Ulcerative colitis

আলসারেটিভ কোলাইটিসের সঠিক কারণ এখনও জানা যায়নি।

তবে বিশেষজ্ঞদের ধারণা, একাধিক বিষয় একসঙ্গে মিলে এই রোগ হতে পারে, যেমন:

• রোগ প্রতিরোধ ব্যবস্থার সমস্যা: এক্ষেত্রে শরীরের প্রতিরোধ ব্যবস্থা ভুল করে নিজের বৃহদন্ত্রের আবরণের ওপর আক্রমণ চালায়, যার ফলে সেখানে প্রদাহ তৈরি হয়
• বংশগত কারণ: পরিবার থেকে পাওয়া জিন
• পরিবেশগত কারণ: যেমন বায়ুদূষণ, ওষুধ এবং পাকস্থলী ও অন্ত্রে থাকা ভাইরাস বা ব্যাকটেরিয়া

Your GP will start by asking about your health and habits to get a clearer picture of what is going on. Expect questions about the pattern of your symptoms, your diet, and any recent travel, since this could point to travellers' diarrhoea instead. They will also want to know about any medicines you are taking, including over the counter ones, whether a bowel condition runs in your family, and any past health problems you have had.

Your GP may also examine your abdomen by hand. They are likely to ask for a stool sample, which can be checked with a qFIT test for blood and mucus, and with a faecal calprotectin test for infection or inflammation. Blood tests may also be arranged to look for signs of inflammation or anaemia.

Additional tests for ulcerative colitis

If your GP suspects ulcerative colitis, you may be referred to a hospital for further tests. These can include a colonoscopy, where a thin, flexible tube with a camera is passed into your bottom to examine the whole of your large bowel, or a sigmoidoscopy, which looks at just the end of your large bowel in the same way. An X-ray, MRI scan, or CT scan may also be used.

You will be told exactly which tests you need and how to prepare for them.

Treatment

Treatment for ulcerative colitis aims to relieve and prevent symptoms.

Your treatment will depend on how severe your symptoms are and how often they flare up. Mild flare-ups can be usually be treated at home. But severe flare-ups usually need treatment in hospital to reduce the risk of complications.

Treatment will usually be provided by a range of healthcare professionals.

Medication

Most people will get medication to treat symptoms of ulcerative colitis. This includes medications like:

• aminosalicylates (ASAs) – often the first treatment option, used to get and keep inflammation under control and can be given rectally as well as orally
• corticosteroids – used to get inflammation under control quickly, but not suitable for long-term use

If you have lots of flare-ups or aminosalicylates do not keep your inflammation under control, you may need other treatments, such as:

• immunosuppressants like azathioprine or mercaptopurine – used to reduce the activity of the immune system
• biologic medicines, like adalimumab, infliximab, golimumab, ustekinumab or vedolizumab
• other advanced medicines like filgotinib, ozanimod, tofacitinib and upadacitinib

Surgery

Surgery to treat ulcerative colitis may be an option if:

• you choose to have surgery instead of taking medications that may cause side effects
• medications don’t control your symptoms
• your quality of life is severely affected by your condition
• you have serious complications of ulcerative colitis

Surgery for ulcerative colitis involves removing part or all of your large bowel (known as a colectomy). This means the small intestine must be used to pass waste products out of your body instead.

During the surgery, your small intestine will either be:

• joined to the surface of your tummy (known as an ileostomy or a colostomy) – after this type of surgery, poo comes out of the opening on your tummy and is collected in special bags that you wear
• joined directly to your rectum (the end of your large bowel), so your poo comes out of your bottom as usual
• used to create an internal pouch that’s connected to your bottom (known as an ileo-anal pouch or J-pouch) – this means your poo can pass through your bottom as usual

Diet

There’s no evidence that a particular diet causes ulcerative colitis. But alongside medications, some changes to your diet may help control symptoms for some people.

You could:

• eat 5 to 6 small meals rather than 3 main meals
• try to eat a healthy, varied diet that includes a wide variety of fruit, vegetables, nuts, seeds, proteins and wholegrains
• drink plenty of water

You could also speak to your IBD team about:

• keeping a food diary to find out if any particular foods affect your symptoms
• removing trigger foods from your diet – but do not make major changes to your diet without talking to your IBD team and make sure you are still getting all the nutrients you need
• taking a food supplement if you are struggling to get enough nutrients from your diet
• being referred to a dietitian

Managing stress

Stress doesn’t cause ulcerative colitis. But, managing stress may reduce how often you get symptoms.

To help manage stress, you could:

• exercise – speak to your IBD team about a suitable exercise plan
• try relaxation techniques like yoga, medication and breathing exercises
• talk to others – Crohn’s & Colitis UK has details of local support groups
• speak to your GP if you think you may have depression

Fertility and pregnancy

A woman’s chance of becoming pregnant isn’t usually affected by ulcerative colitis.

However, surgery for ulcerative colitis might affect your fertility, especially pouch surgery.

Most women with ulcerative colitis will have a normal pregnancy and a healthy baby. But if you’re pregnant or planning a pregnancy you should discuss it with your IBD team. This is because they may need to change your medication.

If you’re having a flare-up of ulcerative colitis you may also be advised to avoid getting pregnant until it’s under control.

আপনার যদি আলসারেটিভ কোলাইটিস থাকে, তাহলে আরও কিছু সমস্যার ঝুঁকি আপনার ক্ষেত্রে বেশি হতে পারে, যেমন:

• অস্টিওপোরোসিস (হাড় ক্ষয়)
• শিশু ও কিশোর-তরুণদের ক্ষেত্রে বেড়ে ওঠা ও বিকাশে ঘাটতি

আরও গুরুতর ও বিরল জটিলতার মধ্যে থাকতে পারে:

• প্রাইমারি স্ক্লেরোজিং কোলানজাইটিস (PSC), অর্থাৎ পিত্তনালির প্রদাহ, যা থেকে লিভারের ক্ষতি হতে পারে
• অন্ত্র সরু হয়ে যাওয়া (স্ট্রিকচার), যা আটকে যেতে পারে বা মল বের হওয়া কঠিন করে তুলতে পারে
• টক্সিক মেগাকোলন, যেখানে তীব্র প্রদাহের কারণে কোলনের ভেতরে গ্যাস আটকে যায়, ফলে কোলন প্রচণ্ড ফুলে ওঠে এবং ফেটেও যেতে পারে
• অন্ত্রের ক্যানসারের ঝুঁকি বেড়ে যাওয়া
• পায়ে বা ফুসফুসে রক্ত জমাট বাঁধার ঝুঁকি বেড়ে যাওয়া