ulcerative colitis treatment

The colon makes up the largest part of the large intestine, which consists of the cecum, colon, and rectum.
The colon extends from the end of the cecum to the beginning of the rectum, with a length of about 150 cm.
The main function of the colon is to absorb water and salts from undigested foods and turn the rest into waste (faeces) to be excreted out of the body through the anus.
The colon is divided anatomically into four sections:

• ascending colon
• Transverse colon
• descending colon
• sigmoid colon

Ulcerative colitis is a chronic inflammatory disease of the large intestine. Ulcerative colitis is characterized by inflammation, irritation, and ulcers in the large intestine.
Inflammation is limited to the large intestine, unlike Crohn's disease, which causes inflammation and ulcers along the digestive tract from the mouth to the anus.

 

Ulcerative colitis is a chronic disease that accompanies the patient throughout his life, causing symptoms that affect the quality of life and cause social or psychological problems for the patient if these symptoms are not managed.
The disease may progress to serious, life-threatening complications that require urgent surgical intervention.

 

In Turkey, ulcerative colitis symptoms are currently managed by several methods, ranging from drug management to surgical procedures.

The main cause of ulcerative colitis is not fully understood, but hypotheses have been made about the possible causes and factors that lead to the occurrence of the disease and exacerbate its symptoms:

heredity hypothesis:
This hypothesis explains the cause of ulcerative colitis to a genetic defect in the work of immune cells, where the immune cells attack the bacteria that live normally in the colon, causing frequent infections and ulcers.
In fact, having a family history of the disease increases the risk of infection in relatives, as it has been found that about 10 to 25% of people with ulcerative colitis have a relative who has either ulcerative colitis or Crohn's disease.

environmental factorsSome studies have linked environmental factors to an increased risk of ulcerative colitis, as the probability of infection is higher for urban residents than for rural residents, which can be caused by air pollution in cities and a diet rich in fats and harmful substances.

Non-steroidal anti-inflammatory drugs (NSAIDS): Some studies have found that up to one-third of patients with ulcerative colitis have a worsening of their symptoms when using these medications.

psychological factors. May play a role in the development of the disease and exacerbation of symptoms, according to A study In 2015, 82% patients with ulcerative colitis had psychiatric problems, and these problems were often diagnosed before ulcerative colitis was diagnosed.

Tobacco: Some studies have found that smokers are less likely to contract the disease (this does not mean that we advise the patient to smoke for prevention, as smoking is associated with countless other medical problems).

Symptoms of ulcerative colitis

 At first we notice the following symptoms:

• haematemesis (blood in the stool)
• Diarrhea may be severe
• lower abdominal pain
• Nausea and tiredness
• Anemia
• Over time, weight loss may occur

Symptoms may worsen over time and the following symptoms may appear:

• Mucus or pus in stool
• Fever and rash
• Pain at the level of the joints
• Uveitis
• severe abdominal pain
• electrolyte disturbance

Diagnosis of ulcerative colitis in Turkey

 In the event that the doctor suspects the possibility of ulcerative colitis, he resorts to a colonoscopy, where a soft, flexible tube connected to a camera is inserted down through the anus and is done through a screen to watch the colon mucosa and search for ulcers or infections at the level of the colon mucosa.
And by endoscopy, a biopsy can be taken from the colon to be examined in the laboratory under a microscope and to check for pathological changes, where several biopsies must be taken to investigate and confirm the infection.

After the diagnosis of ulcerative colitis, a colonoscopy is done periodically for the patient to monitor the condition of the colon and to rule out the emergence of cancer in the colon, as the disease increases the risk of infection. colorectal cancer.

Colonoscopy requires an expert physician trained in the procedure. The intestines must be prepared before the endoscopy and may be associated with complications such as bleeding and rupture.
Colonoscopy is considered the gold standard for diagnosing ulcerative colitis.

The doctor usually orders blood tests to look for anemia or signs of inflammation, such as elevated trichomoniasis, and blood tests also help in leukocyte counts to determine whether or not an infection is present.

Uses fecal transplant To exclude other possible causes such as infection with bacteria or parasites, microorganisms may appear in the stool, and the presence of hidden blood in the stool and white blood cells is also investigated.

The doctor orders other x-rays to rule out other causes such as Crohn's disease. The doctor may order images such as an MRI or CT scan to look for infections elsewhere in the body.

In cases with mild symptoms, ulcerative colitis is treated using medications that reduce inflammation in the large intestine, including:

Aminosalicylates
The most famous drugs used in this group are sulfasinil and mesalamine, where mesalamine is given in the form of a rectal suppository.

steroids
In the absence of response to the previous treatment or in cases with more severe symptoms, steroids are resorted to that inhibit the inflammatory reactions that occur, the most common steroid used is prednisone, and a doctor should be consulted when taking steroids, as they may cause complications that may be dangerous if the drug is suddenly withdrawn or excessive The dose.

biological therapy

In cases of severe ulcerative colitis that have not responded to previous treatments, biologic drugs that have proven effective, such as infliximab, are given, as this drug suppresses the tumor suppressor factor TNF and thus weakens the inflammatory response in the body as a whole.
This medicine is taken in specific doses, as it may increase the risk of infection, especially in those with weak immunity.

According to studies, 30% patients with ulcerative colitis will need surgery at some point in their lives, if drug therapy does not improve the patient’s condition and relieve symptoms or if serious complications arise such as pre-cancerous lesions, severe colonic bleeding, toxic dilatation, or in If the patient desires surgery to relieve his symptoms, surgery is used for management.

It is the most widely used surgical procedure for the treatment of ulcerative colitis, where the colon and rectum are completely removed and then an anastomosis (connection) is made between the small intestine and the anus so that the patient can defecate without the need for an external device or bag.
This procedure is carried out in several stages, that is, the patient needs two or three operations, according to the patient’s health condition.

First, the colon and rectum are removed, and then the doctor creates a J-shaped pouch through the small intestine. Through the pouch, the end of the small intestine is connected to the anal canal to allow wastes to be removed from the anus.

A temporary ileostomy is done with the goal of allowing waste to pass through the abdominal wall where a temporary external bag is placed for a period of time to collect the waste.
The goal of an ileostomy is to allow the pouch to sit well until the outer pouch is removed and the new pouch (j pouch) takes over its function and the role of the removed colon.

About 8 to 12 weeks after the first operation, the inner pouch (j pouch) is ready to perform its function. With this operation, the ileostomy is closed and the outer pouch is removed so that the patient is able to excrete waste through the new pouch that connects the small intestine with the anus.

In this operation, the colon, rectum and anus are removed, after which a permanent ileostomy is made and an external pouch is installed to remove the waste.
In this type of operation, an external bag is worn for the rest of the patient's life. The bag is changed from time to time according to the doctor's instructions. Of course, this method is more difficult for the patient than the first surgery that does not need an external bag.

Preparation before surgery

After the excision and installation of the j pouch, the patient stays in the hospital from 3 to 7 days for observation by the doctor, and the average recovery period is 4 to 6 weeks.
After the operation, the patient is placed on a diet containing soft foods, foods that cause gas should be avoided, and the patient is advised to drink plenty of water.
The body needs a while to get used to the changes taking place. In the beginning, after the installation of the cyst, the new cyst does not give the same function as the colon removed, but rather needs time to take the appropriate shape and size.

Leakage may occur through the new bag, which prompts the person to defecate frequently, and may reach 12 times a day for several weeks, and the stool will be soft and watery.

With time, the new pouch increases in size and the anal sphincter becomes stronger, leading to hard stools and a decrease in the number of defecations per day.
The number of defecations is about 8 times a day after several months of the operation and varies from person to person and the consistency of stool is closer to watery.

Why choose Turkey for treatment?

Turkey is distinguished by the presence of the best hospitals equipped with advanced technologies and a medical staff who has successfully performed this type of operation a large number of times.
Recently, Turkey has become one of the leading countries in the field of medical tourism in the world, due to the provision of appropriate treatment with advanced centers and at a low cost.