83,500 Australians suffer from ulcerative colitis (UC). Patients are most frequently initially diagnosed in two age ranges 15-35 and 55-70; prevalence increases with age, with slightly more men than women. Patients may be of any race, but are likely to be white, while Ashkenazi Jews are at highest risk.
UC is usually categorized according to the parts of the large bowel involved/inflamed i.e.:
- Ulcerative proctitis – anus and rectum only
- Proctosigmoiditis – rectum and sigmoid colon
- Left sided colitis – rectum, sigmoid and descending colon
- Pancolitis – entire colon
The end of the small intestine that meets the colon may also occasionally be inflamed. This is called backwash ileitis.
Symptoms may be limited to rectal bleeding alone but as more of the colon becomes involved symptoms may include fever, abdominal & rectal pain, cramping, and urgency to defecate without being able to go. Sufferers have ongoing diarrhoea unrelieved by over-the-counter medications (often also passing blood and puss), causing dehydration, weight loss, fatigue, anaemia, vitamin deficiencies, serious malnutrition and bone loss. Complications include – liver, skin (erythema nodosum) eye and joint inflammation, perforated colon, increased colon cancer risk, and in serious cases (8-10% of the patients) toxic megacolon and possible death.
The normal colon wall consists of four main layers.
- The mucosa: is a one-cell-thick layer of mucus producing (and other) cells that contact the bowel contents, sitting atop a very thin layer of connective tissue (lamina propria) filled with different immune cells – (macrophages, plasma cells, and others). The lamina propria sits on a thin layer of muscle tissue (muscularis mucosae).
- The submucosa: lies immediately underneath the mucosa. It is made of a thicker layer of connective tissue that contains nerves, blood/lymph vessels, and many different immune cells
- The muscularis: lies immediately beneath the submucosa. Is a thick muscle-cell-layer that surrounds the colon and contracts rhythmically to move colon contents
- Serosa: external layer of connective tissue covering of the colon
UC generally affects the mucosa and submucosa. Only in severe disease is the muscularis involved. There is a sharp border between normal and affected (ulcerated) tissue.
In UC the disease process is as follows: Something initiates damage-to & death-of localized areas of colonic epithelial-lining cells. In an attempt to remedy things, the damaged/dying epithelial cells release distress-hormones to activate local immune responses increasing local blood flow, attracting & activating various immune cells. The affected local area becomes red and swollen. If cell-deaths continue, the mucosa takes on a finely granular look, and becomes friable (breaks easily); normal vascular pattern is lost and eventually scattered haemorrhagic areas appear.
This leads to breakdown of the intestinal epithelial barrier, allows bacteria and other materials to enter tissue which activates immune cells further and perpetuates chronic intestinal inflammation Finally puss-producing mucosal ulcers, characteristic of severe disease appear, in between areas of normal tissue
The question is, what causes colon lining cell damage/death, and is there anything that can be done to stop this? We will have a look at this next month.
Article Written + Submitted by:
Andreas Klein Nutritionist + Remedial Therapist from Beautiful Health + Wellness
P: 0418 166 269