ULCERATIVE COLITIS

AN INFLAMMATORY DISEASE DUE TO CAUSES STILL NOT WELL-IDENTIFIED

Ulcerative colitis is an inflammation of the intestine that affects the superficial layers of the intestinal mucosa, always originating from the rectal area, and may subsequently extend to the colon. Given the above, the ulcerative colitis differs from Crohn's disease, which, instead, can extend to the whole intestine. In the initial stages of the disease, the intestinal mucosa appears blushed and easily bleeding, while, in the more serious ones, it is possible to observe ulcers, also of considerable size and diffusion. When ulcerative colitis reaches critical levels, loss of neuromuscular function may occur, thus leading to gangrene and bowel dilation. If not shown in time, ulcerative colitis, like Crohn's disease, can degenerate and lead to epithelial dysplasia and, in severe cases, to cancer states.

Ulcerative colitis is a widespread disease whose pathogenesis has not yet been fully determined. In any case, it does not appear to be linked to the geographical and social extraction of patients. The most recent studies have highlighted some risk factors such as age (the peak involves patients being 20 to 40 years old), the race (the white one is the most affected), the diet too rich in fat and too low in fiber. Finally, cases of ulcerative colitis are slightly more numerous among women than men. Stress, on the other hand, is considered only a factor that can increase the state of ulcerative colitis after it has already appeared. Regarding the triggering causes, the most reliable scientific theories indicate that ulcerative colitis could be the result of an alteration of the immune system caused by bacterial, alimentary or autogenous allergens. Others theorize that the triggering cause of ulcerative colitis may be in a bacterium or in a virus, which would cause in the organism an exaggerated inflammatory response capable of altering the normal metabolism of intestinal mucous cells.

Ulcerative colitis is characterized by alternating phases of well-being with periods of exacerbation. Symptoms of ulcerative colitis are similar to those of other inflammatory bowel diseases. The chronicity of the pathology does not exclude that patients can enjoy periods of prolonged well-being, but surely it must be considered that the acute phase of inflammation can reappear periodically making suspect that, even when the patient is well, some degree of inflammation remains. The clinical framework can be very variable in the type and intensity of symptoms. The most common ones include:

• recurrent diarrhea more or less abundant with or without bleeding;
• emission of rectal mucus; diarrhea often accompanied by severe abdominal pain (which can be mistaken for attacks of appendicitis);
• emission of rectal mucus; diarrhea often accompanied by severe abdominal pain (which can be mistaken for attacks of appendicitis);

Patients suffering from ulcerative colitis often show bleeding of the rectum and a frequent stimulus to stool evacuation.

The diagnosis of ulcerative colitis can be done with invasive and non-invasive methods. Among the non-invasive methods, the determination of calprotectin concentration in feces is the most reliable method. Subjects suffering from ulcerative colitis normally have higher calprotectin values than healthy subjects. Subjects under remission normally show decreasing values depending on the extent of the inflammation and the effectiveness of the therapy. Being a non-invasive marker, calprotectin can also be used in the follow-up and monitoring of drug therapy of patients with ulcerative colitis. Therefore, calprotectin is very useful for the differential diagnosis between organic and functional disease in individuals suspected of chronic inflammatory bowel diseases (IBD).

Ulcerative colitis usually has a fluctuating pattern and, in most cases, allows a fairly normal life. In some more serious cases, however, the disease can result in a sharp deterioration of the general conditions and the appearance of serious complications (for example, severe anemia, colon perforation), thus requiring the admission in hospital facilities for intensive therapy. If the drug therapy proves to be ineffective, it may be necessary to undergo surgery to solve the patient's problem.

Recent studies have shown that the risk of developing colorectal cancer increases significantly in patients with ulcerative colitis for more than 10 years. The risk decreases if the subject follows a chronic anti-inflammatory therapy.