Ulcerative colitis is a chronic inflammatory bowel disease primarily affecting the mucosal layer of the large intestine. This autoimmune-related condition causes persistent inflammation of the intestinal mucosa, leading to abdominal pain, diarrhea, and the passage of mucus or blood-stained stools. Epidemiological studies indicate that the disease is most common among individuals aged 20 to 40 and 50 to 70, with a higher incidence rate in developed countries.
The core feature of ulcerative colitis overview is that the lesions are confined to the mucosa of the colon, distinguishing it from other inflammatory bowel diseases such as Crohn's disease. Patients may experience long-term remission alternating with acute flare-ups. Severe cases can lead to complications such as ulcer perforation or massive bleeding. Early diagnosis and treatment are crucial for controlling disease progression, but currently, there is no cure. The treatment goals focus on symptom relief and prevention of complications.
The etiology of ulcerative colitis is complex, involving interactions among genetic, immune, and environmental factors. Genetic studies show that individuals with first-degree relatives affected by the disease have a 3 to 5 times higher risk of developing it. Abnormalities in specific genes such as NOD2 and ATG16L1 may impair the intestinal mucosal barrier, making it easier for bacterial antigens to trigger immune responses.
Immune dysregulation is a key pathogenic mechanism, where T lymphocytes mistakenly recognize normal gut bacteria as threats, secreting excessive inflammatory mediators like TNF-α. Environmental triggers include Western dietary patterns (high fat, low fiber), smoking history, antibiotic use, and urban lifestyles, which may induce disease in genetically susceptible individuals.
Typical symptoms usually develop gradually, initially presenting as mild diarrhea or changes in bowel habits. As the disease progresses, patients experience multiple daily episodes of watery diarrhea with mucus and fresh blood, often accompanied by left lower abdominal cramping. About 30% of patients exhibit extraintestinal manifestations, including arthritis, conjunctivitis, and skin erythema, which are systemic symptoms.
Acute flare-ups may present with severe symptoms such as:
A small number of patients may show emergency signs:
The diagnostic process involves excluding infectious colitis and differentiating ulcerative colitis from other conditions. The first step typically involves colonoscopy, directly observing characteristic lesions such as mucosal hyperemia, ulcerations, and bleeding points, while obtaining tissue samples for histopathological analysis to confirm features like crypt hyperplasia.
Imaging studies, such as abdominal CT scans, assess bowel wall thickness and complications like fecal impaction. Blood tests commonly show elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), but these non-specific markers should be interpreted in conjunction with other findings. Stool examinations are used to exclude bacterial infections; detection of leukocytes or pathogens necessitates reevaluation of the diagnosis.
The first-line treatment involves 5-aminosalicylic acid drugs (e.g., mesalamine), which inhibit prostaglandin synthesis and reduce mucosal inflammation. In severe flares, corticosteroids (e.g., prednisolone) are used to control acute symptoms, but long-term use may cause side effects such as osteoporosis.
Biologic agents, such as anti-TNF-α monoclonal antibodies (e.g., infliximab), are suitable for moderate to severe patients unresponsive to conventional therapy. Monitoring for antibody development and infection risk is necessary. Immunomodulators like azathioprine and 6-mercaptopurine are used to maintain remission, with regular monitoring of liver function and white blood cell counts.
Approximately 25-30% of patients eventually require surgical removal of the entire colon for definitive treatment. Indications include refractory cases unresponsive to medication, suspicion of pre-cancerous lesions, and acute toxic megacolon. Surgical options include total colectomy with ileal pouch-anal anastomosis (IPAA), which can preserve anal sphincter function but requires staged procedures and close postoperative monitoring of anastomotic healing.
Currently, there is no way to completely prevent disease onset, but lifestyle management can reduce the frequency of flare-ups. Regular monitoring of body indicators such as hemoglobin, albumin, and inflammatory markers can facilitate early detection of disease changes.
Lifestyle adjustments include:
Psychological interventions such as stress management courses have been shown to reduce relapse risk. It is recommended to develop personalized remission plans in collaboration with healthcare providers.
If you experience the following symptoms, seek medical attention immediately:
Emergency symptoms requiring immediate hospital visit include:
Patients under maintenance therapy should be closely monitored; worsening symptoms require prompt medication adjustments to prevent complication escalation.
How should diet be adjusted during chronic flare-ups to alleviate symptoms?
During flare-ups, a low-fiber, easily digestible diet is recommended, such as white rice, steamed fish, and skinless chicken. Avoid high-fat, spicy, and gas-producing foods. Eating multiple small meals and consulting a nutritionist for a personalized diet plan is advised. If severe diarrhea or bleeding occurs, solid foods should be temporarily discontinued, and oral electrolyte solutions used to maintain hydration.
Does long-term use of biologic agents increase the risk of infection?
Biologics suppress specific immune pathways, which may slightly increase the risk of minor infections such as upper respiratory infections, but the risk of severe infections remains relatively low. Before treatment, physicians evaluate potential infection risks (e.g., tuberculosis history). During therapy, regular serological monitoring is necessary, and patients should avoid contact with infectious sources. Vaccinations such as the flu shot can help reduce some risks.
What changes in quality of life can patients expect after total colectomy?
Post-colectomy, patients require a permanent ileostomy. Initially, adapting to daily care of the stoma is necessary, but long-term, it effectively alleviates intestinal symptoms. Some patients may experience increased bowel movements or control issues, but with proper stoma care education and psychological support, about 80% can gradually resume normal social activities.
How does stress management influence the recurrence rate of the disease?
Stress can trigger abnormal immune responses in the gut, exacerbating inflammation. Techniques such as mindfulness meditation, regular yoga, and social support can reduce cortisol levels and improve symptom control. Studies show that regular stress management can reduce annual relapse rates by 30-40%, and it is recommended to combine these with medication therapy.
Is it safe to use immunosuppressants during pregnancy?
Using traditional immunosuppressants (e.g., azathioprine) during pregnancy requires caution, as they may affect fetal development. Modern treatment strategies prefer discontinuing high-risk drugs before conception and using biologics (e.g., adalimumab) with close monitoring. Research indicates that well-controlled disease during pregnancy does not significantly increase preterm birth risk, but continuous specialist supervision is essential.
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