Colitis ulcerosa

Ulcerative colitis is a chronic inflammatory bowel disease (IBD) with a significantly higher incidence of colorectal carcinoma (CRC) than in Crohn's disease. However, the pattern of infestation differs from that of Crohn's disease. In ulcerative colitis, a continuous infestation of the intestine starting from the rectum is in the foreground.

The cause of the disease is unclear, but an excessive immune reaction against the intestinal mucosa is suspected. Clinically, chronic diarrhea is in the foreground alongside colicky pelvic pain. Furthermore, a drop in performance, loss of appetite, weight loss and tiredness can be observed.

Manifestations outside the bowel are less common than in Crohn's disease. Here, too, the microbiome (intestinal bacteria) has a decisive influence on the disease itself and on the course. As in Crohn's disease, the composition of the microbiome is most likely also related to the development of the disease.

In order to be able to make the diagnosis of ulcerative colitis, a colonoscopy (colonoscopy) with stepped biopsies must be performed. The laboratory examination shows increased inflammation parameters, as well as anemia with iron deficiency and possibly a vitamin B12 deficiency as well as a deficiency in electrolytes. Calprotectin is also increased in the stool. It is important to take a medical history regarding NSAIDs (non-steroidal anti-inflammatory drugs) and antibiotics. A CMV infection (cytomegalovirus) should also be serologically excluded from a differential diagnosis.

The diet in the symptom-free remission phase (without diarrhea, or max. 3 stools per day) should be rich in vitamins, calories and fiber. Fried and fatty foods such as French fries, smoked foods, breaded fried foods, heavily spiced foods, foods that are too hot and too cold should be avoided as far as possible, as they can trigger new attacks. Preparations in the steamer are very well tolerated. Foods rich in omega-3 fatty acids such as linseed oil, salmon, game, and berries containing anthocyanins such as blueberries are anti-inflammatory and well suited. Therapy for acute colitis should always be started conservatively with medication (mesalazine, glucocorticoids, immunosuppressants) and an accompanying low-fiber diet without sugar, as this leads to a relapse-related sugar intolerance. In severe cases, especially if there is no response to therapy or toxic colon and / or in the case of dysplastic adenomas (DALM)—precursors to CRC (colorectal carcinoma)—or if there are complications, surgery may be unavoidable. In this case, however, it makes sense to completely remove the colon down to the anal mucosa, because then the patient is cured compared to Crohn's disease. Partial removal of the colon is only permitted in exceptional cases. After the colon has been completely removed, its function, namely that of thickening, ceases to exist. The rectum also lacks the reservoir function. A reservoir is formed from the small intestine (pouch) and thus a better continence is achieved. The small intestine also partly takes over the function of the large intestine with its thickening. Together with drugs that delay intestinal transit, a useful result can be achieved.

Which therapy option is the most suitable in each individual case must be decided individually. The likelihood of the need for a surgical procedure for colitis is, however, significantly lower compared to that for Mb. Crohn.