What Is Lymphocytic Colitis?
Non-specific ulcerative colitis (UClerative Colitis, UC) is a chronic non-specific inflammatory disease of the colon and rectum whose etiology is not very clear. The lesion is limited to the large intestinal mucosa and submucosa. The lesions are mostly located in the sigmoid colon and rectum, and can also extend to the descending colon and even the entire colon. The course is long and often recurrent. It is also called "ulcerative colitis" or "idiopathic colitis" abroad. Chinese medicine is called "dysentery", "diarrhea", "blood in the stool", "intestinal wind" and "dirty poison".
Basic Information
- nickname
- Ulcerative colitis, idiopathic colitis
- TCM disease name
- Dysentery, diarrhea, blood in the stool, intestinal wind, dirty poison
- Visiting department
- Gastroenterology
- Multiple groups
- 20 to 40 year old women
- Common locations
- Sigmoid colon, rectum
- Common causes
- Etiology unknown, may be related to immune and genetic factors
- Common symptoms
- Blood in the stool, abdominal pain, severe urgency, diarrhea, etc.
Causes of non-specific ulcerative colitis
- This disease is an inflammatory bowel disease whose etiology and pathogenesis are not clear. At present, most scholars believe that the occurrence of this disease is related to immune factors and genetic factors, and other various factors are mostly predisposing factors.
- (I) Immune factors
- Humoral immunity
- Patients with this disease often have elevated immunoglobulins, and a variety of non-specific anti-colon antibodies can be found in the serum.
- 2. Cellular immunity
- The occurrence of this disease is related to the decline of cellular immune function.
- 3. Immune complex
- Immune complex may be one of the causes of local lesions of this disease.
- (Two) genetic factors
- Most scholars believe that genetic factors are important factors in the pathogenesis of UC.
- Relevant data show that patients with inflammatory bowel disease have a higher family incidence compared with the general population, and the closer the blood relationship is, the higher the incidence.
In addition, the occurrence of this disease has regional differences, and the familial and morbidity rates in European and American countries are significantly higher than those in Asian populations. In terms of ethnic differences, the incidence rate is higher in whites and lower in blacks.
- (3) Imbalance of intestinal flora
- Some scholars believe that the imbalance between the pathogenic bacteria and normal flora in the intestine is the trigger point of UC.
- (IV) Environmental factors
- A series of studies have shown that improper diet, fatigue, nervousness, smoking, appendectomy, taking contraceptives, pregnancy, etc. can reduce the immune response ability of susceptible people to intestinal bacteria, leading to the intestinal tract against normal flora Reduced tolerance, which induces ulcerative colitis.
- (V) Infectious factors
- Infection is closely related to the occurrence of ulcerative colitis. Infection can promote the occurrence of ulcerative colitis, but the specific mechanism of action remains to be further studied.
- (6) Other factors
- Food allergies, mental disorders, as well as factors such as nitric oxide, vascular damage and platelet aggregation, and anti-endothelial cell antibodies are related to the occurrence of UC.
Clinical manifestations of non-specific ulcerative colitis
- Blood in the stool
- Blood in the stool is the early and most important symptom of UC, with early blood or dark blood in the stool, and mucus or pus in the later period. Most of the blood is rectal ulcer, and the blood volume is generally large. Prolonged bleeding can lead to anemia.
- Abdominal pain
- Severe and active periods, abdominal pain is more obvious, the pain is refused to press, can be relieved after defecation or given analgesics.
- 3. After the emergency
- Anxious to defecate, but the discharge was not smooth, the anus fell heavily, and often accompanied by pus and blood. Defecation is frequent.
- 4. Diarrhea
- Whether diarrhea and the number of diarrhea reflect the extent of ulcer invasion. If it occurs only in the rectum, stool will generally form and diarrhea will rarely occur. However, if the entire colon is involved, diarrhea will occur, which can reach dozens of times a day at most, and the weight loss will be severe.
- 5. Parenteral symptoms
- Occasionally with arthritis, iridocyclitis, liver dysfunction and skin lesions and fever.
Nonspecific ulcerative colitis
- Palpation of abdomen
- There may be tenderness in the left lower abdomen or lower abdomen. Abdominal tenderness, rebound pain, and abdominal muscle tension may occur in severe cases. Attention should be paid to the occurrence of acute abdomen.
- 2. Endoscopy
- This is the most important inspection method of UC at present. Microscopic observation of intestinal mucosa congestion, edema, granular protrusions, multiple spot-like or patchy shallow erosions or ulcers, and mucus or yellow-white moss on the surface. The intestinal mucosa is fragile. It is easy to bleed when the lens is rubbed. Due to edema and lymphoid hyperplasia, pseudopolyps can be seen.
- 3.X-ray inspection
- The texture of intestinal mucosa folds is disordered, and the edges of intestinal canals are blurred. If you see a round filling defect, it is often a pseudopolyp. In severe cases, the intestinal sack disappears, and the intestine is a long and narrow lead tube.
- 4. Laboratory inspection
- (1) Fecal examination
- Blood, pus, and mucus can be seen with the naked eye. A large number of red blood cells, white blood cells, pus cells, and macrophages can be seen under the microscope in the acute phase.
- (2) Blood test
- Most of the severely ill patients had mild to moderate anemia, decreased hemoglobin, and normal white blood cells.
- (3) Immunological examination
- 1) When immunoglobulins are measured during humoral immune activity, it can be seen that IgG, IgM, and IgA increase, and the most obvious increase is IgG.
- 2) The percentage of T and lymphocytes in patients with cellular immunity is lower than normal.
- 5. Pathological examination
- Visible mucosal inflammatory cell infiltration, heteroepithelial cell proliferation, abnormal glandular arrangement, epithelial fibrosis, and crypt formation.
Diagnosis of non-specific ulcerative colitis
- Clinical manifestation
- Typical clinical manifestations are chronic diarrhea, mucus and bloody stools, and abdominal pain is chronic recurrent or persistent, and may be accompanied by varying degrees of systemic symptoms. The typical symptoms of a small number of patients are not obvious, only constipation or no obvious bloody stool should be combined with auxiliary examination to assist diagnosis. Carefully inquire about the patient's previous medical history, and note whether there are extra-intestinal manifestations such as joints, mouth, eyes, skin, liver and spleen.
- 2.Sigmoid and fiber colonoscopy
- (1) The affected colon mucosa presents with multiple superficial ulcers, accompanied by congestion and edema. The lesions are mostly initiated by the rectum and often involve the other colons, which are diffusely distributed.
- (2) The appearance of the intestinal mucosa is rough and uneven, and it is fine-grained. The tissue is fragile and easy to bleed or cover purulent secretions, like a thin layer of moss attached.
- (3) The colonic bag is often flattened or dulled, and multiple pseudopolyps of varying sizes are sometimes visible.
- 3. Barium meal enema examination
- (1) The colon and intestine are shortened, the colonic pouch disappears or the colon has a tubular appearance.
- (2) Multiple ulcers or multiple pseudopolyps.
- (3) The pathological changes of the colonic mucosa biopsy show an inflammatory response. At the same time, mucosal erosion, crypt abscess, abnormal arrangement of colonic glands and epithelial changes are often seen.
Classification of non-specific ulcerative colitis
- By condition
- Can be divided into mild, moderate and severe.
- 2. According to the clinical process
- Can be divided into initial hair style, chronic recurrence type, chronic persistence type and acute fulminant style.
- 3. By lesion range
- Can be divided into proctitis and sigmoid colitis, left semicolitis, right semicolitis, regional colitis and pancolitis.
Nonspecific ulcerative colitis complications
- Complications of non-specific ulcerative colitis can include toxic colonic dilatation; intestinal perforation; major bleeding; polyps; cancerous changes; enteritis;
Non-specific ulcerative colitis treatment
- Once UC is diagnosed, it should be treated as soon as possible.
- General therapy
- Mild to moderate: Eat highly nutritious, digestible food. Pay attention to rest to prevent overwork.
- Severe: fasting, intravenous nutritional elements, correction of water and electrolyte imbalances, anemia, hypoproteinemia and other symptoms. rest on bed.
- 2. Drug treatment
- (1) Aminosalicylic acid is commonly used as sulfasalazine (SASP), oxasalazine and mesalazine.
- (2) Commonly used drugs of glucocorticoids are prednisone and prednisone, which is one of the effective drugs for suppressing inflammation in the acute active phase of UC.
- (3) Immunosuppressive agents are suitable for those who are ineffective or dependent on hormones, and who cannot undergo surgery.
- (4) Probiotic preparations can be used in conjunction with any of the above drugs.
- (5) Traditional Chinese medicine treatment is based on the principles of strengthening the spleen, warming the kidney, and removing dampness and dissipating blood stasis.
- 3. Surgical treatment
- Drug therapy is the primary treatment for UC, but surgical treatment should be selected when medical treatment is ineffective or accompanied by serious complications or even life-threatening. Common surgical methods include transabdominal colectomy, total colorectal resection and permanent terminal ileal stoma or ileal pouch anal anastomosis to reconstruct the new rectum to restore intestinal continuity. The need for surgery and the specific surgical method requires the doctor to make a final decision based on the specific condition of each patient.
Prognosis of non-specific ulcerative colitis
- UC is a chronic disease, which means that it will be stubborn and recurrent, but it is generally not life-threatening.
Prevention of non-specific ulcerative colitis
- The characteristic of this disease is that it is easy to recur and prolong and hard to heal, so it brings great economic and psychological pressure to patients. Many patients will feel like wearing a heavy hat and can't breathe themselves all day long.
- Therefore, once you are sick, it is very important to regulate your mental state. Treat the disease correctly, build up the confidence to fight for a long time, keep the mood happy, fill yourself with positive energy, and the healthy vitality of the body can defeat the disease.
- Pay attention to the combination of work and rest, not too tired. Patients with fulminant, acute, and severe chronic conditions should stay in bed.
- Eat soft, digestible, nutritious, and calorie-rich foods. It is advisable to eat less and eat more, supplemented with multiple vitamins can promote the healing of ulcers. Eat less raw, cold, greasy, and fiber-rich foods.
- Proper physical exercise to enhance physical fitness, pay attention to food hygiene, and avoid intestinal infections to induce or exacerbate the disease. Avoid tobacco and alcohol, spicy food, milk and dairy products.
- At the same time of self-regulation and recuperation, you must strictly follow the doctor's instructions. Taking regular checkups on time is the prerequisite for disease recovery. [1-3]