Ulcerative Colitis Treatment in Indore

What is Ulcerative Colitis?

Ulcerative colitis, or UC for short, is a chronic disease that inflames the inner lining of the large intestine and creates small open sores, known as ulcers. The disease starts in the rectum, the last part of the bowel, and then spreads upwards in a continuous segment for a variable distance. It involves only the colon and rectum and only the innermost lining of the bowel wall.
The ulcers bleed, exude mucus and pus, and the inflamed bowel is unable to retain stool normally, leading to frequent and urgent stools. UC is one of two major forms of inflammatory bowel disease, the other being Crohn’s disease. It usually occurs between the ages of 15 and 30, with a second smaller peak after age 50.

UC offers a variable course. Flares are periods of active symptoms with periods of remission when symptoms disappear. With regular treatment, most people can stay in remission for long periods of time. Dr. Kriti Bansal treats ulcerative colitis using standard therapies based on the extent and severity of each patient’s disease. The management of ulcerative colitis in Indore depends on the extension of the colon and the activity of the disease.

Extent of Disease in Ulcerative Colitis

The medicine depends on where the inflammation occurs.

• Proctitis: Inflammation confined to the rectum. The main symptoms are bleeding and a feeling that you have to urinate often. Local treatment is often all that is needed.
• Left-sided colitis: The disease spreads from the rectum up to the bend of the colon on the left side with bloody diarrhea and left-sided abdominal pain.
• Pancolitis or Extensive colitis: the entire colon is involved. Symptoms are more severe and the need for stronger medications is greater.

Symptoms of Ulcerative Colitis

Symptoms develop slowly and may worsen over weeks. They are dependent upon the duration and severity of the disease.

• Bloody diarrhea: This is the hallmark. Stools may be loose or watery and may contain blood, mucus, or pus.
• Urgency and frequent stools: Patients have a sudden urge to go, sometimes ten to twenty times a day, and may not be able to hold it.
• Tenesmus: Feeling that the bowel is not empty after passing stool, straining and passing small amounts)
• Lower abdominal cramping pain: The pain is often on the left side and is relieved by movement.
• Night-time stools: Passing stool at nite is not unusual in active disease.
• Fatigue, fever and weight loss: Moderate to severe flares when there is significant inflammation.
• Anemia: Continuous blood loss can give rise to anemia, as a consequence of a fall in hemoglobin. This can cause breathlessness and weakness.

Outside the bowel: Pain in the joints, red eyes, ulcers in the mouth and skin rashes can all occur and in a small percentage of patients a liver condition called primary sclerosing cholangitis is linked with UC.

What Causes and Triggers Ulcerative Colitis?

The cause of UC is not known. The prevailing theory is that people who are genetically predisposed have an immune system that overreacts to bacteria in the gut, leading to chronic inflammation.

• Genetic predisposition: About 1 in 10 patients has a close relative with IBD and many genes have been associated with the risk.
• Immune dysfunction: The lining of the colon protects the body from bacteria, but a malfunction allows bacteria to stimulate immune activity.
• Gut bacteria. In people with UC, the bacteria in the colon are changed.
• Environmental factors: It is believed that urban living, a diet of processed foods and early life factors are involved.

Attacks can be triggered by infections of the gut, stopping medication suddenly, regular use of anti-inflammatory pain-killers such as ibuprofen and diclofenac, some antibiotics, poor sleep and emotional stress. Knowing your own trigger can help you avoid some relapses.

How is Ulcerative Colitis diagnosed?

Bloody diarrhea may be caused by a number of causes including infections, amoebiasis, piles and colon tumors, therefore diagnosis involves careful testing. Stool tests can be used to look for infections, especially for the bacterium Clostridioides difficile and parasites. Blood tests are used for anemia, inflammation and nutrition and fecal calprotectin indicates the amount of inflammation in the bowel.

The primary test is a colonoscopy, or sometimes a flexible sigmoidoscopy during a severe flare. This is the usual picture of UC: erythema, loss of the normal vascular pattern, fine granularity, contact bleeding and ulcers beginning at the rectum and continuing uninterrupted. Biopsies are performed from different segments to confirm the diagnosis and to exclude other conditions.
If the patient is very ill, an abdominal X-ray is taken to see if the colon is dilated. The severity of the flare is graded by stool frequency, blood, pulse, temperature, hemoglobin and inflammatory markers to help decide whether treatment can be at home or needs hospital admission. If you visit an ulcerative colitis specialist in Indore early, you can easily get your diagnosis confirmed before any complications arise.

Treatment of Ulcerative Colitis

The treatment depends on the location of the disease and its activity. The first goal is to control the flare, and the second is to keep the patient steroid-free in remission.

Mild-to-moderate disease
Mesalamine (5-ASA) is the mainstay of therapy. It is available as tablets or granules and for disease in the rectum and left colon it is given with enemas, foam or suppositories, which deliver the drug directly to the inflamed area. If the disease is confined to the rectum, suppositories may suffice. A low dose of steroids that act mainly in the gut, such as budesonide MMX, may be added.

Moderate to severe illness
If symptoms remain uncontrolled on mesalamine, a short course of oral prednisolone is started and then tapered. Some patients relapse or require repeated courses of steroids when they are tapered. These patients are switched to steroid-sparing agents like azathioprine, or to biologic agents like infliximab, adalimumab, vedolizumab and ustekinumab. Other oral options are also available, such as tofacitinib and other small molecule medications. Before starting these medicines, tests for tuberculosis and hepatitis B are checked.

Acute severe UC (ulcerative colitis)
A severe flare (>6 bloody stools per day plus fast pulse, fever, anemia or raised inflammatory markers) is a medical emergency. Patients are admitted for IV steroids, fluids, nutrition and monitoring. If no response is seen within 3 days, then rescue therapy with infliximab or ciclosporin is considered. In such cases early consultation with a surgeon is recommended.

Surgery
Some patients will need surgery. This includes patients with severe flares that do not respond, perforation, uncontrolled bleeding, toxic megacolon, cancer or pre-cancerous changes, or disease that cannot be controlled with medicines. The usual operation removes the colon and rectum and creates an ileostomy or internal pouch so that stool can be passed in a controlled way.

Supportive care
Use of anti-diarrhoeal medicines should be cautious in active colitis. Iron is replaced orally or by infusion and vitamin D, calcium and B12 are administered where required. This includes vaccination and monitoring of bone health.

Monitoring and Cancer Surveillance

Remission should be objectively confirmed. The doctor will examine symptoms, hemoglobin, CRP and fecal calprotectin and may repeat the colonoscopy to see if the lining has healed. Long-standing colitis slightly raises your risk of developing colon cancer. For this reason, surveillance colonoscopy with biopsies is recommended starting about 8 years after the onset of symptoms, and then the interval is determined based on risk, usually every 1 to 3 years. These are the regular check-ups that are a part of the long-term management of ulcerative colitis in Indore along with medicines and diet advice.

Diet and Daily Life With Ulcerative Colitis

Food does not cause ulcerative colitis but it can affect how you feel. In general smaller and more frequent meals of soft, low fiber foods such as rice, khichdi, bananas, curd, boiled vegetables and eggs are better tolerated during a flare. Sticking to non-spicy dishes, raw salads, carbonated drinks, alcohol and excessive caffeine often helps reduce discomfort. A well-balanced diet is encouraged during remission without unnecessary restriction with attention to adequate protein fluids and calories.

Keep a record of foods that appear to trigger symptoms Take medicines as prescribed even if you feel well Avoid painkillers of the anti-inflammatory type Get enough sleep When your UC is under control, most people can continue with normal life; studying, working, traveling and playing sport.

Complications of Ulcerative Colitis

Uncontrolled inflammation can cause several problems. Heavy bleeding over a period of time may cause iron-deficiency anemia, and may require transfusion. A severe flare can cause a toxic megacolon, where the colon becomes inflated and can burst, which can require emergency treatment at a hospital. Chronic inflammation can cause thickening of the bowel wall or formation of polyps and marginally increase the risk of colon cancer over decades.

UC can affect other parts of the body, outside the gut, including the joints, eyes, skin and liver. Heavy diarrhea can lead to dehydration and low potassium levels. Some patients develop blood clots in veins during active disease so it’s important to keep hydrated and keep moving. With early and consistent treatment, the risk of these complications is greatly reduced.

Medicines Used in Ulcerative Colitis at a Glance

• Mesalamine: Used short term to reduce mild to moderate inflammation and used long term to maintain remission.
• Prednisolone and budesonide: Rapidly reduce a flare but only for short periods of time.
• Azathioprine: Helps keep you in remission and reduce the need for steroids but requires regular blood tests.
• Biologics: Infused or injected antibody medicines for moderate to severe disease or when other medications are not effective.
• Small molecule oral drugs: Tablets that block specific inflammatory pathways for select patients after proper screening.
• Iron and vitamins: To replace losses from bleeding and poor absorption.

Ulcerative Colitis and Pregnancy

Pregnancy and fertility Women with UC can have healthy pregnancies, and fertility is usually normal when the disease is quiet. In an ideal world, you should be in remission for a few months before trying pregnancy. Most drugs, like mesalamine and azathioprine, are still used in pregnancy, but some need to be changed, so it is sensible to discuss with the doctor before trying to conceive. Pregnancy: Flares in pregnancy are treated promptly because active disease is more dangerous to the baby than the medicines used to control it. Most UC medications are compatible with breastfeeding.

Differences Between Ulcerative Colitis and Crohn’s Disease

Ulcerative colitis is limited to the colon and rectum, spreads continuously from the rectum upwards and only affects the inner lining. Crohn’s disease can affect any part of the bowel from the mouth to the anus and often in patches with healthy areas in between. It can affect the whole thickness of the bowel wall. UC is normally associated with bloody diarrhea, Crohn’s disease more often with pain, weight loss, strictures and fistulas. The difference between the two affects medicines and type of surgery . Therefore colonoscopy with biopsies and imaging are usually done at diagnosis.

Why Choose Dr. Kriti Bansal

The form of treatment is customized by Dr. Kriti Bansal as per the area of the colon that is affected. For many patients, this means taking oral medicine as well as enemas or suppositories to deliver the drug directly to the inflamed area.

She discusses with patients early signs of a flare and when to call so changes can be made at the clinic instead of the ER. Remission is determined by objective measures, not just by patient’s feelings.

If you are looking for an ulcerative colitis doctor in Indore, she offers colonoscopy, medicine planning, biologic therapy evaluation and long-term follow-up under one roof with a single consistent point of care.

Book a Consultation 

Phone: +91-7610102710

Email: drkritigastro@gmail.com