Ulcerative colitis is a chronic inflammatory bowel disease that primarily affects the mucosal layer of the colon. This autoimmune-related disease leads to persistent inflammation of the intestinal mucosa, causing abdominal pain, diarrhea, and the passage of mucus or blood in the stool. Epidemiological studies indicate that this disease is most prevalent in individuals aged 20 to 40 and 50 to 70, with a relatively higher incidence in developed countries.
The core feature of ulcerative colitis overview is that the lesions are confined to the colonic mucosa, unlike other inflammatory bowel diseases such as Crohn's disease. Patients may experience a cycle of long-term remission and acute flare-ups, with severe cases potentially leading to complications such as ulcer perforation or massive bleeding. Early diagnosis and treatment are crucial for controlling disease progression, but there is currently no complete cure, and treatment goals focus on symptom relief and complication prevention.
The causes of ulcerative colitis are complex, involving interactions among genetic factors, immune system abnormalities, and environmental influences. Genetic studies show that if a first-degree relative has the disease, an individual's risk of developing it increases by about 3 to 5 times. Abnormalities in specific genes such as NOD2 and ATG16L1 may lead to dysfunction of the intestinal mucosal barrier, making it easier for bacterial antigens to trigger an immune response.
Immune system abnormalities are a key pathogenic mechanism, where the T lymphocytes of patients mistakenly perceive normal intestinal bacteria as threats, excessively secreting inflammatory mediators such as TNF-α. Environmental triggers include Western dietary patterns (high fat, low fiber), smoking history, antibiotic use, and urban lifestyles, which may provoke disease onset in genetically susceptible individuals.
Typical symptoms usually develop slowly, initially presenting as mild diarrhea or changes in bowel habits. As the disease progresses, patients may experience multiple daily episodes of watery diarrhea accompanied by mucus and fresh blood, with lower abdominal cramping often located in the left lower abdomen. About 30% of patients may exhibit extraintestinal manifestations, including arthritis, conjunctivitis, and skin erythema as systemic symptoms.
During acute flare-ups, severe combinations of symptoms may occur:
A minority of patients may present with emergency indications:
The diagnostic process requires ruling out infectious enteritis and differentiating from ulcerative colitis. The first step typically involves a colonoscopy to directly observe typical lesions such as mucosal congestion, ulcer formation, and bleeding points, while simultaneously obtaining tissue samples for pathological analysis to confirm histological features such as crypt dysplasia.
Imaging studies, including abdominal CT scans, can assess bowel wall thickness and complications such as fecalith obstruction. Common blood test indicators include elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), but these nonspecific indicators need to be interpreted in conjunction with other test results. Stool tests are used to rule out bacterial enteritis; if leukocytes or pathogens are detected, the diagnostic direction should be reassessed.
First-line treatment involves the use of 5-aminosalicylic acid drugs (such as mesalamine), which can inhibit prostaglandin synthesis and reduce intestinal mucosal inflammation. In severe flare-ups, corticosteroids (such as prednisone) may be used in combination to control acute symptoms, but long-term use may lead to side effects such as osteoporosis.
Biologics, such as anti-TNF-α monoclonal antibodies (like infliximab), are suitable for moderate to severe patients who have failed traditional therapies, requiring monitoring for antibody production and infection risk. Immunomodulators such as 6-mercaptopurine (6-MP) and azathioprine are used to maintain remission, necessitating regular monitoring of liver function and white blood cell counts.
Approximately 25-30% of patients ultimately require surgical resection of the entire colon to cure the disease. Surgical indications include:
Surgical methods include total colectomy with ileal pouch-anal anastomosis (IPAA), which preserves anal function but requires staged procedures, with close monitoring of the anastomosis healing postoperatively.
Currently, there is no way to completely prevent the onset of this disease, but lifestyle management can reduce the frequency of flare-ups. Patients are advised to regularly monitor body indicators, including hemoglobin, albumin, and inflammatory markers, to detect changes in condition early.
Lifestyle adjustments include:
Psycho-social interventions such as stress management courses have also been shown to reduce the risk of flare-ups, and it is recommended to work with the medical team to establish a personalized remission plan.
Seek outpatient medical attention if the following symptoms occur:
Emergency symptoms requiring immediate medical attention include:
Patients under regular follow-up should have their medication regimen adjusted immediately if symptoms worsen during maintenance therapy to avoid complications.
During flare-ups, it is recommended to adopt a low-fiber, easily digestible diet, such as white rice, steamed fish, and skinless chicken, while avoiding high-fat, spicy, and gas-producing foods. Meals can be divided into smaller portions, and consulting a nutritionist to create a personalized meal plan is advised. If severe diarrhea or bleeding occurs, solid food should be suspended, and oral electrolyte solutions should be used to maintain hydration.
Does long-term use of biologics increase the risk of infections?Biologics suppress specific pathways in the immune system, which may increase the risk of minor infections, such as upper respiratory infections, but the likelihood of severe infections is relatively low. Physicians will assess potential infection risks (such as a history of tuberculosis) before treatment, and during treatment, regular monitoring of serological indicators is necessary while avoiding exposure to sources of infection. Vaccination (such as the flu vaccine) can reduce some risks.
What changes in quality of life can patients expect after total colectomy?After total colectomy, patients will require a permanent ileostomy, and initially, they will need to adapt to the daily care of the stoma, but in the long term, it can effectively relieve intestinal symptoms. Some patients may experience increased bowel frequency or issues with bowel control, but with stoma care education and psychological support, about 80% of patients can gradually return to normal social activities.
How does stress management affect the frequency of disease recurrence?Stress can trigger abnormal immune responses in the gut, potentially exacerbating inflammatory reactions. Through mindfulness meditation, regular exercise (such as yoga), and social support, cortisol secretion can be reduced, improving symptom control. Studies show that regular stress management can reduce the annual recurrence rate by 30-40%, and it is recommended to use it in conjunction with medication therapy.
Is it safe to receive immunosuppressive therapy during pregnancy?The use of traditional immunosuppressants (such as 6-MP) during pregnancy should be approached with caution, as they may affect fetal development. Modern treatment tends to discontinue high-risk medications before pregnancy and switch to biologics (such as adalimumab) with close monitoring. Research indicates that pregnant patients with stable symptoms have no significant difference in preterm birth rates compared to the normal population, but they must be monitored throughout by a specialist.
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