What is inflammatory bowel disease? The treatment of inflammatory bowel disease encompasses conditions like “Crohn’s disease” and “ulcerative colitis,” where the cause is unknown and attributed to immune, genetic factors, disrupted intestinal defense mechanisms, and environmental factors. Other terms for inflammatory bowel disease are “inflammatory bowel disease” (IBD) or “inflammatory bowel disease” (IBD) in English. In a study by Rocchi et al. in 2012, the annual total treatment cost for IBD was estimated at 2.8 billion US dollars in Canada, with annual costs per patient calculated at 12,000 US dollars.

At what age and in which individuals does inflammatory bowel disease most commonly occur?

  • The most common onset age for IBD is between 15 and 25 years or between 55 and 65 years, but it can occur in all age groups. Cases in childhood comprise 7-20% of all cases.
  • The disease occurs in about 1 out of 1000 people. In Jewish populations, the rate is 2-4 times higher than in other populations.
  • Women are 30% more likely to be affected than men, and it has been determined that women are more negatively impacted by the disease in terms of quality of life compared to men.
  • There is no increase in IBD flares during pregnancy.

What are the risk factors for inflammatory bowel disease?

  • Genetic factors: Patients with ulcerative colitis have p-antineutrophil cytoplasmic antibodies. Studies by Orholm et al. and Bager et al. show that the risk of developing Crohn’s disease is 2-13 times higher in individuals with a parent having the disease compared to the general population.
  • Immune system-related factors: Antibodies develop against antigens in gut bacteria.
  • Genetic predisposition: It involves chromosomes 12 and 16 and affects one in six members of such families.
  • Smoking
  • Environmental factors
  • Diet: Symptoms may worsen with milk consumption.
  • Inactivity: Studies by Boggild et al. in Denmark found that inactive individuals have a higher risk of inflammatory bowel disease.
  • Similarly, Cucino and Sonnenberg found in their research in the USA that deaths related to inflammatory bowel disease are more frequent in inactive individuals.
  • Complaints may increase after an appendectomy.

Due to weakened immune defense, individuals with inflammatory bowel disease have an increased risk of certain infections. Therefore, it is important to administer protective vaccinations such as Haemophilus influenzae, pneumococcal, hepatitis B, hepatitis A, and human papillomavirus (HPV). Are inflammatory bowel diseases contagious? No, inflammatory bowel diseases are not transmissible from person to person.

Ulcerative Colitis

What is ulcerative colitis? Ulcerative colitis is a disease where the part of the colon lining the inner surface becomes inflamed due to environmental factors. In about 95% of cases, the disease affects the lower part of the colon, the rectum. Ulcerative colitis often spreads along the colon from bottom to top. It commonly occurs between the ages of 15 and 40, but it can also manifest in 5% of cases after the age of 60.

What symptoms occur with ulcerative colitis?

  • Bleeding from the rectum: It often presents as bloody diarrhea accompanied by mucus.
  • Constant urge to defecate (tenesmus), abdominal pain, constipation, gallbladder constriction
  • Fever (above 37.5°C)
  • Elevated heart rate (tachycardia)
  • Weight loss
  • Persistent fatigue
  • Cramp-like abdominal pain
  • Occasional constipation in elderly individuals
  • Symptoms outside the colon: joint inflammation, mouth ulcers, certain eye diseases, primary sclerosing cholangitis (gallbladder constriction), kidney stones, venous occlusions

Are there medications that can cause disease flares? Painkillers, aspirin, certain antibiotics, and birth control pills can trigger disease flares. About 5-10% of patients seek medical help for the first time due to a severe disease flare. In this patient group, it has been observed that 50% experience a recurrence within a year, and 75% within five years after responding to treatment, necessitating surgical intervention.

How is the diagnosis of ulcerative colitis made?

  • Colonoscopy
  • The definitive diagnosis is made through the pathological evaluation of biopsies taken.
  • Blood tests
  • Anemia (hemoglobin level below 10.5 g) occurs in 35-75% of cases.
  • Elevated platelet count
  • Elevated sedimentation rate (above 30 mm/hour)
  • Low albumin level
  • Low potassium level
  • Low magnesium level
  • Elevated alkaline phosphatase

How is the severity of ulcerative colitis classified? The severity of disease activity is often classified according to the Montreal criteria (Truelove-Witts criteria).

  • Remission (quiet phase): less than 3-4 bowel movements per day
  • Mild manifestation: up to 4 bowel movements per day, bloody or non-bloody
  • Moderate manifestation: 4-6 bloody bowel movements per day
  • Severe manifestation: more than 6 bloody bowel movements per day

With which diseases can ulcerative colitis be confused?

  • Colorectal cancer
  • Rectal cancer
  • Inflammatory colitis
  • Ischemic colitis
  • Radiation colitis
  • Lymphocytic colitis

Which medications are used to treat ulcerative colitis?

  • 5-ASA (mesalamin): An important treatment option for maintaining remission, with a dosage of 2.4-4.8 g/day. Tablets and rectal forms are available for application.
  • Sulfasalazine: Used in a dosage of 4-6 g/day and effective in mild to moderate disease and during remission.
  • Infliximab: A tumor necrosis factor inhibitor used in moderate to severe cases of ulcerative colitis.
  • Azathioprine: Used in a dosage of 2.5 mg/kg/day and acts as an immunosuppressant.
  • Cyclosporine: Important for preventing surgery.
  • 6-Mercaptopurine: Used in a dosage of 1.5 mg/kg/day, reducing corticosteroid usage.
  • Ciprofloxacin: An antibiotic inhibiting bacterial growth.
  • Metronidazole: An antibiotic targeting anaerobic bacteria.
  • Corticosteroids: Budesonide (2-8 mg/day) and hydrocortisone (100 mg/day) are used in mild to moderate cases in enema form. In severe cases, intravenous methylprednisolone at 60 mg/day or hydrocortisone at 400 mg/day is administered.
  • Balsalazide: Effective in mild to moderate disease.

Do patients with ulcerative colitis need to follow a special diet? Diet doesn’t have a direct impact, but it’s recommended to avoid foods that may cause diarrhea.

Is there a connection between ulcerative colitis and colorectal cancer? Especially when the lower colon is extensively affected by ulcerative colitis, the risk of developing colorectal cancer increases within the first 8-10 years after the disease’s onset. After ten years, the risk of colorectal cancer increases annually by 1%.

How can colorectal cancer in relation to ulcerative colitis be prevented? In individuals with long-standing inflammatory bowel disease, regular colonoscopies with multiple biopsies are recommended to reduce the risk of colorectal cancer.