How is acute severe ulcerative colitis diagnosed. What are the key management strategies for acute severe ulcerative colitis. Why is early intervention crucial in treating acute severe ulcerative colitis. How do corticosteroids play a role in the treatment of acute severe ulcerative colitis. What are the potential complications of acute severe ulcerative colitis. When should surgery be considered for patients with acute severe ulcerative colitis. How can the risk of venous thromboembolism be minimized in patients with acute severe ulcerative colitis.

Understanding Acute Severe Ulcerative Colitis: Diagnosis and Classification

Acute severe ulcerative colitis (ASUC) is a potentially life-threatening condition that requires prompt recognition and management. The Truelove and Witts criteria, established in 1954, remain the gold standard for diagnosing ASUC. These criteria include:

• Six or more bloody stools per day
• Body temperature above 37.8°C (100°F)
• Heart rate exceeding 90 beats per minute
• Hemoglobin level below 10.5 g/dL
• Erythrocyte sedimentation rate (ESR) greater than 30 mm/hr

The presence of at least three of these criteria indicates ASUC. How does this classification system help clinicians? By providing a standardized approach to diagnosis, it enables early identification of severe cases, facilitating timely intervention and potentially improving outcomes.

The Montreal Classification: A Modern Approach

While the Truelove and Witts criteria remain essential, the Montreal Classification offers a more comprehensive system for categorizing ulcerative colitis. This system considers disease extent, severity, and age at onset. For ASUC, the Montreal Classification defines it as ulcerative colitis with more than six bloody stools per day, in addition to signs of systemic toxicity.

Initial Management: Hospitalization and Assessment

Upon diagnosis of ASUC, immediate hospitalization is crucial. Why is this step so important? Hospitalization allows for close monitoring, rapid implementation of treatment, and quick response to any complications that may arise. The initial management should include:

1. Comprehensive physical examination
2. Blood tests (including complete blood count, electrolytes, liver function tests, and C-reactive protein)
3. Stool cultures to rule out infectious causes
4. Abdominal X-ray to assess for colonic dilatation or perforation

Is colonoscopy recommended in the acute phase? While it can provide valuable information about disease extent and severity, colonoscopy in ASUC carries risks of perforation and should be performed with caution, if at all.

Pharmacological Interventions: The Role of Corticosteroids

Intravenous corticosteroids remain the cornerstone of initial treatment for ASUC. How effective are they? Studies show that approximately 60-70% of patients respond to this therapy within 3-5 days. The recommended regimen typically involves:

• Hydrocortisone 100 mg four times daily, or
• Methylprednisolone 60 mg daily

Why are these high doses necessary? The severe inflammation in ASUC requires potent anti-inflammatory action to rapidly control symptoms and prevent complications. However, it’s crucial to monitor patients closely for potential side effects of high-dose steroids.

Second-Line Therapies: Cyclosporine and Infliximab

For patients who don’t respond to intravenous corticosteroids within 3-5 days, second-line therapies should be considered. The two primary options are:

1. Cyclosporine: A calcineurin inhibitor that acts rapidly to suppress inflammation
2. Infliximab: A tumor necrosis factor (TNF) inhibitor that has shown efficacy in steroid-refractory cases

How do clinicians choose between these options? The decision often depends on factors such as local expertise, patient preferences, and potential contraindications. Some studies suggest that cyclosporine may have a faster onset of action, while infliximab might offer better long-term outcomes.

Addressing Complications: Toxic Megacolon and Perforation

Toxic megacolon is a severe complication of ASUC, characterized by colonic dilatation exceeding 6 cm. Why is it so dangerous? The risk of perforation increases dramatically, potentially leading to sepsis and death if not addressed promptly. Management of toxic megacolon includes:

• Intensive medical therapy
• Bowel rest
• Broad-spectrum antibiotics
• Close monitoring for signs of perforation

When should surgery be considered? If medical management fails to improve the patient’s condition within 24-72 hours, or if perforation occurs, emergency colectomy becomes necessary to prevent life-threatening complications.

Nutritional Support and Bowel Rest: Balancing Benefits and Risks

The role of nutritional support in ASUC has been a subject of debate. Should patients be kept nil by mouth? While bowel rest was once thought to be beneficial, current evidence suggests that enteral nutrition, when tolerated, may be preferable. A balanced approach might include:

1. Clear fluids initially, progressing to low-residue diet as tolerated
2. Supplementary enteral nutrition if oral intake is insufficient
3. Total parenteral nutrition reserved for cases where enteral feeding is not possible or contraindicated

Why is maintaining nutrition important? Adequate nutritional support can help prevent malnutrition, support wound healing, and potentially improve overall outcomes in ASUC patients.

Preventing and Managing Infections: CMV and C. difficile

Patients with ASUC are at increased risk of opportunistic infections, particularly cytomegalovirus (CMV) and Clostridium difficile. How can these infections be identified and managed?

Cytomegalovirus (CMV) Infection

CMV reactivation can complicate ASUC and potentially worsen outcomes. Screening for CMV should be considered in steroid-refractory cases. If detected, antiviral therapy with ganciclovir may be necessary. However, the decision to treat should be balanced against the potential for spontaneous clearance in some cases.

Clostridium difficile Infection

C. difficile infection can mimic or exacerbate ASUC. All patients should be tested for C. difficile upon admission. If positive, appropriate antibiotic therapy (such as oral vancomycin) should be initiated promptly. Why is early detection crucial? C. difficile infection can significantly worsen outcomes in ASUC and may necessitate changes in management strategies.

Thromboprophylaxis: Mitigating the Risk of Venous Thromboembolism

Patients with ASUC are at increased risk of venous thromboembolism (VTE). How can this risk be minimized? Thromboprophylaxis with low-molecular-weight heparin should be initiated for all hospitalized patients with ASUC, unless contraindicated. The benefits of thromboprophylaxis typically outweigh the risks, even in patients with rectal bleeding.

Why is this step so important? VTE can be a life-threatening complication, and the inflammatory state in ASUC significantly increases the risk. Early implementation of thromboprophylaxis can potentially prevent serious morbidity and mortality.

Monitoring Response and Planning Next Steps

Close monitoring of patients with ASUC is essential to assess treatment response and guide further management. What parameters should be monitored?

• Stool frequency and presence of blood
• Vital signs (temperature, heart rate, blood pressure)
• Laboratory markers (C-reactive protein, albumin, hemoglobin)
• Abdominal examination for signs of peritonitis or toxic megacolon

How often should these parameters be assessed? In the acute phase, frequent monitoring (at least daily) is necessary to detect any deterioration promptly and adjust treatment as needed.

Predictors of Poor Response

Several factors have been identified as predictors of poor response to medical therapy in ASUC. These include:

1. Stool frequency >8 per day after 3 days of intensive therapy
2. C-reactive protein >45 mg/L after 3 days
3. Presence of deep ulcerations on colonoscopy
4. Hypoalbuminemia

Why are these predictors important? They can help clinicians identify patients who may benefit from early escalation of therapy or surgical consultation, potentially improving outcomes.

Surgical Management: When and How

Despite advances in medical therapy, approximately 20-30% of patients with ASUC will ultimately require surgery. When should surgery be considered? Indications for urgent colectomy include:

• Perforation
• Refractory toxic megacolon
• Massive hemorrhage
• Failure to respond to medical therapy after 5-7 days

What surgical options are available? The standard approach for ASUC is a subtotal colectomy with end ileostomy, preserving the rectum for potential future restoration of continuity. Why is this approach preferred? It removes the diseased colon while minimizing operative time and complications in acutely ill patients.

Timing of Surgery

The timing of surgery in ASUC is crucial. Delaying necessary surgery can lead to increased morbidity and mortality. How can clinicians strike the right balance? Close collaboration between gastroenterologists and colorectal surgeons is essential. Early surgical consultation should be sought in cases of severe disease or poor response to medical therapy, allowing for timely intervention if needed.

Post-Acute Care and Long-Term Management

After the acute phase of ASUC has been managed, attention must turn to long-term care and prevention of future flares. What strategies can help maintain remission?

1. Maintenance therapy with appropriate medications (e.g., 5-aminosalicylates, immunomodulators, or biologics)
2. Regular follow-up with a gastroenterologist
3. Patient education on recognizing early signs of flare
4. Smoking cessation (for those who smoke)
5. Stress management techniques

Why is long-term management so important? ASUC is a significant event that increases the risk of future severe flares and colectomy. Proper maintenance therapy and close follow-up can help prevent recurrence and improve overall quality of life for patients with ulcerative colitis.

Psychological Support

The experience of ASUC can be traumatic for patients, potentially leading to anxiety, depression, and reduced quality of life. How can healthcare providers address these issues?

• Offering psychological support or referral to mental health professionals
• Providing information about patient support groups
• Addressing concerns about future disease course and management

Why is psychological support crucial? Mental health plays a significant role in overall well-being and can impact disease management and outcomes in inflammatory bowel disease.

Future Directions in ASUC Management

As our understanding of ulcerative colitis pathogenesis evolves, new therapeutic targets and management strategies are emerging. What are some promising areas of research?

1. Novel biologics targeting different inflammatory pathways
2. Personalized medicine approaches based on genetic and microbial profiles
3. Stem cell therapies for severe, refractory disease
4. Advanced imaging techniques for more accurate assessment of disease activity

How might these advances impact ASUC management? They could potentially lead to more targeted therapies, improved prediction of treatment response, and better long-term outcomes for patients with severe ulcerative colitis.

The Role of Microbiome Modulation

Emerging evidence suggests that the gut microbiome plays a crucial role in ulcerative colitis pathogenesis and severity. Could microbiome modulation offer new treatment options for ASUC? Strategies under investigation include:

• Fecal microbiota transplantation
• Targeted probiotic therapies
• Prebiotic interventions to support beneficial bacteria

Why is this area of research exciting? Microbiome-based therapies could potentially offer a more natural approach to managing inflammation in ulcerative colitis, with fewer side effects than traditional immunosuppressive treatments.

In conclusion, the management of acute severe ulcerative colitis requires a multidisciplinary approach, combining rapid assessment, appropriate medical interventions, and timely surgical management when necessary. By following evidence-based guidelines and staying abreast of emerging therapies, clinicians can optimize outcomes for patients with this challenging condition. As research continues to advance our understanding of ulcerative colitis pathogenesis and treatment, we can hope for even more effective and personalized management strategies in the future.

Management of acute severe ulcerative colitis

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Ulcerative colitis – NHS

Ulcerative colitis is a long-term condition where the colon and rectum become inflamed.

The colon is the large intestine (bowel) and the rectum is the end of the bowel where poo is stored.

Small ulcers can develop on the colon’s lining, and can bleed and produce pus.

Symptoms of ulcerative colitis

The main symptoms of ulcerative colitis are:

• recurring diarrhoea, which may contain blood, mucus or pus
• tummy pain
• needing to poo frequently

You may also experience extreme tiredness (fatigue), loss of appetite and weight loss.

The severity of the symptoms varies, depending on how much of the rectum and colon is inflamed and how severe the inflammation is.

For some people, the condition has a significant impact on their everyday lives.

Symptoms of a flare-up

Some people may go for weeks or months with very mild symptoms, or none at all (remission), followed by periods where the symptoms are particularly troublesome (flare-ups or relapses).

During a flare-up, some people with ulcerative colitis also experience symptoms elsewhere in their body; which are known as extra-intestinal symptoms.

These can include:

• painful and swollen joints (arthritis)
• mouth ulcers
• swollen fat under the skin causing bumps and patches – this is known as erythema nodosum
• irritated and red eyes
• problems with bones, such as osteoporosis

In many people, no specific trigger for flare-ups is identified, although a gut infection can occasionally be the cause.

Stress is also thought to be a potential factor.

When to get medical advice

You should see a GP as soon as possible if you have symptoms of ulcerative colitis and you have not been diagnosed with the condition.

They can arrange blood or poo sample tests to help determine what may be causing your symptoms.

If necessary, they can refer you to hospital for further tests.

Find out more about diagnosing ulcerative colitis

If you have been diagnosed with ulcerative colitis and think you may be having a severe flare-up, contact a GP or your care team for advice.

You may need to be urgently admitted to hospital for immediate care.

If you cannot contact your GP or care team, call NHS 111 or contact your local out-of-hours service.

What causes ulcerative colitis?

Ulcerative colitis is thought to be an autoimmune condition.

This means the immune system, the body’s defence against infection, goes wrong and attacks healthy tissue.

The most popular theory is that the immune system mistakes harmless bacteria inside the colon as a threat and attacks the tissues of the colon, causing it to become inflamed.

Exactly what causes the immune system to behave in this way is unclear.

Many experts think it’s a combination of genetic and environmental factors.

Who’s affected

The UK Crohn’s & Colitis UK charity reports at least 1 in every 227 people in the UK has been diagnosed with ulcerative colitis. This amounts to around 296,000 people.

The condition can develop at any age, but is most often diagnosed in people between 15 and 25 years old.

It’s more common in white people of European descent, especially those descended from Ashkenazi Jewish communities, and black people.

The condition is rarer in people from Asian backgrounds, although the reasons for this are unclear.

Both men and women seem to be equally affected by ulcerative colitis.

How ulcerative colitis is treated

Treatment for ulcerative colitis aims to relieve symptoms during a flare-up and prevent symptoms from returning (maintaining remission).

In most people, this is achieved by taking medicine, such as:

• aminosalicylates (ASAs)
• corticosteroids (steroid medicines)
• immunosuppressants

Mild to moderate flare-ups can usually be treated at home. But more severe flare-ups need to be treated in hospital.

If medicines are not effective at controlling your symptoms or your quality of life is significantly affected by your condition, surgery to remove some or all of your bowel (colon) may be an option.

During surgery, your small intestine can be diverted out of an opening in your abdomen known as a stoma. This type of surgery is known as an ileostomy.

In some cases, the stoma is only temporary and can be closed up once your bowel has healed.

An alternative option is to create an internal pouch that’s connected to your anus called an ileoanal pouch.

Read more about treating ulcerative colitis

Complications of ulcerative colitis

Complications of ulcerative colitis include:

• an increased risk of developing bowel cancer
• poor growth and development in children and young people

Also, the steroid medicines used to treat ulcerative colitis can cause weakening of the bones (osteoporosis) as a side effect.

Read more about the complications of ulcerative colitis

IBD or IBS?

Inflammatory bowel disease (IBD) is a term mainly used to describe 2 conditions that cause inflammation of the gut (gastrointestinal tract).

They are:

• ulcerative colitis
• Crohn’s disease

IBD should not be confused with irritable bowel syndrome (IBS), which is a different condition and requires different treatment.

Information:

Social care and support guide

If you:

• need help with day-to-day living because of illness or disability
• care for someone regularly because they’re ill, elderly or disabled (including family members)

Our guide to care and support explains your options and where you can get support.

Page last reviewed: 01 November 2022
Next review due: 01 November 2025

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.