ABSTRACT
Ulcerative colitis is described as a type of inflammatory bowel disease(IBD), the other type is Crohn’s disease. In ulcerative colitis, there is inflammation and ulceration of the colon or rectum. The symptoms will range from light to severe. The etiology is unknown but can be due to an autoimmune condition, or genetic disorders. In some diseases like polyarthritis, sacroiliitis, spondylitis, inflammatory liver diseases, and various skin lesions ulcerative colitis was also commonly seen. Let’s discuss it in detail!
INTRODUCTION
Ulcerative colitis is an autoimmune condition, which can be an acute and chronic disorder of unknown etiology characterized by inflammatory mucosal ulcerations of the colon and rectum. Crohn's disease and ulcerative colitis are types of inflammatory bowel diseases (IBD). Ulcerative colitis mostly begins in the rectosigmoid colon but often extends to affect the entire colon. In Crohn's disease, the inflammatory changes are granulomatous/ granulomatous colitis (a chronic inflammatory condition that affects the colon or large intestine) in Ulcerative colitis the inflammatory changes in the colon are nonspecific. The causative mechanisms of both diseases are common.
CAUSES
The specific cause of ulcerative colitis is unknown but some causes are as follows -
- Abnormal Immune Response - It's an autoimmune condition where the T-cells penetrate the colon and mistakenly attack the healthy cells lining the colon causing inflammation and ulceration in the colon.
- Genetic Factor - Some research shows that certain genes increase the chance of developing ulcerative colitis. Some regions of the genome linked to cause UC as 12, 16, and 19 but the disorder is influenced by multiple genes.
- Environmental Factors - Here the factors include, diet, breastfeeding, medication, stress tobacco use, and use of more dietary substances can lead to inflammation of the colon. More intake of vitamin B6 and unsaturated fat may enhance the risk of ulcerative colitis, and also alcohol use eating meat.
- Microbiome - The good bacteria, fungi or viruses in our gut that help in digestion is called the microbiome, are lacking or in a weak stage if compared with a healthy man and a person suffering from IBD (Inflammatory bowel disease).
SYMPTOMS
- Abdominal pain
- Blood and mucus in diarrhea can be seen for days, weeks, or months.
- In most cases, bloody diarrhea contains stringy mucus, lower abdominal pain, and cramps, usually relieved by defecation.
- Sometimes fever and weight loss (an asymptomatic interval can be seen for some time after which stress physical or mental may typically cause a flare-up)
- Toxic Megacolon - sudden cessation of bowel function with the production of toxic dilatation of the colon
- The bowel may undergo fibrosis with narrowing of the lumen.
- Sometimes deranged electrolytes due to blood in stools, and rectal bleeding.
- Dehydration
- Loss of appetite
- Rectal tenesmus - Incomplete defecation
- Pancolitis - enlargement of the entire large intestine
DIAGNOSIS
Diagnosis can be done by doing:
- Laboratory findings
- Imaging
- Physical examination
1. Laboratory Findings
- FOBT (Fecal occult blood test) detects a small amount of blood in stool, Leukocytosis, Anemia (due to chronic blood loss), Thrombocytosis
- Serum ferritin, ion and total iron-binding capacity, and transferrin saturation
- Serum albumin may be low due to inflammation
- The fecal calprotectin test will be elevated in inflammatory conditions affecting the colon
- Complete blood count (CBC)- look for Anaemia (decrease in hemoglobin and RBCs) and thrombocytosis (increase in platelet count)
- Serum electrolytes for severe dehydration, hypokalemia, and KFT(kidney function test) for kidney injury
- LFT (Liver function diseases) form involvement of bile duct
- A stool culture to check for infectious colitis
- ESR(Erythrocyte sedimentation rate) or c-reactive protein to see for inflammation.
2. Imaging
- X-ray and CT scan to detect perforation or toxic megacolon
- Bowel Ultrasound
- MRI is useful to detect PSC (Primary sclerosing cholangitis)
- Sigmoidoscopy or colonoscopy to view the lining of the rectum, and sigmoid colon for any inflammation.
3. Physical Examination
- Physical examination includes vital monitoring
- Bowel sounds and seeing for tenderness in the abdomen.
- Check for bloating and pain while palpating
- Digital rectal exam to check for blood or mucus in stool.
STAGES OF ULCERATIVE COLITIS
The stages of colitis are based on the severity, which can be mild, moderate, and severe:
- Mild - Person has less than or equal to 4 stools per day with minimal systemic symptoms
- Moderate - More than 4 times stool per day and moderate symptoms
- Severe - More than 6 stools with blood per day systemic symptoms like fever, low hemoglobin, increased heart rate, and life-threatening condition
The extent of inflammation in the colon can also be classified using the Montreal classification system with stages:
- Proctitis (E1) - Inflammation limited to the rectum.
- Left-sided colitis (E2) - Inflammation reaching the splenic flexure.
- Pancolitis (E3) - Inflammation affecting the entire colon.
MANAGEMENT
- Corticosteroids - Reduce inflammation and suppressing the immune system
- Aminosalicylic acid like, 5 Amino Salicylic acid - Treat Inflammation in the colon and small intestine
- Biologics - Used for modifying the immune system.
- Iron Supplementation - Used to maintain hemoglobin, iron level in the body happened due to blood loss
- Anticholinergics - Sometimes used to treat abdominal cramps
- Immunosuppressant therapy and Vaccination - Many patients need immunosuppressant therapy as it is an autoimmune disorder so patients may also require different vaccinations for influenza, hepatitis B, chicken pox herpes zoster diseases, etc.
AYURVEDIC ASPECT
Etiology and pathophysiology
In Ayurveda Ulcerative colitis can be related to Raktaatissar (bloody diarrhea with stools). There are some etiological factors explained in Ayurvedic texts regarding Raktajatisar like food that is heavy for digestion (guru), food that has apposite properties (cold potency food and hot potency food intake together), Koshtha (gut), desha (Region or surrounding areas), Intake of meat of Pig, buffalo, fish mixed with oil cake, Intake of pastries in excess after food, unboil milk intake in excess, Intake of excess Katu rasa (Pungent thing), Amla (Sour taste), Lavana (Sour taste), hot potency food intake in excess, Tikshana (Sharp acting things). Because of these etiological factors and the presence of Ama dosha (toxic substance due to indigestion) the Pitta dosha aggravates in Kostha which agitates the inner lining of the large intestine by which the mucosal stem cells get harmed, and there is blood in the stools.
Pathway of diseases and prognosis
The manifestation of this disease is in the lower tract where the body is dominated by Vata (Urethra and anus due to contact with vitiated Vata) and vitiated Pitta which does the Dushti of Rakta which damage to the inner lining of the large intestine and leads to blood in stools.
Treatment According to classic texts
- Goat’s milk boiled with Padma (Nelumbo nucifera), Utpala (Nymphaea alba), Samanga (Mimosa pudica), Mocarasa (Bombax ceiba) or with Sariva (Hemidesmus Indicus), Yashti (Glycyrrhiza glabra), Lodhra (Symplocos Racemosa Roxb.) or with sprouts of vata (Ficus Benghalensis), etc mixed with honey and sugar is beneficial for use for drinking, as food and for bathing the rectum
- Meat soup which is not sour and mixed with ghee used for drinking and along with food is beneficial.
- Paste of Shatavari (Asparagus Racemosus) mixed with milk should be consumed by the person who takes milk only as food, this cures bleeding diarrhea soon, also the medicated ghee of Shatavari (Asparagus Racemosus).
HERBAL REMEDIES FOR ULCERATIVE COLITIS BY PLANET AYURVEDA
Planet Ayurveda is a leading brand in the field of ayurveda globally, whose main aim is to spread ayurveda and health awareness all over the globe. Planet Ayurveda is GMP, HACCP, ISO, approved and has the best results in managing chronic diseases. These products are purely natural with no side effects. Planet Ayurveda’s products are formed by following the ancient classical texts of Ayurveda and under the guidance of expert Ayurveda MD doctors. Here are some herbal drugs by Planet Ayurveda to be used in Ulcerative colitis:
- Arjuna Capsules
- Vatsakadi Churna
- Pitta Balance
- Kutajghan Vati
PRODUCTS DESCRIPTION
1. Arjuna Capsules
Arjuna capsules are prepared using the standardized extract of the Plant Arjuna (Terminalia arjuna). Arjuna having different properties like astringent taste, light and dry properties and cold potency. Thus it is very beneficial in managing Bleeding in ulcerative colitis. This formulation mainly acts on Kapha and Pitta dosha and has intestinal anti-inflammatory actions, as having Kaphahara properties thus reduces heaviness in the stomach, and improves bowel movement, and because of Pitta pacifying properties it reduces inflammation in the intestine, burning sensation and blood in the stool.
Dosage: 2 tablets twice daily after food with water.
2. Vatsakadi Churna
Vatsakadi churna is a powder blend by Planet Ayurveda having different ingredients like Kutaj (Holarrhena antidysenterica), Bilva (Aegle marmelos), Saunf (Foeniculum vulgare), Dhania (Coriandrum sativum) and various other herbs. Vatsakadi churna maintains gut health or Antidysenteric and does absorption of the toxins accumulated as it has properties like detoxification, antioxidant, anti-inflammatory, and antibacterial.
Dosage: 1 teaspoonful twice daily with plain water after meal.
3. Pitta Balance
Pitta balance is a product of Planet Ayurveda in the form of capsules having different contents like Jahar Mohra Pishti (Natural calcium compound), Kaharwa Pishti (Natural calcium compound), Akik Pishti (Agate compound), etc. As its name indicates, this formulation mainly balances the Pitta dosha in the body and UC is a Pitta dominant condition. Moreover, it is coolant in nature so also useful in managing blood in stool.
Dosage: 1 capsule twice daily with plain water after a meal.
4. Kutajghan Vati
Kutajghan vati is prepared using an extract of Kutaja (Holarrhena antidysenterica) plant bark and is a product of Planet Ayurveda, it comes in the form of a tablet. It has been explained in classic texts it is having different actions in the body such as managing diarrhea, abdominal pain, and worm infection. This formulation is bitter in taste and cold in potency thus balances Pitta and Kapha dosha. Because of all these properties, it is used as antidysenteric and good for gut health.
Dosage: 2 tablets twice daily after food with plain water.
Conclusion
Ulcerative colitis is an autoimmune disorder having most symptoms common in Crohn’s disease and both are classified under Inflammatory Bowel Disease (IBD). In ulcerative colitis, the sigmoid part of the colon is affected causing inflammation and bleeding in the sigmoid colon or rectum. There are some medications like aminosalicylic acids, corticosteroids, immunosuppressant therapy, etc. but the reoccurrence of diseases is very commonly seen. In ayurvedic treatment, there is less possibility of recurrence of the diseases, and no use of steroids or immunosuppressants also. According to ayurveda, maintenance of a proper diet with proper medication is advised. Medications from Planet Ayurveda also have very good results seen in Ulcerative colitis.
