Ulcerative colitis

　　The exact cause of ulcerative colitis is not yet known. However, one thing is clear: it is not because the patient has done something wrong that leads to the disease. It is not transmitted from others, and it is not related to smoking or drinking, nor does a tense lifestyle lead to the disease. Then, what are the possible factors?

　　Most studies believe that this is multifactorial, that is, both intrinsic and extrinsic factors act together to cause ulcerative colitis - including the following three possible factors: genetic factors, inappropriate immune response of the body, and certain factors in the environment. This is a monogenic or polygenic disease. Certain triggering factors in the environment may cause a series of reactions that eventually lead to the occurrence of the disease. Regardless of the cause, it activates the human immune system, which attacks foreign invaders, which is the beginning of inflammation. Unfortunately, the immune system does not shut down, resulting in the continuation of inflammation, or the body's immune system attacks its own intestinal mucosa repeatedly, destroying the colonic mucosa and causing the symptoms related to ulcerative colitis.

　　If ulcerative colitis is not diagnosed in time, it may lead to a variety of complications. Common complications include the following several types:

　　1. Intestinal perforation:It is mostly a complication of toxic megacolon, but it can also occur in severe cases. The use of corticosteroids is considered to be a risk factor for intestinal perforation.

　　2. Toxic megacolon:This is a severe complication of the disease, often occurring in patients with the entire colon, with a mortality rate as high as 44%. The clinical symptoms are marked expansion of the intestinal tract accompanied by toxic symptoms, marked abdominal distension, the most obvious expansion site is in the transverse colon, physical examination of the abdomen may have tenderness or rebound pain, and the bowel sounds are significantly weakened or disappeared.

　　3. Large amount of blood in stool:Blood in stool is one of the main clinical symptoms of the disease, and the amount of blood in stool is also an indicator of the severity of the disease, but it is sometimes difficult to quantify absolutely. The large amount of blood in stool referred to here is a large amount of intestinal bleeding in a short period of time, accompanied by an increased heart rate, decreased blood pressure, and decreased hemoglobin, which requires blood transfusion for diagnosis.

　　4. Intestinal stricture:It often occurs in cases with extensive lesions, persistent course, and lasting for more than 5-25 years. The location is mostly in the left colon, sigmoid colon, or rectum. The cause is due to the thickening of the mucosal muscle layer, or the mass formation of pseudopolyps blocking the intestinal lumen. Clinically, there are usually no symptoms, and in severe cases, it can lead to partial intestinal obstruction.

　　5. Colorectal cancer:The opportunity for ulcerative colitis to be accompanied by colorectal cancer is significantly higher than that of the general population of the same age and gender group. It is generally believed that the trend of malignancy and the course of the disease are not related. After 15-20 years of the course of the disease, the risk of malignancy increases by about 1% each year. However, the incidence rate among the Chinese population is relatively low. Patients with ulcerative colitis for more than 10 years should pay attention to the possibility of malignancy.

　　The initial manifestations of ulcerative colitis can take many forms. Bloody diarrhea is the most common early symptom. Other symptoms include abdominal pain, hematochezia, weight loss, urgency, vomiting, and so on. Occasionally, the main manifestation is arthritis, iridocyclitis, liver dysfunction, and skin lesions. Fever is relatively uncommon. Most patients with ulcerative colitis have a chronic, low-malignant course, and in a small number of patients (about 15%), it presents as an acute, catastrophic outbreak. These patients have frequent bloody stools, up to 30 times per day, and high fever, abdominal pain.

　　The signs and symptoms of patients are directly related to the course of the disease and the clinical manifestations. Patients often have weight loss and pale complexion, and during abdominal examination during the active phase of the disease, the colon area often has tenderness. There may be signs of acute abdomen accompanied by fever and reduced bowel sounds, which are particularly obvious in acute attacks or fulminant cases. There may be abdominal distension, fever, and signs of acute abdomen during toxic megacolon. Due to frequent diarrhea, the perianal skin may have abrasions and desquamation. Perianal inflammation such as anal fissure or fistula may also occur, although the latter is more common in Crohn's disease. Digital rectal examination is always painful. The examination should be gentle in cases with perianal inflammation. It is extremely important to examine the skin, mucosa, tongue, joints, and eyes, because if there are lesions in these areas, the cause of diarrhea may be ulcerative colitis.

　　Since there is no clear etiology for ulcerative colitis, there is a certain difficulty in the prevention of the disease, mainly focusing on preventing recurrence.

　　1. The prevention and treatment of colitis must avoid catching a cold, control emotions, and diet is a very important aspect. During the acute phase and remission period of the disease, foods such as beans and bean products, wheat and flour products, garlic, chives, sweet potatoes, salted eggs, cabbage, peanuts, and melon seeds, which are prone to produce gas, should not be eaten. Because once eaten, the gas in the gastrointestinal tract increases, the gastrointestinal motility is affected, which can trigger the disease, even exacerbate the symptoms.

　　2. Persimmons, pomegranates, and apples all contain tannic acid and pectin components, which have astringent and anti-diarrheal effects and can be eaten in moderation.

　　3. Ulcerative colitis patients are often physically weak and have poor resistance, especially the gastrointestinal tract is prone to secondary infections, so they should pay more attention to dietary hygiene, not eat cold, hard, and deteriorated foods, and avoid alcohol and strong spicy seasonings.

　　4. Ulcerative colitis patients should also closely observe their adaptability to various foods, and pay attention to individual differences. If diarrhea worsens after eating some foods that should not affect the intestines, the cause should be found out, the regularity should be explored, and try not to eat them in the future as much as possible.

　　5. Patients should strengthen their physical exercise in their daily life, such as practicing Tai Chi, to strengthen the waist and kidneys, and enhance their physical fitness.

　　6. Pay attention to abdominal warmth.

　　Ulcerative colitis is a lesion on the surface of the intestinal wall, so colonoscopy is the most important examination.

　　1. The colonoscopy shows multiple superficial ulcers in the mucosa, accompanied by congestion and edema. The lesions usually start from the rectum and are diffusely distributed. 2. The mucosa is rough and granular, the mucosal blood vessels are blurred, and they are fragile and prone to bleeding, or may have purulent and bloody secretions. 3. Pseudopolyps can be seen, and the colon pouches often become blunt or disappear.

　　2. Mucosal biopsy tissue examination shows inflammatory reaction, with concurrent signs of erosion, ulcers, crypt abscesses, abnormal gland arrangement, decreased goblet cells, and epithelial changes.

　　3. Barium enema findings: ① Mucosal roughness or fine granular changes. ② Multiple shallow ulcer shadows or small filling defects. ③ Shortening of the intestine, disappearance of colonic pouches, and the lower part showing a tubular shape.

　　4. Surgical resection or pathological anatomy can show macroscopic or histological characteristics of ulcerative colitis.

　　Since ulcerative colitis is a chronic disease that requires long-term treatment, the coordination of nutrition and diet is very important. The general principle is a high-calorie, high-protein, high-vitamin, low-fat, and low-residue diet.

　　1. High calorie and high protein to compensate for the nutritional consumption caused by long-term diarrhea, and the supply can be gradually increased according to the patient's tolerance to digestion and absorption. Generally, calories are provided at a rate of 40 kcal per kilogram of body weight per day. Protein is 1.5 grams per kilogram of body weight per day, with 50% being high-quality protein.

　　2. Ensure an adequate supply of vitamins and inorganic salts to compensate for the nutritional loss caused by diarrhea.

　　3. Limit fat and dietary fiber: Diarrhea often occurs with poor fat absorption, and severe cases may have steatorrhea. Therefore, the amount of dietary fat should be limited, and low-fat foods and cooking methods should be used. For those with steatorrhea, medium-chain triglyceride oils can be used. Avoid eating foods high in刺激性 and fiber, such as spicy foods, sweet potatoes, radishes, celery, raw vegetables, fruits, and刺激性 herbs such as scallions, ginger, and garlic, as well as coarse grains and dried beans.

　　4. Eat less and more often: To reduce the burden on the intestines, supplement the amount of nutritional intake in a way that eats less and more often.

　　5. Dietary arrangement: (1) During acute attacks or before and after surgery, use liquid or low-residue semi-liquid foods, and avoid milk, eggs, and noodles. Vegetables and fruits must be avoided. They can be made into vegetable soup, vegetable puree, juice, jam, and other foods. Low-residue semi-liquid foods can be chosen to contain high-quality protein such as fish, lean meat, and eggs to make soft foods with little oil, such as boiled fish balls, lotus seed porridge, chicken silk dragon beard noodles, and bread; (2) For patients with severe illness who cannot take oral medications, use tube feeding with elemental diet or intravenous nutritional support, and gradually increase oral natural foods as the nutritional status improves.

　　Ulcerative colitis should be treated comprehensively, including general treatment, drug treatment, and surgical treatment.

　　1. General treatment

　　Including rest, eating a low-residue diet, avoiding milk and allergic foods, correcting electrolyte imbalances, supplementing protein, improving overall condition, relieving mental factors, and symptomatic treatment.

　　2. Drug treatment

　　Ulcerative colitis has no specific cure, but it can be treated with drugs to promote the healing of colonic lesions, and can also alleviate symptoms such as diarrhea, rectal bleeding, and abdominal pain. The two basic goals of treatment are to eliminate symptoms and maintain a symptom-free state. The most commonly used drugs are currently divided into the following four categories:

　　(1) Salicylate drugs: These drugs are effective for mild to moderate ulcerative colitis and can also prevent the recurrence of the disease.

　　(2) Glucocorticoids: This class of drugs mainly includes oral prednisone, and intravenous preparations can also be used for severe patients for a short period. Due to its many side effects, it is not recommended as long-term treatment or maintenance treatment.

　　(3) Immune modulators: Suitable for patients who are ineffective or partially effective to aminosalicylic acid drugs and glucocorticoids, and is one of the best drugs for maintenance treatment at present. It can also be used to alleviate or eliminate the patient's dependence on glucocorticoids. When the patient does not respond to other drugs, it may play a role in maintaining the remission of the disease. However, drugs in this class generally start to take effect after about 3 months of use, and some patients are prone to decreased white blood cells.

　　(4) Biological therapy: This is a class of the latest drugs for treating inflammatory bowel disease. Compared to other drugs, it is a drug with higher efficacy, mainly by blocking the 'on/off' switch of intestinal mucosal inflammatory response. This drug takes effect quickly and can achieve long-term mucosal repair, reduce recurrence, and help in steroid withdrawal, as well as maintenance medication during the remission period.

　　3. Surgical Treatment

　　Patients requiring surgical treatment are generally selected for different surgeries based on the extent of the patient's lesions, age, and overall health. The first type of surgery is a colectomy and rectal resection, which can cure ulcerative colitis, but the patient must live the rest of their life with an ileostomy (an opening on the abdomen to excrete waste). Another surgical approach is to remove the colon while retaining the rectum, avoiding ileostomy. This is the process of connecting the small intestine with the anal sphincter muscle within the body, and this type of surgery does not require an external ileostomy and preserves the function of the rectum. Common surgical complications include surgical site infection and recurrent chronic inflammation (cystitis) (18.8%), decreased female fertility (56-80%), pelvic sepsis (9.5%), and an average of 5.2 bowel movements per 24 hours. When medical treatment is ineffective, surgical treatment may be a hope.