Synonyms in a broader sense
Ulcerative colitis, colitis, chronic inflammatory bowel disease (CED), ulcerative enterocolitis, ileocolitis, proctitis, rectosigmoiditis, proctocolitis, pancolitis, backwash ileitis.
Definition Ulcerative colitis
Like Crohn’s disease, ulcerative colitis belongs to the group of chronic inflammatory bowel diseases (CED). Ulcerative colitis is characterised by isolated inflammation of the colon and rectal mucosa. Ulcerative colitis usually becomes symptomatic (painful) with bloody-mucus diarrhoea and abdominal pain and affects younger people in the 2nd to 4th decade of life.
Frequency
Out of 100,000 inhabitants, 40 to 80 suffer from ulcerative colitis, with an increase in the incidence rate over the last 20 years. The disease affects women only slightly more frequently than men and usually begins at a young age, between the ages of 20 and 40. A second peak of the disease is recorded between the ages of 60 and 70.
In some cases, family and ethnic clusters can be identified. In western countries ulcerative colitis is much more common than in underdeveloped countries. Whites are 4 times more likely to contract the disease than blacks and Latin Americans.
It is not rare for children to be affected. In their case it is particularly serious in that the classically occurring severe, frequent diarrhoea can lead to weight loss and a lack of growth retardation. It is therefore important for the young patients to try to eat a balanced, high-calorie diet, especially between the individual attacks.
A definitive cause of ulcerative colitis is not known. It is assumed to be a multifactorial event, which means that several factors must coincide for the disease to break out. A combination of genetic, immunological, infectious, nutritional, environmental and hygienic factors is assumed.
The presumed mechanism seems to lie in a reduced tolerance to the physiologically colonizing germs, so that antigens (foreign substances) that pass through the intestinal wall can cause an inadequate immune reaction. Although ulcerative colitis is not regarded as a psychosomatic disease, psychosomatic coincidence can trigger a relapse and cause illness. Furthermore, it is assumed that a very low-fibre diet can contribute to the development of ulcerative colitis. Some ingredients, especially proteins from cow’s milk, are also suspected to promote this chronic inflammatory bowel disease. To support this theory, there are studies that show that people who were not breastfed by their mothers in infancy have a higher risk of developing the disease than a control group.
Course and localization
Ulcerative colitis always begins in the rectum and can spread from there to the entire colon. In about half of the patients only the sigmoid colon (penultimate part of the colon; see colon) is affected and in another 40% the entire colon is affected. In rare cases, an inflammation of the small intestine can also be “washed into” the colon; this is also called backwash ileitis.
Ulcerative colitis is usually intermittent, so that there may be pauses between the inflammatory attacks for years (remission). A distinction is made between mild, moderate and severe relapses. An acute flare of the disease lasts on average about 4 to 8 weeks.
In 10% of the patients, however, despite adequate therapy, a chronically active course of the disease occurs without remission being recorded. This is also referred to as a refractory course. With appropriate medication, only the symptoms of the disease can be treated and the frequency and severity of acute attacks can be reduced, but a cure cannot be achieved with them.
This disease can only be cured by a complete removal of the colon. However, this step should not be taken lightly, as the operation carries some risks of complications and in any case leads to temporary, in some cases even permanent, fecal incontinence, which puts a great deal of psychological strain on many patients. – Mild relapse: The general condition of the patient is not affected.
There is no fever and the bloody-slimy diarrhoea occurs “only” up to five times a day. – Moderate relapse: A slight fever may be present, diarrhoea occurs up to eight times a day and is accompanied by cramping abdominal pain. – Severe relapse: It is characterized by mucous-bloody defecation, which occurs more than eight times a day. In addition, there is a high fever above 38°C, an accelerated heart rate (tachycardia), a pressure-painful abdomen and a severely restricted general condition.