Tokushukai Medical Group

Treatment of disorder

Treatment of disorder

Gastroenterological Medicine: Ulcerative Colitis

Mostly common amongst young people but increase in middle age

Because of inflammation occur in large intestine, mucosal on large intestine surface produce redness, erosion or ulceration, then having abdominal pain, diarrhea or melena. It is common mostly among younger people but recently it is increasing in middle aged people.

Main Symptoms are abdominal pain, diarrhea and melena.

It is considered that a genetic predisposition person may develop when having a stressful condition like extreme fatigue, lack of sleep, food antigenic agent, communicable disease. But definitive cause is unknown.
Abdominal pain, diarrhea or melena are the main symptoms, but when symptom is getting stronger, fever, palpitation or sense of fatigue may come up. Also there is a case where canker sore, aching joint or skin inflammation come up. The period when having diarrhea or melena is called as active period, and when these symptoms disappear with no symptom is checked by endoscope checkup, it is called as remission period.

Inflammation from rectum to large intestine

It is important to know clinical symptoms like how it is developed and what is current symptom, but in order to make the assured diagnosis, it is necessary to have blood draw, fecal incubation, colon endoscopic exam (include biopsy pathological exam). Fundamentally, continuous inflammation at large intestine from rectum can be seen, but there is inflammation only at rectum (rectal inflammation type), from rectum to sigmoid colon, descending colon (left-sided colitis type), from rectum to entire large intestine (total colitis type). (Fig.1)


Fig.: Treatment for Ulcerative Colitis
Quoted from “For those having the Ulcerative Colitis: Fundamental Knowledge Need-to-know for the Treatment, 2nd edition, (Research Group (Suzuki Team) for Refractory Inflammation Bowel Disturbance)”

Surgical Treatment needs to be considered when medicine does not heal.

In case of mild to middle stage disease, dosage of 5-Amino Salicylic acid preparation (Pentasa. Asacol, Lialda), or supposition/enema preparation treatment is performed. Most of ulcerative colitis is to be controlled with using 5-Amino Salicylic acid preparation correctly. But when effect is insufficient, Steroid Agent inner dosage/supposition/enema preparation or White blood cell component removal therapy is conducted. When these treatments cannot heal the inflammation, biological drug (Remicade, Humira) or immune-regulating drug (Tacrolimus, Cyclosporine) is used to strongly heal the inflammation.
In case when it is repeatedly recurring, thiopurine Formulations (Imlan, Azanine, Leukerin) may occasionally be used. In case if these medicine treatment does not work out, or in case if a porosity is made (perforation) in large intestine due to large amount of melena or strong inflammation, or bowel cancer is associated, surgical operation may be conducted.


Fig.: Treatment for Ulcerative Colitis
Quoted from “For those having the Ulcerative Colitis: Fundamental Knowledge Need-to-know for the Treatment, 2nd edition, (Research Group (Suzuki Team) for Refractory Inflammation Bowel Disturbance)”

Deduction or stoppage of medicine by itself is the cause of recurrence.

Even when medical treatment heals your symptom better, there is a case where inflammation recur on large intestine so that it is important to continue preventive treatment for recurring for certain period.
Even when Medicine treatment heals the symptom, it may take few months for the inflammation on large intestine to be cured. So that, if the amount of medicine is reduced by preference, it may likely recur. Take a full consultation with attending doctor for the deduction or stoppage of medicine dosage. Depend upon the case, it is considered to continuously take orally 5-Amino Salicylic acid preparation for the time being.

Care for mild food, good for intestine

At the time when having the symptom of diarrhea or melena, it is important to take mild meals not to excite gut tract, but when symptom is improved, and inflammation settlement has been confirmed by endoscope or biologic pathological exam, there is no more limitation on meals.

Reference
Quoted from “For those having the Ulcerative Colitis: Fundamental Knowledge Need-to-know for the Treatment, 2nd edition, Research Group (Suzuki Team) for Refractory Inflammation Bowel Disturbance” (Ministry of Health, Labor and Welfare “Research Study for Refractory Inflammation Bowel Disturbance” group home page, Patient/Family information (http://ibdjapan.org.patient/)

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