Ulcerative Colitis: Complications

The following are the most important diseases or complications that may be contributed to by ulcerative colitis:

Blood, blood-forming organs – Immune system (D50-D90).

Cardiovascular system (I00-I99).

Liver, gallbladder, and biliary tract-pancreas (pancreas) (K70-K77; K80-K87).

  • Primary biliary cholangitis (PBC, synonyms: nonpurulent destructive cholangitis; formerly primary biliary cirrhosis) – relatively rare autoimmune disease of the liver (affects women in about 90% of cases); begins primarily biliary, i.e., at the intrahepatic and extrahepatic (“inside and outside the liver“) bile ducts, which are destroyed by inflammation (= chronic nonpurulent destructive cholangitis). In the longer course, the inflammation spreads to the entire liver tissue and eventually leads to scarring and even cirrhosis; detection of antimitochondrial antibodies (AMA); PBC is often associated with autoimmune diseases (autoimmune thyroiditis, polymyositis, systemic lupus erythematosus (SLE), progressive systemic sclerosis, rheumatoid arthritis); Associated with ulcerative colitis (inflammatory bowel disease) in 80% of cases; long-term risk of cholangiocellular carcinoma (CCC; bile duct carcinoma, bile duct cancer) is 7-15% (5% of patients with ulcerative colitis develop PBC)

Mouth, esophagus (food pipe), stomach, and intestine (K00-K67; K90-K93).

  • Intestinal stenosis (intestinal narrowing; risk of ileus/risk of intestinal obstruction).
  • Dysbiosis (imbalance of the intestinal flora).
  • Toxic megacolon – toxin-induced paralysis and massive dilatation of the colon (widening of the large intestine; > 6 cm), which is accompanied by acute abdomen (most severe abdominal pain), vomiting, clinical signs of shock and sepsis (blood poisoning); lethality (mortality based on the total number of people suffering from the disease) is about 30%.
  • Perforation (rupture) of the intestine.
  • Pronounced anal bleeding

Musculoskeletal system and connective tissue (M00-M99)

  • Osteoporosis (bone loss)

Neoplasms – tumor diseases (C00-D48)

  • Colon carcinoma (cancer of the colon or rectum) – this risk is at:
    • Pancreatitis (inflammation of the entire colon) 10 years after initial diagnosis at about 2%.
    • Distal colitis (involvement of the rectum/masculature and sigmoid/sigmoid colon) from the 15th year of disease 0.5-1.0% per year
    • 30 years after initial diagnosis, the cumulative risk of carcinoma is just below 20% (risk of carcinoma increased by 2.4 times)
  • Prostate cancer (men with inflammatory bowel disease (IBD) have a 4.84-fold higher risk after 10 years).

Psyche – nervous system (F00-F99; G00-G99).

  • Depression
  • Fatigue – fatigue or increased need for rest and limitation of performance.

Symptoms and abnormal clinical and laboratory parameters not elsewhere classified (R00-R99).

  • Cachexia (emaciation; very severe emaciation).

Other consequences include:

Enteral protein loss syndrome

Impairment of the intestinal mucosa results in increased intestinal protein loss, as leakage of plasma proteins through the intestinal mucosa into the bowel exceeds the rate of protein (albumen) synthesis. The decrease in circulating plasma proteins is usually accompanied by a severe deficiency in protein The pathological protein loss may be promoted by a concomitant high dietary fat intake. When long-chain fatty acids are absorbed, lymphatic pressure is increased and high amounts of lymphatic fluid leak into the intestine. As a result of increased lymph concentrations, there is a high enteral protein loss and eventually a decrease in plasma proteins. The increased intestinal protein loss ultimately leads to a decrease in oncotic pressure and thus – depending on the extent of the decreased concentration of plasma proteins (hypoproteinemia) – to the formation of edema.

Inadequate coverage of energy and vital substance requirements (micronutrients)

In ulcerative colitis, general malnutrition occurs primarily due to an unbalanced and misdirected diet, disturbances in absorptive function, and high losses of nutrients and vital substances (macro- and micronutrients) through the stool. In particular, patients have increased deficiencies of protein – due to enteral protein loss syndrome and hypalbulinemia – and the trace element iron. Iron deficiency states – iron deficiency anemias – are much more common in colitis patients than in Crohn’s disease patients because of the greater tendency to bleed. Depending on the extent, the bloody diarrhea is accompanied by high iron losses. The deficiency of energy and important nutrients and vital substances (macro- and micronutrients) in ulcerative colitis patients is often the result of:

  • Inadequate dietary intake – lack of appetite.
  • Unbalanced diet – increased use of refined carbohydrates, such as white sugar (sucrose), white flour products; low fiber consumption; high consumption of chemically processed edible fats.
  • Little varied diet with deficiencies in energy, nutrients and vital substances (macro- and micronutrients) – for fear of intolerances with subsequent symptomatology – including pain, vomiting, diarrhea.
  • Restricted dietary recommendations
  • Food intolerances associated with disorders of nutrient and vital substance absorption (macro- and micronutrients).
  • A disturbed absorption or a reduced absorption surface – in addition to extensive bacterial infestation inside the intestine also after resection of parts of the colon.
  • Of a loss of bile acid
  • An increased excretion with the stool – chologenic diarrhea (chologenic fatty stool) – leading to high losses of nutrients and vital substances (macro- and micronutrients)
  • Of an increased intestinal protein loss – enteral protein loss syndrome.
  • Serious disturbances in protein metabolism with reduction of total protein in the blood – hypalbuminemia – if the normal value of albumin in the blood of 3.6-5.0 g/dl is not reached, the oncotic pressure is reduced and there is edema formation; in addition, the transport capacity of the blood is reduced due to the lack of transport plasma proteins, such as transferrin, whereby the organism can be supplied only inadequately with vital vital substances
  • A negative nitrogen balance due to protein deficiency in the body – endogenous protein-rich tissue, such as muscle tissue, is increasingly degraded and the resulting nitrogen excreted, so that more nitrogen is excreted than absorbed
  • Enteral fistulas, abscesses, strictures.
  • Side effects of medications
  • Of an increased need for energy during surgery, infectious complications, as well as blood poisoning.

Consequences of the deficiency of energy and important nutrients and vital substances (macro- and micronutrients)

If the above-normal need for energy and essential nutrients and vital substances (macro- and micronutrients) is not adequately met, the body weight can rapidly decline to underweight. In addition to being underweight, the inadequate nutritional status is characterized by a negative nitrogen balance and a reduced serum albumin value. If colitis sufferers also exhibit very low serum concentrations of vitamins, minerals and trace elements, those affected suffer from specific deficiency symptoms – frequently blood count disorders, anemia, loss of minerals from the bones with a high risk of osteoporosis, reduced performance as well as symptoms of fatigue. In particular, the organs are significantly impaired in their function due to the insufficient supply. The immune response is lowered – due to reduced antioxidant protection – and the body, already weakened by the disease, is more susceptible to infections. Malnutrition has a negative impact on both how patients feel and how the disease progresses. Patients with ulcerative colitis have an increased need for:

  • Vitamin A, D, E, K
  • Beta-carotene
  • Vitamin C
  • Vitamin B2, B3, B6, B9, B12
  • Calcium
  • Magnesium
  • Phosphorus
  • Potassium
  • Sodium chloride
  • Iron
  • Copper
  • Manganese
  • Molybdenum
  • Selenium
  • Zinc
  • Essential fatty acids, such as omega-3 and -6 fatty acid.
  • Protein and important amino acids
  • Secondary plant compounds, such as carotenoids, sulfides, saponins, phenolic acids, sulfides and flavonoids.
  • Dietary fiber
  • Water

Prognostic factors

  • Obesity – marker for less severe disease progression.