Acute ulcerative colitis Miami Beach Hialeah Gardens
Ulcerative colitis (UC) is a long-term condition that results Acute ulcerative colitis Miami Beach Hialeah Gardens in inflammation and ulcers of the colon and rectum. The primary symptom of active disease is abdominal pain and diarrhea mixed with blood. Weight loss, fever, and anemia may also occur. Often symptoms come on slowly and can range from mild to severe. Symptoms typically occur intermittently with periods of no symptoms between flares. Complications may include megacolon, inflammation of the eye, joints, or liver, and colon cancer Acute Ulcerative colitis Miami Beach Hialeah Gardens
The cause of UC is unknown Theories involve immune system dysfunction, genetics, changes in the normal gut bacteria, and environmental factors.Rates tend to be higher in the developed world with some proposing this to be the result of less exposure to intestinal infections, or a Western diet and lifestyle. The removal of the appendix at an early age may be protective. Diagnosis is typically by colonoscopy with tissue biopsies It is a kind of inflammatory bowel disease (IBD) along with Crohn’s disease and microscopic colitis. Acute ulcerative colitis Miami Beach Hialeah Gardens
Dietary changes may improve symptoms Several medications are used to treat symptoms and bring about and maintain remission, including aminosalicylates suchas sulfasalazine, steroids, immunosuppressants such as azathioprine, and biological therapy. Removal of the colon by surgery may be necessary if the disease is severe, does not respond to treatment, or if complications such as colon cancer develop. Removal of the colon and rectum can cure the disease Acute ulcerative colitis Miami Beach Hialeah Gardens
Together with Crohn’s disease about 112 million people were affected as of 2015. Each year it newly occurs in 1 to 20 per 100,000 people, and 5 to 500 per 100,000 individuals are affected. The disease is more common in North America and Europe than other regions Often it begins in people aged 15 to 30 years, or among those over 60 Males and females appear to be affected in equal proportions It has also become more common since the 1950s Together, ulcerative colitis and Crohn’s disease affect approximately a million people in the United States . With appropriate treatment the risk of death appears the same as that of the general population. The first description of ulcerative colitis occurred around the 1850s Acute ulcerative colitis Miami Beach Hialeah Gardens
The gradual loss of blood from the gastrointestinal tract, as well as chronic inflammation, often leads to anemia, and professional guidelines suggest routinely monitoring for anemia with blood tests repeated every three months inactive disease and annually in quiescent disease Adequate disease control usually improves anemia of chronic disease, but iron deficiency anemia should be treated with iron supplements. The form in which treatment is administered depends both on the severity of the anemia and on the guidelines that are followed. Some advise that parenteral iron be used first because patients respond to it more quickly, it is associated with fewer gastrointestinal side effects, and it is not associated with compliance issues . Others require oral iron to be used first, as patients eventually respond and many will tolerate the side effects. All guidelines advise that parenteral iron should be administered in cases of severe anemia (a hemoglobin level less than 100 g/L). Acute ulcerative colitis Miami Beach Hialeah Gardens
Treatments in development Inflammation of the colon is a characteristic symptom of ulcerative colitis, and a new series of drugs in development looks to disrupt the inflammation process by selectively targeting an ion channel. A crucial step involved in the inflammation signaling cascade involves an intermediate conductance calcium-activated potassium channel (IK channel) known as KCa3.1; a protein coded for in the human gene KCNN4 Ongoing research seeks to prevent T-cell activation and inflammation by inhibiting the KCa3.1 channel, selectively. Since there is an upregulation of IK channel activity during T cell activation, inhibition of the KCa3.1 is able to disrupt the production of Th1 cytokines IL-2 and TNF-∝. Production of these cytokines decreases because inhibition of KCa3.1 reduces the efflux of K+, which in turn diminishes the influx of Ca2+. By lowering elevated intracellular Ca2+ in patients with ulcerative colitis, these novel drug candidates can inhibit the signaling cascade involved in the inflammation process and help relieve many of the symptoms associated with ulcerative colitis Acute Ulcerative colitis Miami Beach Hialeah Garden.
Preclinical study results in 2012 indicated that these selective inhibitors decreased colon inflammation in mice and rats cloned with the human KCa3.1 protein as effectively as the standard inflammatory bowel disease treatment of sulfasalazine. However, these novel selective IK channel blockers are significantly more potent and theoretically would be able to be taken at a much more manageable dosage. Acute ulcerative colitis Miami Beach Hialeah Gardens
Benzothiazinone, NS6180, is a novel class KCa3.1 channel inhibitor in development. Through a number of in Vitro experiments, NS6180 was qualified for KCa3.1 channel inhibition. In vivo experiment of DNBS (2,4 – dinitrobenzene sulfonic acid) induced rat colitis, a frequently used animal model for inflammatory bowel dise Acute ulcerative colitis Miami Beach Hialeah Gardens use, showed comparable efficacy and greater potency than sulfasalazine
Surgery Acute ulcerative colitis Miami Beach Hialeah Gardens
|Crohn’s disease||Ulcerative colitis|
|Mesalazine||Less useful||More useful|
|Antibiotics||Effective in long-term||Generally not useful|
|Surgery||Often returns following
removal of the affected part
|Usually cured by removal
Unlike in Crohn’s disease, the gastrointestinal aspects of ulcerative colitis can generally be cured by surgical removal of the large intestine, though extraintestinal symptoms may persist. This procedure is necessary for the event of: exsanguinating hemorrhage, frank perforation, or documented or strongly suspected carcinoma. Surgery is also indicated for patients with severe colitis or toxic mega colon. Patients with symptoms that are disabling and do not respond to drugs may wish to consider whether surgery would improve the quality of life. Acute ulcerative colitis Miami Beach Hialeah Gardens
Ulcerative colitis affects many parts of the body outside the intestinal tract. In rare cases, the extra-intestinal manifestations of the disease may require removal of the colon. Acute ulcerative colitis Miami Beach Hialeah Gardens
Another surgical option for ulcerative colitis that is affecting most of the large bowel is called the ileoanal pouch procedure. This is a two- to the three-step procedure in which the large bowel is removed, except for the rectal stump and anus, and a temporary ileostomy is made. The next part of the surgery can be done in one or two steps and is usually done at six- to twelve-month intervals from each prior surgery. Acute ulcerative colitis Miami Beach Hialeah Gardens
In the next step of the surgery, an internal pouch is made of the patient’s own small bowel, and this pouch is then hooked back up internally to the rectal stump so that the patient can once again have a reasonably functioning bowel system, all internal. The temporary ileostomy can be reversed at this time so that the patient is internalized for bowel functions, or, in another step to the procedure, the pouch, and rectal stump anastomosis can be left inside the patient to heal for some time while the patient still uses the ileostomy for bowel function. Then, on a subsequent surgery, the ileostomy is reversed and the patient has internalized bowel function again. Acute ulcerative colitis Miami Beach Hialeah Gardens
The gradual loss of blood from the gastrointestinal tract, as well as chronic inflammation, often leads to anemia, and professional guidelines suggest routinely monitoring for anemia with blood tests repeated every three months inactive disease and annually in quiescent disease Adequate disease control usually improves anemia of chronic disease, but iron deficiency anemia should be treated with iron supplements. The form in which treatment is administered depends both on the severity of the anemia and on the guidelines that are followed. Some advise that parenteral iron is used first because patients respond to it more quickly, it is associated with fewer gastrointestinal side effects, and it is not associated with compliance issues. Others require oral iron to be used first, as patients eventually respond and many will tolerate the side effects. All guidelines advise that parenteral iron should be administered in cases of severe anemia (a hemoglobin level less than 100 g/L). Acute ulcerative colitis Miami Beach Hialeah Gardens
- In a number of randomized clinical trials, probioticshave demonstrated the potential to be helpful in the treatment of ulcerative colitis. Specific types of probiotics such as Escherichia coli Nissle have been shown to induce remission in some patients for up to a year. Another type of probiotic that is said to have a similar effect is Lactobacillus acidophilus. The probiotics are said to work by calming some of the ongoing inflammation that causes the disease, which in turn allows the body to mobilize dendritic cells, otherwise known as messenger immune cells. These cells then are able to produce other T-cells that further aid in restoring balance in the intestines by rebalancing systemic inflammation.
- Fecal bacteriotherapyinvolves the infusion of human probiotics through fecal enemas. Ulcerative colitis typically requires a more prolonged bacteriotherapy treatment than Clostridium
The signs and symptoms of colitis are quite variable and dependent on the cause of the given colitis and factors that modify its course and severity. Acute ulcerative colitis Miami Beach Hialeah Gardens
Symptoms of colitis may include: mild to severe abdominal pain and tenderness (depending on the stage of the disease), recurring bloody diarrhea with/without pus in the stools, fecal incontinence, flatulence, fatigue, loss of appetite and unexplained weight loss Acute ulcerative colitis Miami Beach Hialeah Gardens
More severe symptoms may include: shortness of breath, a fast or irregular heartbeat and fever Acute ulcerative colitis Miami Beach Hialeah Gardens
Another lessor rare non-specific symptoms that may accompany colitis include: arthritis, mouth ulcers, painful, red and swollen skin and irritated, red eyes
Signs seen on colonoscopy include: colonic mucosal erythema (redness of the inner surface of the colon), ulcers, and bleeding.[ Acute ulcerative colitis Miami Beach Hialeah Gardens
Diagnosis Acute ulcerative colitis Miami Beach Hialeah Gardens
Symptoms suggestive of colitis are worked-up by obtaining the medical history, a physical examination and laboratory tests (CBC, electrolytes, stool culture and sensitivity, stool ova and parasites et cetera). Additional tests may include medical imaging (e.g. abdominal computed tomography, abdominal X-rays) and an examination with a camera inserted into the rectum (sigmoidoscopy, colonoscopy).
An important investigation in the assessment of colitis is a biopsy. A very small piece of tissue (usually about 2mm) is removed from the bowel mucosa during endoscopy and examined under the microscope by a histopathologist. It can provide important information regarding the cause of the disease and the extent of bowel damage.
There are many types of colitis. They are usually classified by the cause. Acute ulcerative colitis Miami Beach Hialeah Gardens
Types of colitis include:
Micrograph showing intestinal crypt branching, a histopathological finding of chronic colitis. H&E stain.
Micrograph of collagenous colitis. H&E stain.
Micrograph of a colonic pseudomembranes may be seen in Clostridium difficile colitis, a type of infectious colitis. Acute ulcerative colitis Miami Beach Hialeah Gardens
Autoimmune Acute ulcerative colitis Miami Beach Hialeah Gardens
Moreover, several studies recently have found significant relationship between colitis and dairy allergy (including: cow milk, cow milk UHT and casein), suggesting some patients may benefit from an elimination diet
Colitis is an inflammation of the colon. Colitis may be acute and self-limited or long-term. It broadly fits into the category of digestive diseases.
In a medical context, the label colitis (without qualification) is used if:
- The cause of the inflammation in the colon is undetermined; for example, colitismay be applied to Crohn’s disease at a time when the diagnosis is unknown, or
- The context is clear; for example, an individual with ulcerative colitis talking about their disease with a physician who knows the diagnosis.
Genetic factors Acute ulcerative colitis Miami Beach Hialeah Gardens
A genetic component to the etiology of ulcerative colitis can be hypothesized based on the following:
- Aggregation of ulcerative colitis in families.
- Identical twinconcordance rate of 10% and dizygotic twin concordance rate of 3%
- Ethnicdifferences in incidence
- Genetic markersand linkages
Twelve regions of the genome may be linked to ulcerative colitis, including, in the order of their discovery, chromosomes 16, 12, 6, 14, 5, 19, 1, and 3, but none of these loci has been consistently shown to be at fault, suggesting that the disorder is influenced by multiple genes. For example, chromosome band 1p36 is one such region thought to be linked to inflammatory bowel disease.
Some of the putative regions encode transporter proteins such as OCTN1 and OCTN2. Other potential regions involve cell scaffolding proteins such as the MAGUK family. There may even be human leukocyte antigen associations at work. In fact, this linkage on chromosome 6 may be the most convincing and consistent of the genetic candidates.
Multiple autoimmune disorders have been recorded with the neuro visceral and cutaneous genetic porphyrias including ulcerative colitis, Crohn’s disease, celiac disease, dermatitis herpetiformis, diabetes, systemic and discoid lupus, rheumatoid arthritis, ankylosing spondylitis, scleroderma, Sjogren’s disease and scleritis. Physicians should be on high alert for porphyrias in families with autoimmune disorders and care must be taken with the use of potential porphyrinogenic drugs, including sulfasalazine.
Environmental factors[Acute ulcerative colitis Miami Beach Hialeah Gardens
Many hypotheses have been raised for environmental factors contributing to the pathogenesis of ulcerative colitis. They include the following:
- Diet: as the colon is exposed to many dietary substances which may encourage inflammation, dietary factors have been hypothesized to play a role in the pathogenesisof both ulcerative colitis and Crohn’s disease. Few studies have investigated such an association; one study showed no association of refined sugar on the prevalence of ulcerative colitis. High intake of unsaturated fat and vitamin B6 may enhance the risk of developing ulcerative colitis. Other identified dietary factors that may influence the development and/or relapse of the disease include meat protein and alcoholic beverages. Specifically, sulfur has been investigated as being involved in the etiology of ulcerative colitis, but this is controversial. Sulfur restricted diets have been investigated in patients with UC and animal models of the disease. The theory of sulfur as an etiological factor is related to the gut microbiota and mucosal sulfide detoxification in addition to the diet.
- Breastfeeding: Some reports of the protection of breastfeeding in the development of inflammatory bowel disease contradict each other. One Italian study showed a potential protective effect.
- One study of isotretinoinfound a small increase in the rate of ulcerative colitis.
Autoimmune disease Acute ulcerative colitis Miami Beach Hialeah Gardens
Ulcerative colitis is an autoimmune disease characterized by T-cells infiltrating the colon. In contrast to Crohn’s disease, which can affect areas of the gastrointestinal tract outside of the colon, ulcerative colitis usually involves the rectum and is confined to the colon, with occasional involvement of the ileum. This so-called “backwash ileitis” can occur in 10–20% of patients with pancolitis and is believed to be of little clinical significance. Ulcerative colitis can also be associated with comorbidities that produce symptoms in many areas of the body outside the digestive system. Surgical removal of the large intestine often cures t Acute ulcerative colitis Miami Beach Hialeah Gardenshe disease.
Alternative theories Acute ulcerative colitis Miami Beach Hialeah Gardens
|Crohn’s disease||Ulcerative colitis|
|Smoking||Higher risk for smokers||Lower risk for smokers|
|Age||Usual onset between
15 and 30 years
|Peak incidence between
15 and 25 years
Levels of sulfate-reducing bacteria tend to be higher in persons with ulcerative colitis, which could indicate higher levels of hydrogen sulfide in the intestine. An alternative theory suggests that the symptoms of the disease may be caused by toxic effects of the hydrogen sulfide on the cells lining the intestine. Acute ulcerative colitis Miami Beach Hialeah Gardens
Pathophysiology Acute ulcerative colitis Miami Beach Hialeah Gardens
|Crohn’s disease||Ulcerative colitis|
|Cytokine response||Associated with Th17||Vaguely associated with Th2|
Acute ulcerative colitis Miami Beach Hialeah Gardens An increased amount of colonic sulfate-reducing bacteria has been observed in some patients with ulcerative colitis, resulting in higher concentrations of the toxic gas hydrogen sulfide. Human colonic mucosa is maintained by the colonic epithelial barrier and immune cells in the lamina propria (see intestinal mucosal barrier). N-butyrate, a short-chain fatty acid, gets oxidized through the beta-oxidation pathway into carbon dioxide and ketone bodies. It has been shown that N-butyrate helps supply nutrients to this epithelial barrier. Studies have proposed that hydrogen sulfide plays a role in impairing this beta-oxidation pathway by interrupting the short chain acetyl-CoA dehydrogenase, an enzyme within the pathway. Furthermore, it has been suggested that the protective benefit of smoking in ulcerative colitis is due to the hydrogen cyanide from cigarette smoke reacting with hydrogen sulfide to produce the non-toxic isothiocyanate, thereby inhibiting sulfides from interrupting the pathway. An unrelated study suggested that the sulfur contained in red meats and alcohol may lead to an increased risk of relapse for patients in remission. Acute ulcerative colitis Miami Beach Hialeah Gardens
Ulcerative colitis patients typically present with rectal bleeding, diarrhea, tenesmus (urgent desire to evacuate the bowels but with the passage of little stool), and lower abdominal pain. The severity of disease at clinical presentation is important in determining the appropriate therapy. Patients with the mildly active disease will have fewer than 4 bowel movements daily and no signs of toxicity. Individuals with moderate-severity UC have more frequent bowel movements with bleeding. Approximately 70% of patients with ulcerative colitis will have the moderately active disease at presentation. Patients with the severely active disease will have signs of toxicity with fever, tachycardia, and anemia. Patients with fulminant or toxic colitis or toxic megacolon often have more than 10 bowel movements in a day, continuous bleeding, abdominal distention and tenderness, and radiologic evidence of edema and, in some cases, bowel dilation. These people most often require immediate colectomy because 10% have a perforated colon at the time of surgery. Acute ulcerative colitis Miami Beach Hialeah Gardens
Miami Beach • Miami Gardens Aventura • Bal Harbour • Bay Harbor Islands • Biscayne Park • Carol City • Coral Gables • Cutler Bay • CutlerRidge • Doral • El Portal • Fisher Island • Florida City • Golden Beach • Hialeah • Gardens • Homestead • Indian Creek • Islandia • Kendall • K