Dr Avinash Patel1, Dr. Mahima1
Ulcerative colitis is a type of inflammatory Bowel Disease along with Crohn’s Disease (CD).1 US is superficial inflammation of the colonic mucosa.2
Incidence of disease more in developed countries and affect any age group but mostly affected in second and third decades of life (20-30yrs).1 Male and female are equally affected.2
Etiology and pathogenesis of disease is idiopathic but normally a state of homeostasis exists in microbiota, intestinal epithelial cells (IECs) and immune cells are disrupt due to environmental factors e.g., smoking, antibiotics, entropathogenes and genetic factors.1 UC usually involves the rectum and rectosegmoid part (40-50%); other parts (30-40%) and whole parts (20%).1 Small intestine are not involved.2 According to involvement of part of colon, UC is classified in- Proctitis- limited to the rectum; Proctosegmoiditis or left sided colitis- extend up to splenic flexure; Pancolitis- extending in to the transverse colon.2
Diagnosis of UC based on clinical features, endoscopic findings and histological findings.1
Clinical features of UC are bleeding for rectum is most common2 and other symptoms are diarrhea, tenesmus, passage of mucous and cramping pain in abdomen.1 Symptoms are often chronic but some time intermittent or progressive. Recurrent diarrhea and per rectal bleeding must be occure.2 Sings and symptoms are also depend on part of colon involve.
1. ulcerative proctitis (UC with proctitis)- passage fresh blood or blood stained mucus either mixed with stool or streaked on the surface of normal or hard stool1 with hematochezia (a sense of rectal urging), constipation2 but rarely have abdominal pain.1
2. Proctosigmoiditis- left sided colitis present with either constipation or diarrhea with tenesmus, urgency and rectal bleeding. Cramping pain in left lower quadrant are most common.
3. Pancolitis- inflammation extends to transverse right colon. Diarrhea associated with rectal bleeding and urgency.2
According to severity of disease UC is present in- Mild- <4 bowel movement/day, mostly occurs in daytime with minimal cramp and urgency. Do normal activity of life. Moderate- 4-8 bowel movement/day, with frequent urging and postprandial cramping. Blood is present in most of stool. Affect daily work, school activity and social life. Severe- 8 bowel movement/day, with nocturnal bowel movements, sever urgency with or without incontinence, low grade fever, night sweats, weakness and weight loss. Abdominal tenderness, tachycardia, anemia, leukocytosis and hypoalbuminemia. Fulminant- >10 bowel movement/day, with nocturnal bowel movement, severe abdominal pain and restlessness, rebound tenderness, prostration, high grade fever and hypotension.2
Laboratory investigation- Rise acute – phase reactants (C-reactive protein) [CRP], platelet counts and ESR. Decrease Hb.
Endoscopy- from sigmoidoscopy and endoscopy assess diseases extent and activity. In mild- Erythema, decreased vascular pattern and mild friability; In moderate- marked erythema, absent vascular pattern, friability and erosion; In sever- spontaneous bleeding and ulceration are found.
Histological- histologic finding helps to differentiate UC to other disease of colon e.g., infectious diseases. In UC mucosa and superficial submucosa are affected, dipper layers are unaffected except fulminant disease. Two major features are finding first is distorted crypts architecture i.e. crypts are bifid and reduced in numbers. Gap between crypts bases and muscularis is increases. Second is basal plasma cells and multiple basal lymphoid aggregated.1
Radiology useful in sever disease where mucosa become thick and superficial ulcers are seens.1 Plain abdominal radiography are useful.2 CT scanning and MRI are not helpful.
Dite management3– avoid food with high rich fibers e.g., whole grain food- whole grain oats, wild rice, brown rice, wheat berries, millets etc. Nuts and seeds- almond, cashews, walnuts, peanuts, pumpkin seeds etc. legumes- beans, pea etc. Fibrous fruits and Dairy products. Taken antioxidants, low fibers food and fruits, drink plenty of water and electrolytes, calcium and Vit. D.
Yoga4 1. Kapalbhati Pranayama- Stimulate abdominal organs and cure constipation and diarrhea disorders. 2. Bridge Pose (Setu Bandhasana)- improve metabolism, digestion and calms your brain. 3. Seated Forward Bend Pose (Paschimottanasana)- improve appetite and helps in digestion. 4. Downward Facing Dog Pose (Adho Mukha Svanasana)- improves circulation of blood and oxygen and removes fatigue and stress. 5. Headstand (Sirsasana)- calms the nervous system, improves memory and concentration, and releases stress, etc.3
1. therapeutic medicine5– Aloe., Ars., Bapt., Colch., Dulc., Merc-c., Merc., Nit-ac., Nux-v., Phos., Sil., Sulph., Ter.
Aloe scotrina– Urging to pass stool, Arsenicum album– anxiety and restlessness, Babtisia tinctoria– low grade fever along with muscular soreness, Colchicum autumanale– joint pain along with gastric compline, Dulcamara– cutting pain with bloody mucous, Mercurius corrosives– loose stool with mucus and blood, Mercurius solubilis– loose stool and bleeding from rectum, Nitricum acidum– intense pain in rectum on passing stool, Nux vomica– constant urging to pass stool with tenesmus, Phosphorus– bloody diarrhea with marked weakness, Silicea terra– constipation, rumbling in bowel, Sulphur– complete loss of, or excessive appetite, Terebenthina– entero-colitis with hemorrhage and ulcer in bowel.
2. Reportorial totality6–
- STOMACH – APPETITE – diminished
- ABDOMEN – PAIN – cramping
- STOOL – MUCOUS – bloody
- STOOL – BLOODY – covered with blood
- RECTUM – PAIN – tenesmus
- RECTUM – DIARRHEA
- RECTUM – URGING – frequent
- RECTUM – CONSTIPATION
- GENERALS – WEAKNESS
- Harrisons. Inflammatory Bowel Disease. In: Fauci AS, Longo DL editors.Harrisons principles of internal medicine. 19th ed. USA:2012. p1947.
- Hanauer B. S. Inflammatory Bowel Disease. IN:Dall D. C, Daniel D. F.(Eds.). ACP Textbook of medicine. 10th ed. 2007.
- Fletcher J. Food to eat and avoid with ulcerative colitis. MedicalNewsToday [online]. 2017 [2019 June 25]. Available from: http://www.medicalnewstoday.com.
- Pradhan R. Yoga Asanas for Intestinal Ulcer and Ulcerative Colitis. [online]. 2017 [2019 June 23]; Available from: https://rakeshyoga.com/health/yoga-poses-for-ulcerative-colitis/#.XRJ7Z4kzbIU
- Boericke W. New Manual of Homoeopathic Materia Medica and Repertory. Reprint Edition 2004 New Delhi: B. Jain Publishers.
- RADAR 10.Archibel Homoeopathic Software. Belgium. 2009.
Dr. Avinash Patel1, Dr. Mahima1
1PG Scholar, Dr.MPK Homoeopathic Medical College, Hospital & Research Centre ( Homoeopathy University), Jaipur, Rajasthan, India.