Episodes in ulcerative colitis | Ulcerative colitis

Episodes in ulcerative colitis

Ulcerative colitis is one of the chronic inflammatory bowel diseases, as is Crohn’s disease. The disease is characterized by the fact that it usually consists of phases without symptoms and acute phases with symptoms. These phases, in which the affected persons suffer from very frequent and pronounced, often bloody diarrhoea and abdominal pain, are called relapses.

This means the occurrence of a relapse after a period of rest. However, there are also patients who suffer permanently from symptoms of the disease, which is called a chronically active course. The treatment of ulcerative colitis often consists of long-term medication and acute medication, which is used when an acute flare occurs.

Long-term medication is intended to limit the disease activity as much as possible, while relapsing medication is mainly used to reduce symptoms quickly. However, it is often not possible to control the symptoms completely with medication. It can happen that the symptoms during a relapse are so severe that treatment in hospital is necessary.

Here, certain drugs can be administered intravenously as infusions, which often leads to faster relief than taking the drugs in tablet form. The diagnosis of ulcerative colitis is made by blood tests and, above all, colonoscopy, including a histological examination of a sample of the mucous membrane. The most important differential diagnosis is Crohn’s disease, which is very similar to ulcerative colitis, especially in its symptoms.

In 10% of patients with unspecific colitis, the definitive diagnosis cannot be made at the beginning of the disease. During the doctor-patient consultation (anamnesis), the frequency and quality of stool, blood admixtures, pain and other symptoms can be asked. The physical examination often does not reveal any specific findings.

Sometimes a pressure-painful abdomen can be palpated and blood can be found on the glove during the rectal palpation. During the blood examination some parameters may indicate an inflammation in the body. The blood sedimentation rate (BSG) may be accelerated, the C-reactive protein (CRP) may be elevated and an increased number of white blood cells (leukocytes) may be found.

A lowered hemoglobin level in the blood (anemia) can be caused by blood loss. In about half of the patients an autoantibody can be found in the blood, the so-called prinuclear antineutrophic cytoplasmic antibody (p-ANCA). In order to be able to partially exclude other diseases that can occur in the abdominal cavity, sonography of the abdomen is often performed.

An important exclusion diagnosis is an infectious cause of intestinal inflammation (colitis), which is also associated with diarrhoea. For the differential diagnosis, a stool examination (stool sample) must therefore sometimes be carried out in order to exclude particularly bacterial pathogens as the cause. However, the most important diagnostic measure is a colonoscopy.

Colonoscopy: The “endoscopy” (endoscopy) of the intestine is the diagnostic tool of choice for the direct assessment and classification of mucous membrane damage and should be performed if a chronic inflammatory bowel disease is suspected. During colonoscopy, images are transmitted to a monitor via a tube camera (endoscope). For this purpose, the camera is advanced up to the caecum (part of the colon) and then the mucosa is assessed while slowly retracting.

During the colonoscopy, additional tissue samples (biopsy) can be taken from inflamed areas of the mucosa. The fine-tissue evaluation of the biopsies under the microscope (histological findings) is far more meaningful than the (macroscopic) findings recorded with the naked eye. Depending on the severity of the inflammation, a simple swelling (edema) of the mucosa is noticeable during the examination of the intestinal mucosa, up to extensive ulcers with massive bleeding and loss of the mucosa relief.

Sometimes pseudopolyps can be found in the endoscopy, which are caused by an excessive healing reaction (regeneration) of the mucosa. Rectoscopy (recto-sigmoidoscopy): This method allows the rectum to be viewed through a rigid tube. In the case of an isolated inflammation of the rectum, this method can be used to monitor the progress of the disease.

However, a complete colonoscopy should always be performed for the initial diagnosis. Histological examination: The biopsy taken in the endoscopy should be examined histologically by the pathologist under the microscope. Often the characteristic mucosal involvement can differentiate ulcerative colitis from other intestinal inflammations, such as Crohn’s disease.

The characteristic microscopic feature of ulcerative colitis of the colon is an isolated inflammation of the mucosa. This is characterised by a high accumulation of inflammatory cells (lymphocytes) in the mucosa and a strong reduction of the goblet cells typical of the colon. Abscesses in the crypts of the colon mucosa are considered to be particularly characteristic.

Colonic contrast enema : In a colonic contrast enema, the colon is made visible in an X-ray image by the administration of contrast medium via the anus (enema, enema, enema). In addition, the colon can be inflated with air so that the contrast medium is deposited on the walls of the colon, making even the finest changes in the colon wall visible. It is possible to assess inflammatory diseases of the intestinal wall such as ulcerative colitis and the associated constrictions (stenoses, strictures).

In some cases, an MRI according to Sellink is also performed. Here, the MRI is performed from the abdomen after oral administration of contrast medium using the Sellink technique. Especially diseases of the small intestine can be diagnosed well with this technique.