What are the key symptoms of acute severe ulcerative colitis. How is ASUC diagnosed and treated in hospital settings. Who is at highest risk for developing this serious complication of ulcerative colitis. What are the long-term outcomes and prognosis for patients with ASUC.

Understanding Acute Severe Ulcerative Colitis (ASUC)

Acute Severe Ulcerative Colitis (ASUC) is a serious complication of ulcerative colitis, affecting approximately 10-20% of individuals with the condition. Unlike the typical mild to moderate symptoms experienced by most ulcerative colitis patients, ASUC presents as a medical emergency requiring immediate hospitalization and intensive treatment.

ASUC is characterized by a severe flare-up of ulcerative colitis symptoms, including:

• Frequent bowel movements
• Bloody diarrhea
• Rapid heart rate
• Abdominal tenderness
• Fever
• High levels of inflammation
• Anemia

One of the most concerning aspects of ASUC is the risk of developing toxic megacolon, a potentially life-threatening condition where the colon becomes severely dilated and at risk of perforation.

Diagnosis and Initial Management of ASUC

When a patient presents with symptoms suggestive of ASUC, prompt diagnosis and treatment are crucial. The diagnostic process typically involves:

1. Blood tests to assess inflammation levels and anemia
2. Stool tests to rule out infectious causes
3. Sigmoidoscopy to examine the lower portion of the colon

Upon diagnosis, patients are usually admitted to the hospital for intensive management. The average hospital stay for ASUC treatment ranges from 4.6 to 12.5 days, during which time a multidisciplinary team including gastroenterologists, colorectal surgeons, dietitians, pharmacists, and stomal therapists collaborate to provide comprehensive care.

Initial Treatment Approaches

The primary goals of ASUC treatment are to end the flare, control symptoms, and induce remission. Initial management typically includes:

• Intravenous fluid administration to address dehydration
• Intravenous steroid medications as first-line treatment
• Close monitoring of vital signs and symptoms

Healthcare providers aim to stop rectal bleeding and diarrhea while promoting the return of normal bowel movements. It’s important to note that rehospitalization is common in ASUC patients, highlighting the challenging nature of the condition.

Advanced Treatment Options for ASUC

While intravenous steroids are the initial treatment of choice, they are not effective for all patients. In fact, 30-40% of ASUC patients do not respond adequately to steroid therapy. Moreover, prolonged steroid use (over 10 days) can increase the risk of complications.

If steroid treatment fails to produce improvement within 3-5 days, healthcare providers may initiate “medical rescue therapy” using immunosuppressive drugs such as:

• Cyclosporine
• Infliximab

These medications aim to suppress the overactive immune response contributing to intestinal inflammation.

Surgical Intervention in ASUC

In cases where medical treatments prove ineffective, surgical intervention may become necessary. A colectomy, which involves the removal of part or all of the colon, may be recommended. Research indicates that patients admitted with ASUC who experience more than eight bowel movements per day and have higher blood inflammation levels have an 85% likelihood of requiring surgery.

Immediate surgical intervention is typically required in cases of colon perforation or toxic megacolon. Delaying surgery in these scenarios can significantly increase the risk of post-operative complications.

Emerging Treatments

Ongoing research is exploring new treatment options for ASUC. One promising area involves Janus kinase (JAK) inhibitors, which target specific enzymes that are overactive in ASUC. Early studies have shown potential in reducing the need for colectomy surgery, but further research is needed to establish their efficacy and safety in ASUC management.

Risk Factors and Demographics of ASUC

Understanding who is at highest risk for developing ASUC can aid in early detection and management. Key demographic and risk factors include:

• Age: ASUC commonly appears between ages 34 and 48
• Gender: Men are at higher risk of requiring colectomy
• Time since UC diagnosis: 54% of ASUC cases occur within 1 year of initial UC diagnosis
• Age at UC diagnosis: Patients diagnosed before age 40 tend to have a more aggressive disease course

Additional factors associated with increased ASUC risk include:

• Presence of large or deep ulcers on the colon
• Higher levels of inflammation
• Early prescription of steroid medications in the disease course

Long-Term Prognosis and Outcomes of ASUC

The long-term outlook for patients with ASUC is complex and varies significantly between individuals. Some key prognostic factors include:

• 20% chance of requiring colectomy after first ASUC hospitalization
• 40% chance of requiring colectomy after second ASUC hospitalization
• 1% risk of death associated with severe flares
• Increased mortality risk with age (over 10% in patients over 80 compared to less than 2% in patients aged 50-59)

It’s crucial to note that while these statistics provide a general overview, individual outcomes can vary greatly based on factors such as overall health, response to treatment, and adherence to management plans.

Prevention and Management Strategies for ASUC

While preventing ASUC entirely may not always be possible, there are strategies that can help reduce the risk and improve overall management of ulcerative colitis:

1. Regular medical check-ups to monitor disease activity
2. Adherence to prescribed medications and treatment plans
3. Prompt reporting of any changes in symptoms to healthcare providers
4. Maintaining a healthy lifestyle, including a balanced diet and regular exercise
5. Stress management techniques, as stress can exacerbate symptoms
6. Avoiding known triggers, such as certain foods or medications

Implementing these strategies can help maintain better control over ulcerative colitis symptoms and potentially reduce the risk of developing ASUC.

The Role of Patient Education in ASUC Management

Educating patients about ASUC and its management is crucial for improving outcomes. Key areas of focus should include:

• Recognizing early warning signs of a severe flare
• Understanding the importance of prompt medical attention
• Knowing what to expect during hospitalization and treatment
• Learning about potential complications and how to minimize risks
• Understanding the long-term management of ulcerative colitis to prevent future ASUC episodes

Healthcare providers play a vital role in ensuring patients are well-informed about their condition and equipped with the knowledge to make informed decisions about their care.

Future Directions in ASUC Research and Treatment

As our understanding of ASUC continues to evolve, researchers are exploring new avenues for improving diagnosis, treatment, and long-term management. Some promising areas of research include:

• Development of more targeted biological therapies
• Improved predictive models for identifying patients at high risk of ASUC
• Personalized medicine approaches based on genetic and microbiome profiles
• Novel drug delivery systems for more effective local treatment of inflammation
• Refinement of surgical techniques to improve outcomes and quality of life for patients requiring colectomy

These ongoing research efforts hold the potential to significantly improve the prognosis and quality of life for patients with ASUC in the coming years.

The Importance of Multidisciplinary Care in ASUC

Managing ASUC effectively requires a coordinated effort from a diverse team of healthcare professionals. This multidisciplinary approach typically involves:

• Gastroenterologists: Specialists in digestive system disorders who oversee overall treatment
• Colorectal surgeons: Experts who can intervene if surgical management becomes necessary
• Dietitians: Professionals who help manage nutritional needs during and after ASUC episodes
• Pharmacists: Experts in medication management to optimize treatment efficacy and minimize side effects
• Stomal therapists: Specialists who provide care and education for patients who may require ostomy surgery
• Mental health professionals: Providers who address the psychological impact of ASUC and chronic illness

This comprehensive care model ensures that all aspects of a patient’s health are addressed, from acute medical management to long-term wellness strategies.

Nutritional Considerations in ASUC

Proper nutrition plays a crucial role in managing ASUC and supporting recovery. During acute episodes, patients may require:

• Total parenteral nutrition (TPN) to provide essential nutrients intravenously
• Enteral nutrition through a feeding tube to support healing of the intestinal lining
• Carefully planned reintroduction of oral foods as symptoms improve

Long-term nutritional management for ASUC patients may involve:

• Identifying and avoiding trigger foods
• Ensuring adequate intake of essential nutrients, particularly in patients with malabsorption
• Supplementation of vitamins and minerals as needed
• Consideration of probiotics to support gut health

Working closely with a dietitian can help patients develop a personalized nutrition plan that supports their recovery and overall health.

The Psychological Impact of ASUC

Experiencing an episode of ASUC can have significant psychological effects on patients. Common challenges include:

• Anxiety about future flares and potential complications
• Depression related to the impact of the condition on daily life
• Body image concerns, particularly for patients who require ostomy surgery
• Stress related to managing a chronic condition and frequent medical interventions

Addressing these psychological aspects is crucial for comprehensive care. Strategies may include:

• Referral to mental health professionals specializing in chronic illness
• Participation in support groups for patients with inflammatory bowel disease
• Teaching stress management and coping techniques
• Providing resources for patients to learn more about their condition and feel empowered in their care

The Economic Burden of ASUC

ASUC not only impacts patients’ health but also carries a significant economic burden. Factors contributing to the cost of ASUC include:

• Extended hospital stays, often in specialized units
• Expensive medications, including biologics and immunosuppressants
• Potential surgical interventions and associated recovery periods
• Lost productivity due to illness and recovery time
• Long-term follow-up care and management of potential complications

Understanding these economic implications is important for healthcare systems, insurers, and policymakers to ensure appropriate resources are allocated for the care of ASUC patients.

Global Perspectives on ASUC Management

While the general principles of ASUC management are similar worldwide, there can be variations in approach based on regional factors such as:

• Availability of specific medications and treatments
• Healthcare system structure and access to specialized care
• Cultural factors influencing patient preferences and treatment decisions
• Local guidelines and treatment protocols

Ongoing international collaboration and research help to standardize care and ensure that patients worldwide have access to the best possible treatments for ASUC.

The Role of Telemedicine in ASUC Care

While ASUC requires in-person hospital care during acute episodes, telemedicine is playing an increasingly important role in the overall management of ulcerative colitis, including:

• Remote monitoring of symptoms to detect early signs of flare-ups
• Virtual follow-up appointments to adjust treatment plans
• Providing patient education and support between in-person visits
• Facilitating communication between patients and their healthcare team

As telemedicine technologies continue to advance, they may offer new opportunities for improving the care and outcomes of patients at risk for ASUC.

Pediatric Considerations in ASUC

While ASUC is often associated with adult patients, it can also affect children with ulcerative colitis. Pediatric ASUC presents unique challenges, including:

• Potential impact on growth and development
• Considerations for medication dosing and side effects in children
• Psychosocial effects on school performance and social interactions
• Long-term implications for health and quality of life

Specialized pediatric gastroenterology teams are essential for managing ASUC in children, ensuring that treatment approaches are tailored to the unique needs of young patients.

The Importance of Ongoing Research in ASUC

Continued research into ASUC is crucial for improving patient outcomes. Current areas of focus include:

• Identifying biomarkers to predict ASUC risk and treatment response
• Developing new targeted therapies with improved efficacy and safety profiles
• Investigating the role of the gut microbiome in ASUC development and management
• Refining surgical techniques to minimize complications and improve quality of life
• Exploring potential preventive strategies to reduce ASUC incidence in ulcerative colitis patients

Ongoing clinical trials and basic science research hold the promise of transforming ASUC care in the coming years, offering hope for improved outcomes and quality of life for patients facing this challenging condition.

Acute Severe Ulcerative Colitis: How Is It Treated?

Written by Jodi Helmer

• What Is Acute Severe Ulcerative Colitis?
• How Is Acute Severe Ulcerative Colitis Treated?
• Who Is at Risk for Acute Severe Ulcerative Colitis?
• What Are the Long-Term Outcomes for Acute Severe Ulcerative Colitis?

For the 907,000 Americans with ulcerative colitis, living with symptoms like urgent bowel movements, abdominal cramps, and loose or bloody stools can be overwhelming, but treatments can help keep symptoms in check.

Ulcerative colitis is a chronic disease, and most people have mild to moderate symptoms (called flares) that alternate with periods of remission. Between 10% and 20% of people with ulcerative colitis will have a more aggressive form of the disease called acute severe ulcerative colitis.

Acute severe ulcerative colitis (ASUC) is a serious complication of ulcerative colitis. It’s diagnosed when the disease flares and causes frequent bowel movements and bloody diarrhea, rapid heart rate, abdominal tenderness, fever, high levels of inflammation, and anemia. Inflammation in the intestinal wall makes the colon swollen and dilated, causing the stomach to become bloated. This is linked to a risk of developing toxic megacolon, the most serious complication of colitis.

ASUC is considered a medical emergency, and you’ll probably be hospitalized to help manage the disease. Without treatment, ASUC could be life-threatening.

ASUC is a challenging condition to treat. Once you’re admitted to the emergency room, you’ll get a series of tests, including blood tests, stool tests, and an exam of your bowel called a sigmoidoscopy. You’ll also get intravenous fluids to boost hydration.

The average hospital stay for ASUC treatment ranges from 4.6 to 12.5 days. During this time, your health care providers may include a gastroenterologist, colorectal surgeon, dietitian, pharmacist, and stomal therapist. The goal of hospitalizing you is to end the flare, get your symptoms under control, and put the disease into remission. Your doctors will want to make sure that rectal bleeding and diarrhea have stopped and normal bowel movements have returned. Rehospitalization is common.

Intravenous steroid medications are the most common treatment for ASUC. For 30% to 40% of ASUC patients, steroid treatments don’t work – and taking steroid medications for more than 10 days increases your risk of complications.

If the steroids don’t help within 3 to 5 days, your health care team will start “medical rescue therapy” with immunosuppressive drugs like cyclosporine or infliximab.

You might get an operation to remove part (or all) of your colon, called a colectomy, if your ASUC doesn’t respond to steroids, immunosuppressants, or other medical treatments.

Research shows that patients who were admitted to the hospital for ASUC with symptoms that included more than eight bowel movements per day and higher levels of inflammation in their blood had an 85% likelihood of needing surgery.

If you have complications like a perforation of the colon or toxic megacolon, surgery will be the first treatment. Delaying surgery could increase your risk of complications following the operation.

Researchers have explored whether medications called Janus kinase (JAK) inhibitors, which block certain enzymes that are overactive in ASUC, could help treat the disease and decrease the number of patients who needed colectomy surgery. The study showed promising results, and research is ongoing.

Most diagnoses of ulcerative colitis are in men between the ages of 15 and 35. The disease course for ASUC can be harder to predict, but it commonly appears between ages 34 and 48.

There is data showing that 54% of those who developed ASUC get it within 1 year of their UC diagnosis; 18% developed ASUC within 1 to 5 years of their initial diagnosis; and 28% were diagnosed with ASUC more than 5 years after their UC diagnosis.

Additional studies show that those who were diagnosed before the age of 40 had an aggressive disease course, had large or deep ulcers on their colons, higher levels of inflammation, were prescribed steroid medications earlier in their disease, and were at a higher risk of severe disease, including ASUC. Men were at higher risk of needing a colectomy than women.

The long-term outlook for ASUC is guarded. There is a 20% chance that you’ll need colectomy surgery after your first hospitalization, but that chance rises to 40% after two hospital admissions for ASUC. Severe flares are linked to a 1% risk of death.

Older age is linked with higher death rates. The death rate from ASUC is over 10% in people over 80 compared to fewer than 2% for people between the ages of 50 and 59.

UC is a chronic disease with no cure. Developing acute, severe symptoms is a risk for up to 20% of those diagnosed with the disease. With hospitalization, medical management, and a knowledgeable health care team, you can recover from a bout of ASUC and go into remission, but new flares are possible.

Top Picks

Management of acute severe ulcerative colitis

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Ulcerative colitis – symptoms, causes, treatment

This ailment has recently become more common, and not only among the elderly, but also among young people. If earlier “the stomach” complained mainly of the townspeople, today the disease “captures” the rural areas as well. What are the reasons and how to deal with the situation?

Natalya Timchenko, doctor-gastroenterologist of OKDC, head of the Gastroenterological Diagnostics Center, Candidate of Medical Sciences, answers these questions.

– Natalya Alekseevna, it’s no secret that the effectiveness of any disease treatment directly depends on early detection and competent, timely diagnosis. What symptoms should alert a person and tell him that it is time to consult a specialist in order to detect an ailment at an early stage?

– The manifestations of ulcerative colitis and their severity vary greatly. In some patients, quite a decent state of health has been maintained for many years, and the disease manifests itself only with an admixture of blood in the stool. Such patients often associate this symptom with hemorrhoids, refuse a full examination and are addicted to self-medication. Others, on the contrary, from the very beginning of the development of ulcerative colitis are hospitalized with repeated bloody diarrhea, fecal incontinence, high fever, abdominal pain, palpitations and general weakness.

The most specific symptoms of ulcerative colitis are: blood, mucus and pus in the feces, diarrhea or vice versa, constipation, which often indicate an inflammatory lesion of the lower parts of the colon. Sometimes patients experience false urge to empty the bowels, nocturnal bowel movements, fecal incontinence, bloating and pain in the left side of the abdomen.

In severe and widespread inflammation, fever, vomiting, heart palpitations, weight loss, dehydration, loss of appetite appear. In 10% of cases, in addition to the mentioned intestinal and general symptoms, extraintestinal manifestations occur: articular lesions, various rashes on the skin and mucous membranes, for example, in the mouth, lesions of the liver and bile ducts; thrombus formation.

– The symptoms are, frankly, unpleasant. The question immediately arises – why did the disease arise and how to avoid it …

– Despite numerous scientific studies, all the causes of ulcerative colitis of the intestine have not yet been established. It has been suggested that the disease can be provoked by some unidentified infection, although ulcerative colitis is not contagious, or an unbalanced diet with a lack of fiber, genetic mutations, drugs – certain non-hormonal anti-inflammatory drugs, as well as stress and changes in the intestinal microflora. The trigger for ulcerative colitis can be dysbacteriosis; sedentary lifestyle; diet poor in dietary fiber and rich in carbohydrates; dysbacteriosis; neuropsychic overload.

– Is it possible to take some preventive measures in this case…

– Methods of prevention are well known. It is necessary to eat right, avoiding too fatty, spicy and salty foods, not to abuse alcohol, lead a mobile lifestyle, without exposing yourself to unnecessary stress, physical and mental overload. And at the slightest discomfort and pain, I recommend immediately contacting a competent specialist in order to establish an accurate diagnosis and develop an individual treatment strategy.

– What is included in the mandatory standard of gastroenterological examination today?

These are primarily instrumental types of examination. Gastroscopy and colonoscopy. Diagnostic gastroscopy and colonoscopy are performed in the OKDC using high-tech video information systems of the expert class “EVIS EXERA 2” and “EVIS EXERA 3” complete with video endoscopes with narrow-spectrum and magnification functions, as well as video archiving of the identified pathology.

The equipment of the endoscopic department of the OKDC allows to significantly expand the possibilities of diagnostics – to obtain an image of the smallest details, to identify and classify structural changes in the mucous membrane of internal organs, so as not to miss the tumor pathology.

Our specialists perform a wide range of endoscopic examinations and manipulations:

• video esophagogastroduodenoscopy (VGDS) – assessment of the condition of the mucous membrane of the esophagus, stomach and duodenum;

• videocolonoscopy (VCS) – assessment of the condition of the colon mucosa;

Serious attention is paid to the morphological diagnosis of detected endoscopic pathology. In almost 100% of studies, a mucosal biopsy is performed for cytological and histological studies, and express tests are carried out.

Endoscopic tissue biopsy for gastrointestinal examinations is usually taken from any suspicious site. This is the standard that allows you to identify early gastrointestinal cancer and treat it successfully. If cell degeneration is detected at the very beginning, then their early endoscopic removal without surgery is possible.

– Is it possible to cope with the disease without surgery?

In the treatment of ulcerative colitis, both conservative and surgical methods are used, the choice depends on the patient’s condition and the nature of the course of the disease.

Drug treatment of ulcerative colitis is based on the use of anti-inflammatory, nonsteroidal drugs. In addition, patients are shown the use of symptomatic painkillers, physiotherapy: interference therapy, diadynamic therapy.

After the period of exacerbation of the disease has passed, the patient must take anti-inflammatory drugs for another six months. Then a follow-up colonoscopy is performed. If there are no inflammatory processes on the colonic mucosa, then the treatment process is completed.

Diet is important in the treatment of ulcerative colitis. If the disease is severe, then during its exacerbation, the patient is recommended to completely refuse food and drink only water.

An ulcerative colitis diet during an exacerbation is needed to reduce irritation of the intestinal mucosa and to stop diarrhea. Foods that contain fiber and dietary fiber, as well as sour and spicy foods, coarse foods, and alcoholic beverages should be excluded from the diet. Since the inflammatory process in the large intestine leads to depletion of the body, the diet for ulcerative colitis outside the period of exacerbation involves the use of high-calorie, protein-rich and vitamin-rich foods. You need to eat at least six times a day in small portions.

Spices, sauces, fried and fatty foods, raw vegetables and fruits are excluded from the diet. Be careful with dairy products. Allowed: fish, lean meat (turkey, beef, rabbit, chicken) in boiled and baked form, cereals, soups on low-fat fish and meat broth, eggs, rice, potatoes, jelly, jelly from various fruits and berries, dried bread, cottage cheese souffle. You can drink black coffee, tea, cocoa on the water, decoctions of bird cherry, wild rose, blueberries. And only in cases of ineffective conservative treatment, surgical intervention is used.

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Ulcerative colitis / Diseases / Clinic EXPERT

Ulcerative colitis is a severe chronic disease characterized by erosive and ulcerative lesions of the colon mucosa, progressive course and frequent development of complications (bleeding, perforation, narrowing of the lumen, etc. ). The second name of this disease is non-specific ulcerative colitis (NUC).

Clinical trial of patients with bowel disease is being recruited

Clinic EXPERT invites you to participate in a long-term phase II study to evaluate the efficacy and safety of the drug in patients with moderate or severe inflammatory bowel disease.

More details

Membership: 58 weeks.

We welcome patients aged 18 to 65 with:

• Crohn’s disease
• ulcerative colitis.

In order to participate in clinical trials, a patient must meet the criteria set by the drug company. If you are interested in this study, sign up for an initial paid evaluation consultation with a gastroenterologist Kharitonov A.G. or to the gastroenterologist Sokolova K.S. to determine if you can participate. Participants in the study are guaranteed free examinations, specialist consultations and treatment with drugs from the pharmaceutical company.

You can contact us by phone 8 (812) 426-35-35:

• Mon-Sat: from 09-00 to 21-00
• Sun: from 09-00 to 16-00.

The causes and origin of ulcerative colitis of the intestine have not yet been determined, despite the study and research on this topic.

Symptoms

The symptoms characteristic of ulcerative colitis can be divided into three groups:

• general
• intestinal
• extraintestinal

General symptoms

These are manifestations of the disease on the part of the whole organism as a whole, are not specific for ulcerative colitis and occur in many diseases: cervical symptoms

These are various disorders in bowel function, such as:

• diarrhea
• in rare cases – constipation
• blood and mucus in the stool
• “false” urges, imperative (urgent) urge to defecate
• pain in the abdomen (more often pain occurs in the left iliac region, but can spread throughout the abdomen)
• bloating, rumbling of the abdomen.

If these symptoms appear, it is recommended to be tested to rule out ulcerative colitis.

Extraintestinal manifestations of the disease

The disease has manifestations from other organs, which may appear before symptoms from the intestines.

These are changes from outside:

• skin (rashes, pustules on the skin)
• oral cavity (sores in the oral cavity)
• eyes (pain, pain in the eyes, redness of the eyes, lacrimation and photophobia, decreased vision, discoloration of the iris)
• joint damage ( pain, swelling, redness, stiffness of the joints)
• damage to the liver and biliary tract (yellowing, itching of the skin)
• other conditions (anemia, including iron deficiency, malnutrition).

Exacerbations of ulcerative colitis are manifested by frequent stools, increased body temperature and laboratory parameters (ESR, C-reactive protein).

The following degrees of severity of exacerbation are distinguished:

Mild

• stools with blood less than 4 times a day
• pulse, temperature, hemoglobin and ESR are normal.

Moderate

• stools with blood more than 4 but less than 6 times a day
• pulse not more than 90 bpm less 105 g/l
• ESR above normal, not higher than 30 mm/h

Severe

• stool with blood more than 6 times a day
• pulse more than 90 bpm
• body temperature more than 37.5 C
• hemoglobin less than 105 g/l
• ESR more than 30 mm /hour.

Mild to severe attacks can be treated in outpatient/day hospital settings. With a severe attack, hospitalization is necessary.

In severe forms, patients are recommended to undergo mandatory examination and treatment in a hospital, since any diagnostic, therapeutic procedures and interventions can have serious complications with a risk of death.

With any severity of the disease, you should immediately contact a gastroenterologist for help, as a mild attack can worsen to severe at any time, which is a life-threatening situation.

Diagnosis

The EXPERT Clinic has developed a clear algorithm for diagnosing ulcerative colitis. Necessary comprehensive examination includes:

Laboratory methods

• The infectious nature of the disease is excluded: the patient’s feces and blood are examined for bacteria, viruses, protozoa and fungi.
• clinical, biochemical blood tests, coprogram
• immunological screening for inflammatory bowel diseases (blood for ASCA, pANCA)
• feces for calprotectin (reflects the presence of inflammation in the intestine)

Instrumental studies

90 088

Sigmoidoscopy with biopsy. It is very important to assess the condition of the mucosal surface, as well as to perform a biopsy with further examination of a piece of mucosa by a morphologist.

Important! The volume of the necessary examination can only be determined by a gastroenterologist.

Treatment

Ulcerative colitis is a fairly serious disease that can progress (abruptly or gradually) /. Some patients initially have resistance to the drugs used or it develops during treatment, and life-threatening complications are possible.

Depending on the specific clinical situation, the following are used in the treatment:

• preparations containing 5-acetylsalicylic acid. Both in the form of tablets, granules or capsules, and in the form of dosage forms for administration into the rectum (suppositories, ready-made enemas or foams)
• corticosteroids in the form of tablets, regular or rectal (introduced through the anus), infusions
• immunosuppressants
• biological therapies.

All types of drug therapy must be prescribed and monitored by a gastroenterologist, because:

• these drugs have serious side effects on other organs and systems
• some patients have initial resistance or gradually develop resistance to drugs

EXPERT Clinic adheres to the principle of stages in treatment.

At the first stage, a treatment plan is drawn up, which includes:

• regimen
• diet
• selection of basic therapy with 5-aminosalicylic acid preparations
• if necessary – antibacterial drugs, pre- and probiotics, since exacerbation of ulcerative colitis in most cases is accompanied by severe intestinal dysbiosis

At the second stage, the effectiveness of the therapy is evaluated:

• clinical symptoms become less pronounced, then the regimen and diet expand, a date for a second visit to the doctor is set.
• If there is no improvement in well-being during the therapy, the issue of prescribing stronger drugs (systemic and local glucocorticoids, cytostatics, biological therapy) is decided. However, it should be noted that in case of a very severe course of the process, these drugs can be prescribed immediately, at the first stage of treatment.

The third stage of treatment is carried out after achieving a stable remission.

It is a scheme to gradually reduce the doses of prescribed drugs to maintenance.

Even after achieving the long-awaited remission, the patient is advised to be attentive to himself and regularly see a gastroenterologist, as the risk of disease recurrence is high.

Virtually all patients need to take their doctor’s recommended anti-relapse medication. Some drugs help reduce the risk of developing colon cancer.

Prognosis

Ulcerative colitis is a severe chronic disease that worsens over time without adequate treatment, symptoms become more pronounced, exacerbations are longer and more frequent, and there is a high probability of complications (rupture of the intestinal wall, intestinal bleeding).

Patients with ulcerative colitis have a significantly increased risk of developing bowel cancer. In this regard, long-term maintenance treatment is often prescribed.

At the moment, it is impossible to cure ulcerative colitis with the help of drugs, however, properly selected therapy in most cases allows achieving a stable and long-term remission of the disease.

If you have any of the symptoms listed above (abdominal pain, diarrhea, blood or mucus in your stool), you should seek immediate medical attention.

Remember that it is very important to start treatment in the early stages of the disease, as in advanced cases, as a rule, long-term, difficult and expensive therapy is required.

Recommendations

To prevent the development of the disease, as well as relapse, it is necessary to adhere to a correct, balanced and regular diet – avoid fast food, canned, flavored foods, fried, smoked; It is recommended to eat at the same time. It is important to protect yourself from stressful situations.

During the period of exacerbation, patients are recommended a sparing diet that meets the following requirements:

• elimination of coarse fiber (raw vegetables, berries, fruits, nuts, seeds, poppy, sesame, bran, legumes, etc.)
• foods are steamed or boiled
• warm foods are rubbed or (for constipation) boiled vegetables are grated on a coarse grater
• chemical irritants of the intestinal mucosa are excluded (spicy, salty, pickled, sour foods)
• high-protein foods are recommended (lean meat, turkey, low-fat river fish, egg white, soy products, cottage cheese, etc.)
• special therapeutic food mixtures sold in pharmacies (Modulen, etc.).

In order to prevent relapses, all patients are recommended to consult a gastroenterologist once a quarter for the necessary correction of drug therapy.

Frequently asked questions

Can ulcerative colitis be cured?

Ulcerative colitis is a chronic autoimmune disease. The body produces antibodies against the mucosa of its own colon, as a result of which the mucosa is damaged. What causes the production of these antibodies is still not known. Without knowing the cause, it is impossible to find a cure for it.

Thus, the available drugs are aimed at reducing the intensity of the inflammatory process, allow achieving remission, but cannot completely cure the disease.

The only possible cure is surgical treatment (removal of the colon). Indications for surgical treatment of ulcerative colitis are the low effectiveness of conservative therapy or the impossibility of its continuation, intestinal complications of ulcerative colitis (toxic dilatation, intestinal perforation, intestinal bleeding), as well as colon cancer or a high risk of its occurrence.

What causes disease?

For what reasons this disease develops is still not exactly known.

A significantly higher incidence of ulcerative colitis among the urban population, in contrast to the rural population, has been established. It is assumed that genetic predisposition and environmental factors (ecology, malnutrition, stress) play a role in the occurrence of the disease.

Is the disease a contraindication to pregnancy?

Ulcerative colitis is not a contraindication to pregnancy, however, before planning it, it is important to achieve a stable remission of the disease, it is necessary to conduct a series of examinations, as well as select medications that can be used during pregnancy.

Can ulcerative colitis present with constipation?

Ulcerative colitis may present with constipation due to rectal spasm due to inflammation. It is recommended to undergo a complete examination to exclude this pathology.

Is there an increased risk of getting ulcerative colitis if a close relative has the disease?

Having a relative’s ulcerative colitis increases your risk of having the disease.

Treatment histories

Case №1

Patient N., 23 years old, turned to the gastroenterologist of the EXPERT Clinic with complaints of pain in the lower abdomen before defecation, mushy stools up to 4-5 times a day with an admixture of scarlet blood, general weakness .

At the beginning of her illness, when the patient noticed blood in the stool, she tried to treat herself, assuming that it was hemorrhoids, but without effect. Over time, the situation worsened, and the state of health worsened: general weakness increased, the number of bowel movements increased to 5-6 per day, the pain intensified. She called an ambulance several times, underwent rectoscopy and colonoscopy. According to the results of the research, the mucosa of the rectum, sigmoid colon is inflamed, bleeding, with multiple erosions. The patient was prescribed a course of anti-inflammatory drugs. The state of health remained the same, the girl began to notice an increase in body temperature up to 37.2 C, lost weight by 9kg.

In the EXPERT Clinic, the examination was carried out in stages: a thorough examination of the skin, tongue, measurement of temperature, height, weight, palpation of the abdominal cavity. Then – general clinical tests, the results of which revealed iron deficiency anemia, in the coprogram – a large amount of mucus and erythrocytes. The doctor ruled out an infectious process: no harmful bacteria were found in the feces. The patient underwent rectoscopy, FGDS, abdominal ultrasound. Based on the results of the entire examination, a diagnosis of ulcerative colitis, acute course, and intestinal dysbacteriosis was made. The doctor also noted HP-associated superficial gastritis, and the first stage of gallstone disease.

The patient consulted an experienced nutritionist: given the severity of the inflammation, she was explained the diet, indicated the permitted and prohibited foods and how to prepare them. The gastroenterologist prescribed drugs to restore the mucous membrane of the stomach and intestines, normalize the outflow of bile, iron preparations to eliminate anemia. Given the presence of intestinal dysbacteriosis with the growth of opportunistic flora, a course of intestinal antibiotics and probiotics was prescribed.

After a week of treatment and diet, the patient’s condition improved, and after two months all symptoms gradually disappeared.