving the penetration of instruments and the optical system into the large intestine.
- Biopsy means a sample taken during a colonoscopy is sent for histological examination, which allows not only to confirm the diagnosis, but to establish the severity and duration of the inflammatory process.
Treatment of ulcerative colitis abroad
Ulcerative colitis is treated conservatively starting from a diet eliminating spicy food and dairy. If a patient suffers from a severe form he might be indicated diet with minimum fiber content. This means that a patient has to give preference to the small amount of high-energy food.
Drug treatment is provided with the help of 5-amino-salicylic acid, glucocorticoids, and cytostatics. If they don’t show any effect than antagonists of tumor-alpha necrosis factor are administered. They have to detox patient’s organism, correct anemia and prescribe antibacterial treatment if there are some acute conditions.
Surgery is indicated when:
- There are complications like bleeding or perforation
- Mega colonand conservative treatment is ineffective within three days from the moment of hospital admission
- Intestinal obstruction
- Malignancy is suspected (cancer development)
- Epithelial dysplasia in several tissue samples obtained during biopsy
- Severe course of ulcerative colitis, which is not controlled by conservative methods of treatment
Pathological area of the large intestine is removed during the surgery. Volume and a kind of surgery are determined by a specialist relying on the clinical case, technical and personnel potential of the clinic.
Latest treatment techniques of ulcerative colitis
The aim of new treatment findings is to increase conservative therapy effectiveness, reduce the need in surgery and mortality level.
Lately, new directions of ulcerative colitis treatment have appeared:
- Leukocyteaphaeresis presupposes the purification of blood from activated T cells in order to achieve remission in 20-80% of cases (data reported in different studies). According to data obtained during a research in German hospitals, remission was achieved in 52% of patients that did not respond to azathioprine medication treatment. Another research proved the speed of remission onset depends on the procedure frequency. Thus, when leukocyteaphaeresis was done once a week, remission has set within 22 days on average. Leukocyteaphaeresis three times a week anticipated remission in 7, 5 days.
- As recent research has shown, interferon alfa pegylated use in a dose of 0.5 μg / kg allows remission in 60% of patients on condition of daily injections for 12 days.
- Alikaforsen medicine was in Phase III clinical trials in 2016. This desensitizing oligodeoxynucleotide inhibits the activity of leukocytes provoking the inflammatory process in the large intestine.
- Bacterial recolonization of the intestine is used to increase the duration of remission. Bacterial cultures, mainly E. colinissle and Lactobacillus acidophilus, are introduced into the human intestine orally or in the form of enemas. Facts prove fecal bacteria therapy (the introduction of feces of a healthy person to a sick person using an enema). It is assumed that the mechanism of therapeutic influence is caused by competition arising between pathogenic and opportunistic bacteria.
- Helminthes therapy is a new direction still being explored. Leading developments are done in USA. A person is infected with helminthes that otherwise are not able to reproduce in his body. According to one of the studies of the University of Iowa (USA), infection of a human with Trichurissuis eggs allows achieving a stable remission in 70% of cases.
Prognosis for ulcerative colitis
Prognosis here depends on the severity of the illness and about 20% of patients require surgical treatment. General mortality within 25 years after the diagnosis is 40%.
Risk of colon cancer within 10 years reaches 5-10% and 15% within 30 years in these patients.
The highest risk of malignancy is noticed if total intestinal damage present throughout its extent. In such patients, the probability of cancer is 35% within 10 years.
Severe form of ulcerative colitis has the worst prognosis and lethal outcome reaches 30% while acute attacks.