How Effective Is Azathioprine for Ulcerative Colitis?

Ulcerative colitis is a chronic non-specific inflammatory disease of the colon and rectum whose etiology is not very clear. The lesions are limited to the large intestine 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. The disease is seen at any age, but it is most common between the ages of 20 and 30 years.

Basic Information

nickname

Chronic nonspecific ulcerative colitis

English name

ulcerative colitis

Visiting department

Gastroenterology

Multiple groups

20 to 30 years old

Common causes

unknown

Common symptoms

Bloody diarrhea, abdominal pain, blood in the stool, weight loss, severe after anxiety

Contagious

no

Causes of ulcerative colitis

The cause of ulcerative colitis is still unknown. Genetic factors may have a certain status. Psychological factors play an important role in the worsening of the disease, and the previously existing ill spirits such as depression or social distance significantly improved after colectomy. Ulcerative colitis is considered to be an autoimmune disease.

At present, the pathogenesis of inflammatory bowel disease is considered to be the result of the interaction between host response, genetic and immune effects caused by foreign substances.

Clinical manifestations of ulcerative colitis

The initial manifestations of ulcerative colitis can take many forms. Bloody diarrhea is the most common early symptom. Other symptoms in turn include abdominal pain, blood in the stool, weight loss, exacerbation, and vomiting. Occasional manifestations are arthritis, iridocyclitis, liver dysfunction, and skin lesions. Fever is a relatively uncommon sign. In most patients, the disease is chronic and low-grade, and in a few patients (about 15%), it is an acute and catastrophic outbreak. These patients present with frequent bloody stools, up to 30 times / day, and high fever and abdominal pain.

Signs are directly related to the disease stage and clinical manifestations. Patients often have weight loss and pale, and often experience tenderness in the colon during abdominal examinations during active disease. There may be signs of acute abdomen with fever and decreased bowel sounds, especially in acute or fulminant cases. Signs of bloating, fever, and acute abdomen may be seen in toxic megacolon. Frequent diarrhea may cause abrasions and exfoliation of the perianal skin. Perianal inflammation such as fissure or anal fistula can also occur, although the latter is more common in Crohn's disease. Digital rectal pain is painful. Examination of the skin, mucous membranes, tongue, joints and eyes is extremely important.

Diagnosis of ulcerative colitis

According to the following clinical manifestations and auxiliary examinations to help the diagnosis of this disease.

Clinical manifestation

With the exception of a few patients with sudden onset, the onset is generally slow and of varying severity. Symptoms are mainly diarrhea, and feces containing blood, pus, and mucus are excreted, often accompanied by paroxysmal colonic spasm, which can be severe after exacerbation and can be relieved after defecation.

Symptoms are mild in patients with less than 5 diarrhea per day.

Severe daily diarrhea is more than 5 times. It is watery diarrhea or bloody stool, severe abdominal pain, fever symptoms, body temperature can exceed 38.5 , pulse rate is more than 90 times / minute.

Bursts are rare. The onset is rapid, the condition develops rapidly, the amount of diarrhea is large, and blood in the stool is often present. Body temperature can rise up to 40 ° C, and severe cases of symptoms of systemic poisoning. The disease does not heal for a long time, and weight loss, anemia, malnutrition, and weakness can occur. Some patients have extraintestinal manifestations, such as nodular erythema, iritis, chronic active hepatitis, and peritubular inflammation.

2. Auxiliary inspection

The diagnosis mainly depends on fiber colonoscopy, because 90% to 95% of patients are affected by the rectum and sigmoid colon, so in fact, the diagnosis can be clearly confirmed by fiber sigmoidoscopy. Congestion and edema of the mucosa can be seen on the microscopic examination, which is brittle and easy to bleed. Ulcers can be seen in progressive cases, surrounded by raised granulation tissue and edema of the mucosa, which look like polyps, or can be called pseudopolyps formation. The rectal and sigmoid colonic cavities can be significantly reduced in chronic progressive cases. In order to determine the extent of the disease, a fiber colonoscopy is used for a full colon examination, and multiple biopsies are performed at the same time to distinguish it from clonitis.

Air-barium enema double contrast angiography is also a diagnostic test that is particularly helpful in determining the extent and severity of the lesion. In the barium perfusion imaging, the colonic bag shape disappeared, the intestinal wall was irregular, the formation of false polyps, and the intestinal cavity became thin and rigid. Although barium enema tests are valuable, care should be taken to avoid bowel cleansing as it can worsen colitis. For cases without diarrhea, a liquid diet can be given for 3 days before the examination. Barium enema is not recommended for patients with abdominal signs, but plain X-ray films of the abdomen should be used to observe the signs of toxic megacolon, colonic dilatation, and free gas below the diaphragm.

Ulcerative colitis complications

Toxic colonic dilatation

Occurs during the acute active phase, with an incidence of approximately 2%. It is because the inflammation spreads to the muscularis of the colon and the intermuscular plexus, and the intestinal wall is low in tension, showing a phased paralysis, a large accumulation of intestinal contents and gas, which causes acute colonic expansion, thinning of the intestinal wall, and more common lesions in the sigmoid or transverse colon. The incentives include hypokalemia, barium enema, use of anticholinergic drugs or opioids, etc. The clinical manifestations are rapid deterioration of the disease, obvious symptoms of poisoning, accompanied by abdominal distension, tenderness, rebound pain, weakening or disappearing of bowel sounds, and increased white blood cell count. X-ray abdominal plain film showed widened bowel cavity and disappeared colonic bag. Prone to intestinal perforation. Case fatality rate is high.

2. Intestinal perforation

The incidence is about 1.8%. It occurs mostly on the basis of toxic colonic dilatation, causing diffuse peritonitis, and the occurrence of free gas below the diaphragm.

3. Major bleeding

It is pointed out that those with large blood volume who need transfusion treatment, the incidence rate is 1.1% to 4.0%. In addition to bleeding due to ulcer-related blood vessels, hypothrombinemia is also an important cause.

4. Polyps

The incidence of polyps in this disease is 9.7% to 39%. This kind of polyps is often called pseudopolyps. Can be divided into mucosal droop type, inflammatory polyp type, adenoma-like polyp type. Polyps are more common in the rectum, and some people think that the descending colon and sigmoid colon are the most, and they decrease in order. Its outcome can disappear with the healing of the inflammation, destruction with the formation of ulcers, long-term persistence or canceration. The cancer is mainly from adenoma-like polyps.

5. Cancerous

Incidence has been reported differently, and some studies suggest that it is many times higher than those without colitis. More common in colitis lesions involving the entire colon, childhood onset and history of more than 10 years.

6. Enteritis

The lesions complicated by enteritis are mainly in the distal ileum, manifested as umbilical or right lower quadrant pain, watery stools and fatty stools, which accelerates the progress of patients with systemic failure.

7. Complications Related to Autoimmune Response

The common ones are: arthritis ulcerative colitis arthritis is about 11.5%, which is characterized by the concurrent occurrence of severe enteritis. Large joint involvement is more common, and often a single joint lesion. The joints were swollen, and the synovial fluid was not damaged. No rheumatic changes in serology. And often coexist with eye and skin-specific complications. Skin and mucosal lesions Nodular erythema is more common, with an incidence of 4.7% to 6.2%. Others include multiple abscesses, localized abscesses, pustular gangrene, and erythema polymorpha. Stubborn ulcers of the oral mucosa are also not uncommon, sometimes as thrush, and the treatment effect is not good. Ocular lesions include iritis, iridocyclitis, uveitis, corneal ulcers, etc. The former is most common, with an incidence of 5% to 10%.

Ulcerative colitis treatment

For patients with violent and severe illness, such as cases of poor medical treatment, surgical treatment will be considered.

Medical treatment

(1) Bed rest and whole body support treatment Including fluid and electrolyte balance, especially potassium supplementation, hypokalemia should be corrected. At the same time, we should pay attention to protein supplementation and improve the nutritional status of the whole body. If necessary, we should provide total parenteral nutrition support. Those with anemia can be transfused. Milk and dairy products should be avoided when ingesting the gastrointestinal tract.

(2) Drug treatment Sulfasulfapyramide salicylic acid preparation is the main treatment drug, such as Edissa, mesalazine and so on. Corticosteroids are commonly used as prednisone or dexamethasone, but long-term hormone maintenance is not currently believed to prevent relapse. Hydrocortisone or dexamethasone can also be administered intravenously during acute episodes, and hydrocortisone added to saline every night as a retention enema. The value of hormonal therapy during acute episodes is certain, but in There is still disagreement about whether or not to use hormones in the chronic phase. Due to its side effects, most people do not advocate long-term use. The value of immunosuppressive agents in ulcerative colitis is still questionable. According to Rosenberg et al., Azathioprine does not control the disease as it progresses, but it helps reduce corticosteroid use in chronic cases. Traditional Chinese medicine can be used to treat diarrheal ulcerative colitis with traditional Chinese medicine, and the effect is ideal. At the same time should pay attention to diet and lifestyle.

2. Surgical treatment

20% to 30% of patients with severe ulcerative colitis have final surgical treatment

(1) Indications for surgery Indications that require emergency surgery are: a large amount of uncontrollable bleeding; toxic megacolon with near or clear perforation, or ineffective treatment of toxic megacolon for several hours instead of days; Fulminant acute ulcerative colitis is ineffective for steroid hormone treatment, that is, those who have not improved after 4 to 5 days of treatment; Obstruction due to stenosis; Colon cancer is suspected or confirmed; Repeated episodes of refractory ulcerative colitis Worsening, chronic persistent symptoms, malnutrition, weakness, inability to work, and participation in normal social activities and sexual life; when the steroid hormone dose is reduced, the disease worsens, so that hormone therapy cannot be stopped for months or even years; When chronic colitis affects its growth and development; Severe extracolonic manifestations such as arthritis, gangrenous pyoderma, or bile liver disease may be effective.

(2) Surgery options There are currently four types of surgery for ulcerative colitis. Total colorectal resection and ileostomy; Total colon resection and ileal anastomosis; Controlled ileostomy; Total colorectal resection and ileal pouch-anal anastomosis.

At present, there is no effective long-term prevention or treatment method. In the current four types of surgery, total colorectal resection and ileal pouch-anal anastomosis are reasonable and optional.

Ulcerative colitis prevention

1. Pay attention to the combination of work and rest, not too tired; violent, acute and severe chronic patients, should rest in bed.

2. Pay attention to clothing and keep fit and cold; appropriate physical exercise to enhance physical fitness.

3. Generally, you should eat soft, digestible, nutritious and sufficient calorie food. Small meals and multiple vitamins should be added. Do not eat raw, cold, greasy, and fiber-rich foods.

4. 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.

5. In general, keep your mood comfortable, avoid mental stimulation, and relieve all kinds of mental stress.