Ulcerative Colitis

Question 1

What are some common clinical features of UC?

Answer 1

• Rectal bleeding –> most common symptom
• Inflammed mucosa
• Abdominal pain
• Fatigue
• Anaemia
• Inflammation of joints, skin, liver, or eyes
• Weight loss
• Malnutrition
• Pain improves after defication
• Holding of stools can lead to high pain

Gradual onset, from the rectum up to the colon

Question 2

What is Ulcerative Colitis?

Answer 2

An inflammatory bowel disease that affects the colon starting at the rectum, with inflammation occurring all the way through –> in the large intestine
Affects mucosa
More common in developed countries
Affects around 70 per 100,000
More common in women and white people
There is an increased incidence of UC of about 10% in first-degree relatives.
Incidence is bimodal with a peak at 20-40 years and a secondary peak at 60-80 years –> can be diagnosed in children

Question 3

What are the main triggers of UC?

Answer 3

Genetics? –> can be a carrier of genes
Environmental?

• Nature of the intestinal microflora –> changes
• Intestinal barrier function –> anything that can damage the gut cells
• Immunological responses –> something that can trigger an autoimmune response

Postulated but unproven aetiological factors
- major infection
- psychosocial factors
- immunological abnormalities
- defective gut mucosa
- giving up smoking –> increased risk

Question 4

What can cause a UC relapse?

Answer 4

• Emotional stress
• Infection
• Acute gastroenteritis
• Medications such as antibiotics and NSAIDs

Question 5

What would you expect to see in the endoscopy of someone with UC?

Answer 5

Affected mucosa with hyperaemia (increased blood flow to the region) with surface pus and blood. Fine lesions of the mucosa.

The damaged area can repair to form multiple pseudoplyps which are hanging fragments of mucosa that resemble polyps and which are visible by endoscopy –> over the long term in some cases they can become malignant cells (cancer) they can also spread and cause secondary tumours in the body

Question 6

How is UC diagnosed?

Answer 6

Measure biochemistry inflammatory markers
- Erythrocyte sedimentation –> early marker for whether the patient is suffering from inflammation can also be used in cancer diagnosis –> measures the capacity of blood cells to settle down in an hour, depending on gender and age.
- White blood cells -> IM
- C-reactive protein -> IM

• Albumin –> low levels may be related to malabsorption of protein and increased need for protein (gut damage), affected area of UC is where protein is absorbed, so lack of absorption is a strong indicator for a malabsorption problem if the diet is protein sufficient.
• Stools –> analysis of bacteria as well as to identify blood and immune cells. Also the presence of blood.

Question 7

What does a erythrocyte sedimentation show with UC?

Answer 7

Indicates inflammation.
RBC fall at a faster rate in those with inflammatory conditions such as UC. RBC clump together and form a stack at the bottom
Doesn’t tell the cause, just whether inflammation is present.

Question 8

How is UC diagnosed?

Answer 8

Sigmoidoscopy –> tube only travels to the sigmoid colon
Endoscopy –> can examine higher regions
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Look at the tissue and give an idea of what is happening internally, and make any links to symptoms.
Biopsy to analyse the structure of tissue and identify any polyps.

Radiography
- not very useful for ulcerative colitis
- can give some indication of lesions
- can distinguish between Crohn’s and UC
- contrast can help enhance differentiation among different tissues

Question 9

How is UC managed?

Answer 9

Purpose to induce and extend periods of remission
General support from medical staff and dietitians is usually adequate
The use of anti-inflammatory drugs may be useful to get the condition into remission

Corticosteroids:
- Strong anti-inflammatory
- Be careful in patients with diabetes –> not recommended due to changes in fat and glucose metabolism
- Corticosteroids can challenge blood glucose management
- Not recommended for chronic use –> can cause mitochondrial damage

Aminosalicylates:
- Asacol and Pentasa
- Lower effects on glucose metabolism

Surgery
- May need to remove a distal portion of colon or rectum

Ileostomy bags
- After some surgeries

Question 10

What are the diet recommendations for those with UC?

Answer 10

Enteral or parenteral diet may be required at first to reduce intestinal inflammation
Then move to a liquid diet, then slowly to solids

Energy intake
- Important to keep an eye on weight and energy levels
- Some may struggle to eat due to pain

Macronutrients
- Check general markers of nutritional status
- Increased protein consumption (1.5g/kg during remission period)
- Omega-3-fatty acids (improving damage by UC)

Micronutrients
- Check general markers of nutritional status
- Bone density check
- May have increased demands of some vitamins and minerals due to malabsorption
- Supplementation may be required

Pre and probiotics
- After remission and once stable, they can be introduced to help promote positive changes on the gut microbiome and prolong remission periods

Dietary fibre
- Individual responses are variable so it is important to check their sensitivity to fibre
- Usually recommended after all symptoms are gone to introduce fibre slowly, if tolerated they should try to meet the dietary recommendations of dietary fibre
- May help manage their condition and prevent future relapses
- Monitor response