In this video we will learn more about ulcerative colitis, an important inflammatory disease that affects the intestine and which in Italy affects about 60 to 70 individuals for every 100,000 people.
Ulcerative colitis is a chronic inflammatory disease, which mainly affects the mucous membranes of the terminal tract of the intestine, ie the rectum and more or less extensive parts of the colon. It would therefore be more correct to speak of ulcerative rectum-colitis. As the name of the disease suggests, this inflammation of the intestinal wall causes real ulcerations; these are small lesions that struggle to heal and that cause bleeding and overproduction of mucus. Then there are bouts of diarrhea accompanied by abdominal pain and watery stools with traces of mucus and blood; in addition, there may be fever, general weakness associated with anemia and weight loss. Ulcerative colitis is a chronic disease characterized by an intermittent course; therefore periods of exacerbations, with aggravation of symptoms, are interspersed with others of remission, which last for months or years.
The underlying causes of this inflammatory process are not yet well defined; a multi-factorial origin was hypothesized, therefore dependent on multiple concomitant factors, with an important autoimmune component. Ulcerative colitis can occur in patients of any age, but it generally affects young adults with a peak incidence between the ages of 25 and 40. As for the treatment, I anticipate that we cannot yet speak of a real cure; however, several drugs are now available that can alleviate the typical symptoms of ulcerative colitis and induce remission even for long periods. In cases refractory to drug therapy, however, a surgical approach may need to be considered.
As we have anticipated, the exact causes of ulcerative colitis are not yet known, although the involvement of genetic, immunological and environmental factors is hypothesized. The most probable hypothesis is that in genetically predisposed subjects a triggering factor, such as the infection of a specific microorganism, or particular dietary habits, activates an exaggerated immune response with autoimmune mechanisms; in practice, abnormal antibodies would be produced that attack the cells of the intestinal mucosa, identifying them as dangerous and therefore deserving of an immune attack.
The most common symptoms of ulcerative colitis are bloody and mucous diarrhea, associated with abdominal pain and cramps. The faeces are therefore liquid and mixed with more or less abundant traces of blood and mucus. In the acute phases, other symptoms may occur, such as fever, general weakness, joint pain, weight loss and urgency to defecate associated with "tenesmus", ie a feeling of incomplete evacuation. Other times, the exacerbations are so violent that the numerous diarrheal discharges, the onset of fever and the possible dehydration make urgent hospitalization necessary, to give the patient an intravenous rehydrated therapy. Sometimes, intestinal inflammation can be associated with simultaneous inflammatory states affecting other organs, such as liver, eyes and skin. In rare cases, ulcerative colitis can have a severe course, with marked anemia due to chronic blood loss and motor paralysis of the colon. One of the most feared complications is certainly toxic megacolon, that is an abnormal dilation of the colon that exposes it to the risk of perforation; this eventuality is accompanied by severe abdominal pain, bloody diarrhea that worsens over time, severe signs of dehydration, tachycardia and fever. If not treated adequately, the chronic inflammation that accompanies ulcerative colitis can lead over time to irreversible changes, with the possible development of cancerous lesions. In this regard, it should be noted that extensive and chronic ulcerative colitis is associated with an increased colon cancer risk.
Ulcerative colitis can be suspected based on the symptoms described by the patient; the suspicion can then be reinforced by the results of blood and stool tests, which in the presence of ulcerative colitis show an inflammatory picture of the organism; these tests also allow to exclude intestinal infections or parasites. However, the certainty is obtained only through the execution of instrumental tests. Among these, the reference diagnostic procedure is colonoscopy, completed by a histological examination performed on the biopsies. This investigation, in fact, allows the endoscopic observation of the intestinal wall, thanks to which the doctor can appreciate the lesions and the extension of the inflammatory process. As anticipated, during the colonoscopy it is possible to take samples of the intestinal mucosa, on which the subsequent microscopic analysis may show typical alterations and exclude other inflammatory bowel diseases, such as Crohn's disease. Other tests, such as abdominal and bowel radiography or ultrasound, provide information on the location of ulcerative colitis, as well as on the possible development of complications.
The treatment of ulcerative colitis depends on the extent of the inflammation. The goal is to control diarrhea and bleeding, as well as reduce inflammation. Mild or moderate forms can be treated by administering topical anti-inflammatories, such as mesalamine or aminosalicylates. In severe cases, however, treatment with corticosteroids and immunosuppressants is used, which act by modulating the immune response. Biological drugs, such as inflixima, are instead indicated in cases refractory to other therapies. Infliximab is a monoclonal antibody that selectively blocks one of the fundamental factors of the inflammatory response: TNF-alpha. If ulcerative colitis does not improve with drug therapy or complications have developed, then surgery to remove the diseased colon may be necessary.
