Ulcerative colitis (UC), usually called ulcerative colitis, is characterized by diarrhea, mucus, purulent bloody stool, abdominal pain and acute diarrhea. The severity of the illness varies, and it is often repeated or prolonged. It is a chronic nonspecific intestinal inflammatory disease, characterized by persistent and diffuse inflammatory changes of colorectal mucosa.
Although the etiology is not very clear, it is generally believed that the disease is related to many factors such as immunity, heredity, environment and intestinal infection. The incidence of China is less than 5/ 10? .
Because UC is difficult to cure, the incidence rate is increasing year by year, and it tends to become cancerous. It has been listed as a modern refractory disease by WHO and is called "green cancer".
1. What is ulcerative colitis?
Ulcerative colitis (UC), usually called ulcerative colitis, is a chronic nonspecific inflammatory disease of rectum and colon with unknown etiology. The lesions were mainly confined to the mucosa and submucosa of large intestine. The main clinical manifestations are diarrhea, mucopurulent bloody stool and abdominal pain, which often recur and persist.
2. What are the causes of ulcerative colitis?
The etiology of ulcerative colitis is not clear, but it may be related to environmental factors, genetic factors, infection factors, mental factors and autoimmune factors.
3. What kind of people are prone to ulcerative colitis?
People with ulcerative colitis in immediate family members are more likely to get ulcers. In addition, being in a state of tension, anxiety or depression and intestinal infection may increase the risk of ulcers.
4. Can ulcerative colitis be prevented?
Because the causes and pathogenesis of ulcer formation are still unclear, there is no specific method to prevent ulcer formation. However, for patients with ulcer in remission, effective methods can be used to prevent ulcer recurrence. Avoiding mental stimulation such as anxiety and depression, avoiding the stimulation of spicy and cold food on the intestine, reducing the chance of intestinal infection, strengthening physical exercise and improving self-immunity can effectively prevent the recurrence of ulcers.
5. What are the clinical manifestations of ulcerative colitis?
Mucous purulent blood is an important manifestation of ulcerative colitis in the active stage. Patients with mild symptoms can defecate 2-4 times a day, and those with severe symptoms can reach more than 10 times a day. Other symptoms are atypical, such as abdominal pain, bloating, loss of appetite, nausea and vomiting. In severe cases, patients will also have recurrent oral ulcers, peripheral arthritis and other gastrointestinal manifestations, as well as systemic manifestations such as weakness, anemia and emaciation.
6. What are the symptoms that can be suspected of ulcerative colitis?
If diarrhea, bloody stool, mucous purulent stool and other symptoms often appear, and the symptoms last for a long time and persist repeatedly, you may suffer from ulcerative colitis. You should seek medical attention in time, do colonoscopy and related blood tests, and make a diagnosis in time.
7. How long should ulcerative colitis be suspected after mucus is bloody?
Different diagnosis and treatment guidelines have different views on the duration, and it is generally believed that patients who last for 6 weeks should pay attention to it. For the initial patients with atypical clinical manifestations and colonoscopy changes, they can be followed up for 3-6 months before diagnosis.
8. Is abdominal pain, diarrhea and mucus blood necessarily ulcerative colitis?
There is no specific change in ulcerative colitis, and many reasons can cause similar changes in intestinal inflammation. Therefore, even if there are recurrent or persistent abdominal pain, diarrhea, or even mucus and bloody stool, it is not necessarily ulcerative colitis. The diagnosis should be combined with laboratory examination and colonoscopy.
9. How to divide the clinical types of ulcerative colitis?
According to clinical manifestations, ulcers can be divided into the following four types:
(1) The first attack refers to the first attack with no previous medical history;
(2) Chronic recurrent type, the most common in clinic, with alternating onset and remission;
(3) Chronic persistent type, with persistent symptoms and aggravated acute attack symptoms;
(4) Acute fulminant type, which is relatively rare, has serious illness and many complications. All types can be transformed into each other.
10. How to classify the severity of ulcer?
According to the symptoms such as diarrhea and related blood test indexes, the severity of ulcer can be divided: mild refers to diarrhea less than 4 times a day, no bloody stool or lightness, no fever, fast pulse, no anemia or lightness and ESR; 30 mm/hour; Patients between mild and severe are moderate.
1 1. What diseases does ulcerative colitis need to be differentiated from?
Because a variety of enteritis can also cause symptoms similar to ulcerative colitis, it needs to be differentiated from infectious enteritis such as bacillary dysentery, amebic dysentery, chronic schistosomiasis and intestinal tuberculosis, and non-infectious enteritis such as Crohn's disease and ischemic bowel disease.
12. What tests can be used to diagnose ulcerative colitis?
Tissue biopsy under colonoscopy is the gold standard for the diagnosis of ulcerative colitis.
In addition, X-ray barium enema examination, ESR, C- reactive protein and p-ANCA are also commonly used as auxiliary examinations to help diagnose ulcerative colitis.
13. Is ulcerative colitis contagious?
At present, there is no evidence that ulcerative colitis is caused by microorganisms such as viruses or bacteria, so ulcerative colitis will not spread from person to person.
14. Will ulcerative colitis be passed on to the next generation?
European and American countries have done a lot of research on heredity. The incidence of first-degree relatives of patients with ulcerative colitis is significantly higher than that of the general population, while the incidence of spouses of patients does not increase. The current view is that ulcerative colitis has a certain genetic tendency, but it is not necessarily passed on to the next generation.
15. Can ulcerative colitis get married and have children?
Ulcerative colitis does not affect the reproductive function, and there is no evidence that the next generation of patients with ulcerative colitis will definitely get sick, so as long as they can be treated according to the correct plan, ulcerative colitis will not affect the normal life of patients and they can get married and have children.
However, in pregnancy or early postpartum period, it can aggravate colitis in about 1/3 inactive or 2/3 active ulcerative patients. Therefore, whether ulcerative patients are pregnant or not should be fully weighed.
Aminosalicylic acid preparation is generally safe during pregnancy, but it will interfere with the absorption of folic acid. It is recommended to supplement folic acid.
The use of immunosuppressants should be avoided during pregnancy, especially the absolute prohibition of methotrexate;
Quinolones may have teratogenic effects on the fetus and should be avoided as much as possible during pregnancy.
In view of the fact that most drugs for treating ulcers may have adverse effects on the fetus, you should consult a doctor before pregnancy.
16. If I have ulcerative colitis, do I have to quit smoking and drinking?
Recently, several clinical trials have found that smoking is a protective factor for ulcerative colitis, that is, smoking may reduce the occurrence of ulcerative colitis, but its protective mechanism is not clear. Alcohol has a very strong stimulating effect on the intestine and is easy to cause the recurrence of ulcerative colitis. However, considering the overall health, it is still recommended to quit smoking and drinking.
17. With ulcerative colitis, what should I pay attention to in my diet? Why?
The effect of diet on inflammatory activity of ulcerative colitis is not clear, but changing diet may improve the symptoms of ulcerative colitis. For patients with serious illness, especially those with explosive or serious complications such as intestinal obstruction, intestinal perforation and gastrointestinal bleeding, fasting should be given.
Dietary fiber can absorb water in the large intestine, promote defecation and easily aggravate the condition of patients with ulcerative colitis. Therefore, for most patients with ulcerative colitis, fiber intake should be reduced during the rising period of disease activity, that is, the aggravating period. If they can stand it, they can keep milk and other dairy products, such as rice, fish, steamed eggs, soybean milk, filtered vegetable juice, fruit juice, etc. These foods contain less fiber and belong to a low-residue diet. This diet can reduce the irritation to the intestine and reduce the frequency of defecation.
However, for patients with ulcerative proctitis (the lesion is confined to rectum, constipation is more common than diarrhea), we should advocate a high residue diet, reasonably increase the intake of dietary fiber and promote defecation.
The intake of irritating foods such as cold, spicy and alcohol may aggravate the symptoms such as abdominal pain and purulent stool, while patients with ulceration often have poor absorption of greasy foods containing more fat, so they should avoid taking irritating foods such as spicy and cold, and reduce or even avoid the intake of greasy foods.
18. What kind of lifestyle should ulcer patients adopt?
First of all, patients with ulceration should pay attention to diet, and it is recommended to adopt the above diet; In addition, decompression and good pressure relief can improve the symptoms of patients, and reducing or even avoiding the occurrence of anxiety and depression can effectively reduce the recurrence of ulcers. If necessary, you can use anti-anxiety drugs appropriately, and even seek the help of professional psychological counselors.
19. Can ulcerative colitis be cured?
At present, there is no specific drug or method to completely cure ulcerative colitis, but standardized treatment can reduce recurrence, prolong remission period and improve quality of life.
20. What are the common complications of ulcerative colitis?
Ulcerative colitis can cause digestive system and parenteral complications. For the digestive system, ulcers can lead to very serious complications, such as toxic Hirschsprung's disease, colorectal cancer, intestinal bleeding and even intestinal perforation. In addition, ulcers can also cause systemic complications, such as oral ulcers, bone and joint diseases, skin diseases, liver and kidney diseases, arteritis, thromboembolism and so on.
2 1. Can ulcerative colitis be cured?
At present, there is no specific drug or method to completely cure ulcerative colitis, but standardized treatment can reduce recurrence, prolong remission period and improve quality of life.
22. How to treat ulcerative colitis?
The treatment of ulcer mainly includes drug treatment and surgical treatment. Drug therapy mainly includes aminosalicylic acid, corticosteroids, immunosuppressants, antibiotics, probiotics and anti-TNF drugs, among which aminosalicylic acid is often used as the first choice and maintenance treatment drug. Corticosteroids, commonly known as hormones, can quickly relieve symptoms and are mostly used for acute attacks, while immunosuppressants can reduce or eliminate the dependence on hormones and can be used to maintain and relieve ulcers when aminosalicylic acid maintenance treatment fails. When the medical treatment is ineffective and there are surgical indications, appropriate surgical treatment can be taken to remove the diseased intestinal segment.
23. What are the side effects of drugs for ulcerative colitis?
Although aminosalicylic acid, hormones and other commonly used drugs for treating ulcers play a very important role in the treatment of ulcers, they also have certain side effects. Gastrointestinal adverse reactions such as nausea, vomiting, dyspepsia and anorexia are common but not serious adverse reactions of aminosalicylic acid. When using this kind of drugs, rare adverse reactions such as leukopenia, autoimmune hemolysis, aplastic anemia, allergic reaction and agranulocytosis may occur.
Long-term use of hormones may lead to osteoporosis and even necrosis of femoral head.
The side effects of immunosuppressants mainly include myelosuppression, pancreatitis and gastrointestinal reaction. Infliximab may cause allergic reactions and infections, and some data show that it may increase the risk of lymphoma and cancer. When there are adverse reactions after taking the medicine, you should consult your doctor in time and consider changing other drugs instead of stopping taking the medicine yourself, so as not to cause repeated symptoms.
24. How to reduce the side effects of drugs?
The side effects caused by drugs generally vary from person to person and are unpredictable. Timely supplementation of folic acid, regular blood monitoring and liver and kidney function examination, and immediate withdrawal of drugs in case of adverse reactions can minimize the damage to the body caused by drug side effects. When using monoclonal antibodies, we should pay close attention to allergic reactions, enhance resistance and avoid infection. In short, the side effects of drugs can be prevented and cured, so don't be afraid to take medicine because of side effects.
25. Does ulcerative colitis need regular review? What is the appropriate time interval?
The condition of ulcerative colitis is easy to recur and requires regular follow-up. The interval depends on the degree of illness, and it is the best choice to follow the doctor's advice to decide the time for review. Re-examination items generally include stool routine, blood routine, erythrocyte sedimentation rate, C-reactive protein (CRP), liver function and other laboratory tests. X-ray or barium enema examination, CT examination and colonoscopy can be performed when necessary.
26. Will ulcerative colitis become cancerous?
Generally speaking, patients with ulcerative colitis have a higher probability of developing colorectal cancer than normal people, especially those with extensive colitis in childhood and a long course of disease.
At present, there is no exact data to show how high the canceration rate is, but foreign research reports that the canceration rate after 20 years and 30 years is 7.2% and 16.5% respectively.
27. How to monitor the canceration of high-risk groups?
For patients with extensive colitis, pancolitis, left hemicolitis and rectosigmoiditis with a course of 8- 10 years or more, and patients with primary sclerosing cholangitis, colonoscopy should be performed at least once every two years, and multi-site biopsy should be performed. If abnormal development is found by histological examination, it should be closely followed up. If it is severe dysplasia, it should be treated by surgery immediately.
28. What is dysplasia?
It is a gradual process, and the repeated attacks of ulcers repeatedly stimulate the intestinal mucosa, which makes the differentiation of intestinal mucosal cells deviate from the normal direction and leads to dysplasia. Dysplasia is a precancerous lesion, which may develop into colorectal cancer if not treated in time.
29. Will the quality of life of patients with ulcerative colitis be poor?
The current medical level determines that ulcerative colitis is impossible to cure, but patients can generally have a better quality of life as long as they strictly follow the reasonable treatment plan and insist on taking medicine. For patients who can't insist on taking medicine, acute explosion, intestinal perforation and other complications, and are older (> 60 years old), the prognosis is generally poor and the quality of life is lower than that of patients who insist on taking medicine.
30. When does ulcerative colitis need surgery?
When patients have the following symptoms, they may need to undergo elective or even emergency surgery:
(1) complicated with colorectal cancer;
(2) The medical effect of chronic protracted cases is not ideal, which seriously affects the quality of life;
(3) Although glucocorticoid can control the disease, the adverse reaction of glucocorticoid is too great to be tolerated;
(4) Patients complicated with massive hemorrhage, intestinal perforation and severe symptoms, especially those complicated with toxic Hirschsprung's disease, who are ineffective after active medical treatment and accompanied by severe toxic blood symptoms.
3 1. What is the effect of surgical treatment for ulcerative colitis?
Although many patients' conditions can be well controlled by drug treatment, there are still 15% ~ 30% UC patients who need surgery. The ulcer can be cured theoretically by completely removing all possible diseased tissues.
In the past, total colectomy and ileostomy were usually used. In order to avoid the disadvantage of pouch inflammation in ileostomy, ileal-anal pouch anastomosis has been adopted in recent years, which can not only remove the whole colon, but also preserve the anal defecation function.
32. What can family members do for patients with ulcerative colitis?
First of all, family members should ease patients' emotions, help patients build confidence in overcoming diseases, and actively cooperate with doctors' treatment;
Secondly, family members should also strive to improve patients' mood, keep patients' mood comfortable, reduce patients' pressure and avoid excessive anxiety and depression due to illness;
Finally, family members should adjust the diet structure of patients, reduce fiber intake, pay attention to low-residue diet, and avoid patients eating cold and irritating food.