ULCERATIVE COLITIS / INFLAMMATORY BOWEL DISEASE
Inflammation of the layer on the inner surface of the large intestine, manifested by complaints such as fever, abdominal pain, diarrhea, rectal bleeding, in which genetic background and environmental factors play a role in the formation of the disease.
Ulcerative colitis can be seen at any age. However, it usually starts between the ages of 15 and 30, and is less frequent in the fifties and seventies. The frequency of incidence in men and women is considered equal. It is more frequent in white race than in blacks.
ETIOLOGY (CAUSALITIES) AND PATHOPHYSIOLOGY (FORMATION MECHANISM)
Reason cannot be explained. It is thought to be connected to environmental and genetic infrastructure. One of the theories that is emphasized is the triggering of inflammation by constantly stimulating the immune system of a virus or bacterium in the intestinal wall. It is thought that an excessive reaction of the immune system constitutes complaints, but it is not known how this develops.
Ulcerative colitis can be seen along the inflammatory colon (limited to the large intestine).
Dr. Ceyhun NURI’s Approach to Formation Mechanism:
- Effect on the environment of physiology
Unconscious drug use such as Aspirin, Antibiotic, Cigarette, Alcohol, Stress, Blood Transfusion, Tonsillectomy, Appendectomy, Appendicitis, Nontosteroid anti-inflammatory drugs (Painkillers), The Frequent, Confused, Mixed intake of added foodstuffs that cannot be consumed causes the intestinal wall surface to be covered with an indigestible waste layer. Intestinal probiotic flora begins to be affected in the worst way. As a result, the intestinal surface protection shield is removed. This process forces the regeneration process of the intestinal surface epithelium. The bowel surface begins to lose its property (it turns into fibrous tissue).
In Ulcerative colitis, inflammation of the intestinal mucus is seen as a cause of the growth of some microorganisms under the development of inflammation. Ulcerative colitis, inflammation of the intestinal mucus is seen as a cause of the growth of some microorganisms under the development of inflammation. As the intestinal natural flora is destroyed for some reason as mentioned above, the pathogenic microorganisms start to settle here, and these microorganisms start intense immune reaction against themselves or the toxic factor, cytokine, enzymes they secrete. (Th1 begins to increase further in the inflammatory response and releases the proinflammatory IL2 ITF-Gamma cytokines, which maintain the response). If inflammation is persistent, epithelium, mucous membrane destruction and ulceration begin to develop. Some of these pathogenic microorganisms are: Salmonella, E. coli, Campylobacter, Yersinia, E.Hysterica, measles virus. Maybe it is the microorganism that initiates damage on the intestinal wall, but it cannot be named because it cannot be produced in culture.
- The effect of the environment on genetic structure
There are microRNAs carried by each food, plant, and nutrient item. As an example, the genetic information that passes through the rice leads to an increase in the level of LDL that plays a role in cardiovascular diseases. Once the RNA in the food structure is absorbed in the gut, it is transported to the tissues of your body and begins to interfere with human genes. Changes in the DNA or RNA sequence begin. With the change of genetic information, the structure of proteins and enzymes encoded by DNA starts to change. This change results in disruption of structure and metabolism. The mutated genetic information begins to be transmitted. But let’s not forget that there are DNA repair mechanisms in our bodies that will correct genetic mutations. It is sufficient to support them!
As a result, when the DNA changes, it encodes it and starts to change in the proteins and enzymes that it sets its functionality. The enzyme either completely loses its function or causes incorrect metabolic processes. Here, some of the enzymes necessary for digestion (lipase, peptidase, amylase, lactase, etc.) lose their functional activity and the food taken into the intestines cannot be digested. There is a dense immune response to toxins that accumulate in the gut surface and in the gut lumen. If this process is prolonged (if the attack takes a long time) surface damage is inevitable. If, over time, it does not interfere with the course (wrong feeding, uncontrolled drug use, etc.), it is inevitable that the inflammatory process on the surface of the intestine changes direction to colon cancer. Do not forget that a certain structure of the cell is enough to create some conditions to destroy DNA (acid shift of ph balance, decrease in oxygen reaching the cell, deterioration of blood quality which removes toxins from the cell and nutrient accumulation etc.). Also, in this process, DNA synthesis and repair stops (Prostaglandin, Prostasiclines, IL-1, TNF-gamma and bacterial lipopolysaccharides stop Nitric Oxide inducers (triggers), NO stops mitochondria functions (a building block of cells) and inhibits DNA synthesis).
Ulcerative colitis is one of the most important risk factors of positive family history. In other words, it is the existence of the disease in the close family members like parents. The important thing to keep in mind is that due to the mistakes made by your parents, the DNA structure changes and the mutation is transferred to the child.
There are some genetic reading errors detected in the frame of our current knowledge. Chromosome 3,6,7,12 susceptibility locus, polymorphism in cytokine genes (TNFalpha, IL-1RA). HLA-DR2 is considered to be an important factor in susceptibility to the disease. These are the genetic reading mistakes that are transmitted from parents to children.
The severity of the disease varies from person to person. It manifests itself in a one-to-one following of exacerbation and goodness.
The most common symptoms of ulcerative colitis are cramp-shaped abdominal pain and bloody diarrhea. In addition, stool and mucus discharge can be seen. As the inflammation of the region close to the intestinal outlet increases, the stooling impulse increases, but the stool passage becomes smaller or lesser as the outlet region contracts with the cause of edema and inflammation. Symptoms that can be seen as inflammation and ulcers, as areas become more severe are:
Nausea / Vomiting
Loss of appetite
Frequent bowel movements (if the inflammation affects the rectum area)
Liquid, nutrient, elemental loss (Diarrhea Iron, B12 Vit, Ca malabsorption)
Constipation (from complaints seen in older ages, preventing the emergence of rectal spasms)
Outside the intestinal system, the most common symptom in the UC is the musculoskeletal system.
Sacroileite (Continuous pain in the lower part of the belly, very mixed with spinal disc herniation)
Ankylosing Spondylitis (morning dysfunction, moving back / back pain)
Other autoimmune diseases can be seen together:
Uveitis, Retinal hemorrhages, Cataracts
Primer sclerosing cholangitis
Psoriasis, Vitiligo, Pyoderma Gangrenosum, Erythema Nodosum
Nephrotic Syndrome, Glomerulonephritis
In addition, involvement and problems related to some circulatory system and neurological system can be seen in the UC.
Uveitis, Retinal hemorrhages, Cataracts
Primer sclerosing cholangitis
Psoriasis, Vitiligo, Pyoderma Gangrenosum, Erythema Nodosum
Nephrotic Syndrome, Glomerulonephritis
In addition, involvement and problems related to some circulatory system and neurological system can be seen in the UC.
Anemia (anemia due to chronic bleeding due to frequent bleeding)
Thrombocytosis, Thrombophlebitis (Vein Occlusion)
Thrombocytopenic purpura (slight bumps or unexplained bruises)
Pericarditis (inflammation of the heart membrane)
Bronchopulmonary involvement (Respiratory system involvement)
Peripheral neuropathy (especially pain in feet, manifested by pain)
Myasthenia gravis, cerebrovascular blindness (some neurological problems)
The first step to progression is to apply the physical examination without skipping any detailed history and no phase. (Including rectal touch)
Ulcerative colitis is among the diseases that should come to our attention if we have intestinal complaints (nausea, abdominal pain, diarrhea etc.), joint pain, general fatigue, increased gastrointestinal complaints, frequent fever and similar complaints.
The laboratory tests to be requested are:
|– Whole Blood Count
-Iron, Ferritin, Iron
– Zinc, Zinc binding
-Insulin (Hunger), Hunger- blood sugar
-CRP, RF, ES Speed
– Calcium, Phosphorus
– Liver enzymes
-Total protein, albumin
– microscopic inspection of stool
-PTH, vitamin D
-IgA, IgG, IgM
|-Thyroid function tests
– Thyroid antibodies (TG, Anti Tg, Anti TPO)
— Autoantibodies (ANA, dsDNA, AMA, ASMA, LKM 1)
– Cranial MR
– Tissue group
Stool Microscopy and Culture:
Eosinophils, erythrocytes, inflammatory cells can be seen. Amoeba, Salmonella, Shigella, Yersinia, E. coli, Clostridium difficile, Campylobacterium.
The most valuable diagnostic method in UC is colonoscopy and biopsy results obtained during this procedure. But the following imaging methods can also be used.
- Barium Column Graphic
- Computerized Tomography
- Magnetic Resonance
- Ultrasonography (Fistula, abscess, valuable in detecting fluid accumulations)
- Standing Direct abdomen Graph
Although the involvement is observed in many parts of the large intestine, the most common involvement is rectum (area near the anus). Inflammation usually involves mucosa and submucosa in the UC. So the involvement is usually superficial.
Diseases with ulcerative colitis
• Bacterial infections (Shigella,
Yersinia, Campylobacter, ameba, Escherichia coli, Clostridium difficile)
• Anal Fissure
|• Collagenous colitis
• Ischemic Colitis
• Intestinal tuberculosis
• Cecal Diverticulitis
• Acute appendicitis
• Tubo-ovarian disease
• Pelvic Inflammatory Disease
• Ectopic Pregnancy
• Systemic vasculitis
Classical Treatment Approach
THERE IS NO DEFINITIVE TREATMENT.
The purpose of the treatment is to improve the quality of life of the patient, to control the inflammatory damage (naturally not possible to eradicate the cause as it is not known exactly), to reduce symptoms (such as abdominal pain, diarrhea, correction of malnutrition). The approach to this is shown as follows:
- Drug Treatment
Expectations from Treatment: the provision of remission and improvement of patients’ quality of life. To this end, medicines containing 5-aminosalicylic acid (5-ASA) for controlling inflammation. Sulfasalazine sulfapyridine is also used in remission. However, many side effects such as nausea, vomiting, heart attack, diarrhea, and headache can be seen in these drugs. In addition, drugs such as corticosteroids such as prednisone, hydrocortisone and drugs used to reduce inflammation. Side effects such as weight gain, acne, hypertension, increased risk of infection can be seen. Therefore, prolonged use is not recommended.
If the complaints are not taken under control and the drugs above are not responded, some immunosuppressive medicines have to be applied. Immunomodulators such as azathioprine and 6-mercaptopurine (6MP), cyclosporine A try to reduce inflammation by influencing the immune system. These drugs also have many side effects such as pancreatitis, hepatitis, leukopenia (reduction of immune cells), and increased risk of infection.
In cases where the drugs cannot be suppressed and cannot be controlled, surgical procedures are called for, which is called proctocolectomy, resulting in removal of the rectum and large intestine, if necessary, insertion of the intestines into the abdomen wall with a bag (Colostomy).
- CEYHUN NURI’S APPROACH TO THE TREATMENT
- Trying to suppress a condition whose reason you cannot detect on your body with anti-inflammatory (anti-inflammatory), immunosuppressive (immunosuppressive) drugs, is actually the biggest evil done to the patient without realizing. Although recourse to irreversible pathways (bowel removal) is done with the intention of improving the quality of life of the patient, extinguish the love of life of man, maybe kill the human!!!
IT IS POSSIBLE TO COMPLETELY ELIMINATE THE DISEASE AS WE DO KNOW THE REASON OF IT.
- The detox program, which will help repair the intestinal sealing wall and cleanse the liver system, should be applied quickly.
- Now that food and nutrients are influencing the structure of DNA and RNA then it is necessary to keep away from processed, added, misplaced and structurally altered foods (fried, roasted cookies, processed drinks, stale foods etc.). It is essential to resort to phytotherapeutic solutions that will activate DNA repair mechanisms and assist in the correct coding of genetic material and regeneration of ulcer sites (seeds that do not deteriorate structure)
- Absent, missing elements and other deficiencies should be rapidly resolved (Iron, B12Vit, Ca, Mg, P, Na, K, etc.)
- When complaints are flare up, besides the main treatment we apply, the most important additional measure is the rest of the intestines. So it would be right to feed light foods that support the intestinal biological life, keeping the intestines away from heavy foods.
COMPLICATIONS THAT CAN BE DEVELOPED IF NOT TREATED
- Toxic megacolon is one of the most dangerous outcomes that Ulcerative Colitis can cause (enlargement process without any blockage in the intestines)
- Dangerous conditions such as perforation may occur in the intestines.
- The UC should be taken seriously and the development of intestinal ulcers, fluid, nutrients, elemental loss, permanent blood loss and other autoimmune problems are inevitable if the underlying cause is not treated.
- The anemia that can be seen in the UC may be due to the loss of many substances such as chronic disease, loss of blood, deterioration of intestinal absorption, removal of the intestines by surgery. Drugs that suppress the immune system, which are used for a long time, cause the bone marrow to shrink and reduce the production of blood cells.
- Additional complaints such as fistula, anal fissure, abscess, hemorrhoids may occur in the intestine.
- If chronic, pseudo-polyps may develop on the intestinal wall.
- Inflammation can spread to the liver, gallbladder, joints.
- Clotting disorder may develop
- Colon cancer develops in about 5% of Ulcerative Colitis patients (the longer the period of retention in the disease and the greater the intestinal area, the greater the risk increases).
RECOMMENDATIONS OF DR.CEYHUN NURI:
Besides the main treatment that we apply, patients can get nutritional and herbal supplements that can help reduce the symptoms of UC at home:
- As feeding on probiotics (Kefir, Yogurt) rises intestinal beneficial biological flora (Lactobacilli, Bifidobacteria etc.), it helps to reduce complaints.
- Cesarean birth that destroys the bowel flora, unnecessary use of medication, wrong nutrition style should be abandoned
- Smoking should definitely be abandoned (exacerbation and recurrences increase).
- Omega 3 fatty acids help relieve inflammation, relieve symptoms of UC, and prevent the recurrence of the condition. These patients should use at least 2-3 grams of Omega 3 preparation per day.
- Evening primrose oil is very useful in resolving the UC complaints. We recommend consuming a sweet spoon, on an empty stomach, three times a day.
- Plantaginis ovatae Yellow semen psyllii are also useful herbal supplements in addition to the main treatment. Prolongation of the remission and prevention of relapses (Repeat) have been shown to be as effective as this drug in comparison with mesalazine.
- In the UK, patients often lose many nutrients, minerals, and elements with blood loss, malabsorption, frequent diarrhea and dehydration. For this reason, many minerals such as folic acid, B12, D, E vitamins, Magnesium, Iron, and Calcium will be correct.
- Aloe Vera containing various enzymes (protease, lipase, amylase, catalase, Carboxypeptidase etc.), polysaccharides, vitamins (A, B1, B2, B12, E, Choline), minerals (Iron, Na, Manganese, is useful for the regeneration of the colon mucosa structure in the UC with the reason of its viscous structure. We recommend consuming 1 or 2 tablespoons on empty stomach a day.
Dr. Ceyhun NURİ
For more information, please contact us at our contact details.
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