Best Ulcerative Colitis Treatment in Delhi, India

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes long-lasting inflammation and sores (ulcers) in the innermost lining of the large intestine (colon) and rectum. The inflammation usually begins in the rectum and lower colon but can spread to the entire colon. UC can lead to debilitating symptoms and, in some cases, may cause life-threatening complications.

Ulcerative colitis (UC) can be categorised into several types based on the location and extent of inflammation in the colon and rectum:

• Ulcerative Proctitis: This type involves inflammation confined to the rectum, the last part of the colon.
• Proctosigmoiditis: Inflammation affects both the rectum and the sigmoid colon, which is the lower part of the colon just above the rectum.
• Left-Sided Colitis (Distal Colitis): Inflammation extends from the rectum through the sigmoid and descending colon, located on the left side of the abdomen.
• Pancolitis (Universal Colitis): Inflammation affects the entire colon, spanning from the rectum to the cecum.
• Fulminant Colitis: A severe form of pancolitis that involves extensive inflammation of the entire colon and often requires urgent medical attention.

The exact cause of ulcerative colitis is unknown, but several factors are believed to play a role:

• Immune System Dysfunction: Ulcerative colitis is thought to result from an abnormal immune response. Normally, the immune system protects the body from infection. In UC, the immune system mistakenly attacks the cells of the colon, causing chronic inflammation and ulceration.
• Genetics: Family history of ulcerative colitis or other inflammatory bowel diseases increases the risk, suggesting a genetic predisposition. Certain genetic mutations have been associated with an increased risk of developing UC.
• Environmental Factors: Although the exact environmental triggers are unknown, factors such as diet, stress, and exposure to certain substances (e.g., NSAIDs, antibiotics) may exacerbate or trigger the disease in genetically predisposed individuals.
• Microbiome: An imbalance in the gut microbiota (the community of bacteria in the intestines) may contribute to the development and exacerbation of UC. Certain bacteria may trigger an immune response that leads to inflammation.

Several factors can increase the risk of developing ulcerative colitis:

• Age: UC can occur at any age, but it often starts before the age of 30. However, some people may not develop the disease until their 50s or 60s.
• Ethnicity: People of Ashkenazi Jewish descent have a higher risk of developing ulcerative colitis. Caucasians also have a higher risk compared to other ethnic groups.
• Family History: Having a close relative, such as a parent or sibling, with ulcerative colitis increases the likelihood of developing the condition.
• Geographical Location:People living in urban areas and industrialised countries are at higher risk, possibly due to dietary factors and environmental exposures.
• Diet: While diet alone does not cause ulcerative colitis, a diet high in fat or low in fibre may influence the development and severity of the disease.
• Use of Certain Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and oral contraceptives have been associated with an increased risk of UC.

Understanding these causes and risk factors can help in early identification and management of ulcerative colitis, potentially reducing the impact of the disease on quality of life.

The symptoms of ulcerative colitis can vary depending on the severity of inflammation and the part of the colon affected. Common symptoms include:

• Diarrhoea: Frequent, loose, or watery stools, often with blood or pus.
• Abdominal Pain and Cramping: Pain and cramping in the abdomen, often relieved by defecation.
• Rectal Pain and Bleeding: Pain in the rectum and bright red blood in the stool.
• Urgency to Defecate: A sudden, intense need to have a bowel movement, sometimes leading to an inability to defecate despite the urge.
• Weight Loss: Unintentional weight loss due to reduced appetite, malabsorption, or frequent diarrhoea.
• Fatigue: Persistent tiredness and lack of energy, often due to chronic inflammation and anaemia.
• Fever: Low-grade fever, particularly during active disease flares.
• Anaemia: Reduced number of red blood cells due to chronic blood loss, leading to fatigue and weakness.
• Growth Problems in Children: Delayed growth and development in children due to malnutrition and chronic disease.

Symptoms may fluctuate, with periods of active disease (flares) and periods of remission. The severity and frequency of symptoms can significantly impact the quality of life, making proper management and treatment essential.

Diagnosing ulcerative colitis involves several tests to confirm the presence and extent of inflammation in the colon and rectum:

Medical History and Physical Examination

The doctor will review the patient's symptoms, family history of ulcerative colitis or other inflammatory bowel diseases, and any other relevant medical conditions. A physical examination, particularly of the abdomen, will follow to check for tenderness, swelling, or other abnormalities.

Laboratory Tests

• Blood Tests: These tests can detect anaemia (a common complication of UC), signs of infection, and markers of inflammation such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
• Stool Tests: These tests help rule out infections and check for the presence of blood in the stool.

Endoscopic Procedures

• Colonoscopy: A flexible tube with a camera is inserted through the rectum to examine the entire colon. This procedure allows doctors to directly visualise inflammation, ulcers, and any other abnormalities. Small tissue samples (biopsies) are often taken during this procedure for further analysis.
• Flexible Sigmoidoscopy: Similar to a colonoscopy, but only examines the rectum and the lower part of the colon. It is less invasive and may be used in cases where a full colonoscopy is not necessary.

Imaging Tests

• CT Scan or MRI: These imaging tests provide detailed pictures of the colon and surrounding tissues, helping to assess the extent of inflammation and detect complications such as abscesses or strictures.
• X-ray: When a patient exhibits severe symptoms, the healthcare provider might suggest a standard abdominal X-ray to check for serious complications like megacolon or a perforated colon.
• Computerised tomography (CT) enterography and magnetic resonance (MR) enterography: These noninvasive imaging tests may be recommended to rule out inflammation in the small intestine. They are more effective at detecting bowel inflammation than traditional imaging methods, with MR enterography offering a radiation-free option.

Biopsy

During an endoscopic procedure, small tissue samples are taken from the colon and rectum. These samples are analysed under a microscope to confirm the diagnosis of ulcerative colitis and rule out other conditions like Crohn's disease or colorectal cancer.

Treatment for ulcerative colitis focuses on reducing inflammation, managing symptoms, and achieving and maintaining remission. The treatment plan may include:

Medications

• Aminosalicylates (5-ASA): These medications, such as mesalamine, are designed to reduce inflammation in the lining of the colon and are often used for mild to moderate cases of UC.
• Corticosteroids: Used to control flare-ups, these drugs reduce inflammation quickly but are not suitable for long-term use due to potential side effects.
• Immunomodulators: Drugs like azathioprine and methotrexate suppress the immune system to decrease inflammation and are used for patients who do not respond to other treatments.
• Biologic Therapies: These medications, including TNF inhibitors like infliximab and integrin inhibitors like vedolizumab, target specific components of the immune system to reduce inflammation.
• Janus Kinase (JAK) Inhibitors: Newer oral medications such as tofacitinib target specific pathways involved in the inflammatory process and are used for moderate to severe cases of UC.

Surgery

In serious cases or when other treatments fail, surgery may be necessary. Surgical options include removing the entire colon and rectum (proctocolectomy) and creating an ileostomy or an ileoanal pouch (J-pouch), which allows waste to leave the body.

Diet and Nutrition

While no specific diet cures UC, making dietary adjustments can help manage symptoms and prevent malnutrition. Working with a nutritionist can help patients create a balanced diet plan that avoids foods triggering symptoms.

Lifestyle Modifications and Home Remedies

Regular exercise, stress reduction techniques, and avoiding known food triggers can help manage symptoms and improve overall well-being. Maintaining a healthy lifestyle can support treatment and remission.

Monitoring and Follow-up

Regular check-ups with a gastroenterologist are essential to monitor disease progression, treatment efficacy, and potential side effects of medications. Consistent follow-up care ensures that any complications are promptly addressed and managed.

Ulcerative colitis can lead to several complications, some of which may be serious or life-threatening. These complications can arise from the disease itself or as side effects of treatments. Key complications include:

• Colon Cancer: The risk of colon cancer increases with the duration and extent of ulcerative colitis. Regular screening through colonoscopy is essential for early detection and prevention.
• Severe Bleeding: Chronic inflammation can lead to significant blood loss, causing severe anaemia that might require hospitalisation and blood transfusions.
• Perforated Colon: A severe flare-up can cause a hole to form in the colon, leading to a potentially life-threatening infection in the abdominal cavity (peritonitis).
• Toxic Megacolon: This rare but serious condition involves rapid swelling of the colon, which can be life-threatening and usually requires emergency surgery.
• Dehydration and Malnutrition: Chronic diarrhoea can lead to significant fluid and nutrient loss, resulting in dehydration and malnutrition.
• Bone Loss (Osteoporosis): Long-term use of corticosteroids and chronic inflammation can lead to weakened bones, increasing the risk of fractures.
• Primary Sclerosing Cholangitis (PSC): A condition where inflammation causes scarring within the bile ducts, leading to liver damage and potential liver failure.
• Increased Risk of Blood Clots: Patients with ulcerative colitis have an increased risk of developing blood clots in veins and arteries.
• Joint Pain and Swelling: Inflammation can affect other parts of the body, including joints, leading to conditions such as arthritis.

While there is no definitive way to prevent ulcerative colitis, certain strategies can help reduce the risk of flare-ups and manage the disease more effectively:

• Healthy Diet: Eating a balanced diet rich in fruits, vegetables, lean proteins, and whole grains can support overall health. Identifying and avoiding trigger foods that exacerbate symptoms is also important.
• Regular Exercise: Engaging in regular physical activity helps maintain overall health and reduces stress, which can contribute to flare-ups.
• Avoiding NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can trigger or worsen flare-ups. Patients should use alternative pain relief options under medical advice.
• Smoking Cessation: While smoking has been found to have a complex relationship with ulcerative colitis, quitting smoking is always beneficial for overall health.
• Stress Management: Employing stress-reduction techniques such as yoga, meditation, or deep breathing exercises can help manage stress, which can trigger symptoms.
• Medication Adherence: Consistently taking prescribed medications as directed by a healthcare provider can help maintain remission and prevent flare-ups.
• Regular Medical Check-Ups: Regular visits to a gastroenterologist for monitoring and early detection of complications are crucial.
• Vaccinations: Staying up-to-date with vaccinations, especially if taking immunosuppressive medications, helps prevent infections that could complicate ulcerative colitis.

By following these strategies, patients with ulcerative colitis can better manage their condition and potentially reduce the frequency and severity of flare-ups.

Can ulcerative colitis go away without treatment?

Ulcerative colitis is a chronic condition, and while some individuals may experience periods of remission where symptoms improve or disappear without treatment, the disease itself typically does not resolve spontaneously. Without treatment, ulcerative colitis can lead to complications and worsening symptoms over time.

Does ulcerative colitis go into remission?

Yes, ulcerative colitis can go into remission. Remission refers to a period when symptoms are significantly reduced or absent, and inflammation in the colon and rectum subsides. Achieving and maintaining remission is a key goal of treatment for ulcerative colitis.

Is ulcerative colitis reversible?

Ulcerative colitis is not typically reversible. While treatments can help manage symptoms and bring about remission, the underlying inflammation and damage to the colon and rectum may persist even during periods of remission.

What factors influence the choice of treatment for ulcerative colitis?

The choice of treatment for ulcerative colitis depends on various factors, including the severity of symptoms, extent of inflammation, patient's overall health, medication preferences, and potential side effects. Factors such as response to previous treatments, presence of complications, and patient preferences also play a role in treatment decisions.

How does ulcerative colitis affect fertility and pregnancy outcomes?

Ulcerative colitis may affect fertility and pregnancy outcomes in some individuals. Chronic inflammation and certain medications used to treat ulcerative colitis can impact fertility and increase the risk of complications during pregnancy. However, many women with ulcerative colitis can have successful pregnancies with proper management and monitoring.

Is it safe to get pregnant if I have ulcerative colitis?

In most cases, it is safe to get pregnant if you have ulcerative colitis. However, it's important to discuss your plans with your healthcare provider, as they can provide personalised guidance and monitoring throughout pregnancy to ensure optimal outcomes for both mother and baby.

What precautions should I take if I am planning to conceive or already pregnant?

If you are planning to conceive or already pregnant, it's important to work closely with your healthcare provider to manage your ulcerative colitis and any medications you may be taking. Your doctor may recommend certain medications or adjustments to your treatment plan to minimise risks during pregnancy.

Can smoking worsen ulcerative colitis symptoms?

Yes, smoking can worsen ulcerative colitis symptoms and increase the risk of flare-ups and complications. Quitting smoking is strongly recommended for individuals with ulcerative colitis to improve disease control and overall health.

How can I manage stress to help control my ulcerative colitis symptoms?

Managing stress through techniques such as relaxation exercises, mindfulness meditation, regular physical activity, and seeking support from friends, family, or support groups can help reduce stress and potentially improve ulcerative colitis symptoms.

What are the potential side effects of the medications used to treat ulcerative colitis, and how can they be managed?

Medications used to treat ulcerative colitis can have various side effects depending on the type of medication. Common side effects may include nausea, diarrhoea, headache, and increased risk of infections. It's important to discuss potential side effects with your doctor, who can monitor your response to treatment and adjust your medication regimen as needed.

How long does it typically take for medications to start working and alleviate symptoms?

The time it takes for medications to start working and alleviate symptoms can vary depending on the type of medication, the severity of symptoms, and individual response to treatment. Some medications may provide rapid relief, while others may take several weeks or months to take full effect.

Are there any alternative or complementary therapies that can be effective in managing ulcerative colitis symptoms?

Some individuals find relief from ulcerative colitis symptoms through alternative or complementary therapies such as acupuncture, herbal supplements, probiotics, and dietary modifications. However, it's essential to discuss these options with your healthcare provider before trying them, as they may not be suitable for everyone and could interfere with existing treatments.

What factors contribute to the long-term prognosis and quality of life for individuals with ulcerative colitis?

Several factors can influence the long-term prognosis and quality of life for individuals with ulcerative colitis, including disease severity, response to treatment, presence of complications, adherence to medication and lifestyle recommendations, access to healthcare, and overall emotional and psychological well-being. Regular monitoring, effective management of symptoms, and support from healthcare providers and support networks can all contribute to better long-term outcomes and quality of life.

Reviewed By Dr Pawan Keshrwani - Senior Director Urology, Robotic Surgery, Kidney Transplant on 29 Oct 2024.