Ulcerative colitis is an inflammatory disorder of the colonic mucosa characterized by relapses and remissions. The rectal mucosa is always involved, occasionally by microscopic inflammation alone, and the disease extends proximally.

Etiology of Ulcerative colitis

Autoimmune factor

Even though exact mechanism of ulcerative colitis is not clear, there are some factors which may point out at autoimmune reaction.

Dysfunctional immunoregulation

In the intestinal wall results in inappropriate production of cytokines. This creates an imbalance between various interleukins resulting in inflammatory changes.

Psychosomatic and personality factor

Ulcerative colitis is more common in western women. Emotional stress, family stress, stress from divorce are the contributing factors.

Dietary factors

Westernization of the diet which is rich in red meat has been blamed. Vegetarian diet is supposed to protect the colon’s mucosa.

Allergy to milk protein is responsible for ulcerative colitis in few patients.

Defective mucin production

Defective mucin production and a defective mucosal immunological reaction is considered as a chief factor responsible for ulcerative colitis.

Clinical features of ulcerative colitis

Onset is usually gradual. Bloody diarrhoea is the hallmark of the disease, though proctitis may present with rectal bleeding and constipation. Urgency and crampy abdominal discomfort before defecation. Stool frequency is related to the severity of disease.

Systemic signs and symptoms mainly include

• Anorexia

• Weight loss

• Anemia

• Profound weakness

• Fever

• Tachycardia

• Abdominal tenderness

• Distension of the abdomen

• Malnutrition

• Hypoprotienaemia

Investigations

Sigmoidoscopy and rectal biopsy

The appearance can be graded as mild, moderate, and severe.  Characteristic microscopic features are a chronic inflammatory infiltrate, glandular distortion, goblet cell depletion and crypt abscesses.

Plain abdominal radiography

In only severe disease, to assess faecal distribution, to exclude colonic dilatation. It is also helpful in demonstrating proximal constipation in patients with very distal disease.

Colonoscopy and barium enema

colonoscopy is always preferable in initial investigation of bloody diarrhoea, because it provides better mucosal definition and allows biopsies. Colonoscopy however is dangerous in acute episode; flexible Sigmoidoscopy after phosphate enema is then the procedure of choice.

Other investigations

• Stool examinations to exclude pathogens

• Full blood count and ESR or C-reactive protein to evaluate severity

• Liver function investigation once in remission

Complications of ulcerative colitis

Toxic megacolon – it is an abdominal emergency encountered with fulminating colitis, severe abdominal pain and tenderness, toxemia, high fever, tachycardia, leucocytosis, toxemia are the features.

Massive hemorrhage – per rectum is uncommon. It is treated by blood transfusion.

Perforation is to be treated as peritonitis with resection of colon. Mortality rate is around 25-50%.

Carcinoma of colon – routine Sigmoidoscopy and biopsy have to be done when the disease is present for more than 10 years.

Recurrent Perianal abscess, resulting in Perianal fistula.

General complications

• Protein malnutrition
• Skin ulceration
• Conjunctivitis
• Iritis
• Arthritis involving large joints
• Bile duct cancer

Homeopathic treatment of ulcerative colitis

Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat ulcerative colitis but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several well-proved medicines are available for ulcerative colitis treatment that can be selected on the basis of cause, condition, sensation and modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following well proved medicines which are much helpful for the treatment of ulcerative colitis:

Ignatia – remarkable remedy for ulcerative colitis, since the emotional element is uppermost in Ignatia, relationship of this physical irritation first needs to be established. To resolve this emotional state Ignatia is much helpful.

Natrum Mur – in chronic of Ignatia. Ill effects of grief, fright and anger aggravations by consolation are the characteristic features. Cutting pain in abdomen and the abdominal ring, burning and stitching pain in the rectum after a copious diarrhoea.

Staphisagria – is a nervous personality with marked irritability. This irritability is reflected in temper as well as in function of the digestion. The peristalsis is aggravated with the emotional outburst.

Aurum met – has feeling of self-condemnation and utter worthlessness, profound despondency that affects the digestion.

Nux Vomica – excellent medicine for ulcerative colitis, if one studies the Nux Vomica, one sees a clear picture of this condition.

Lycopodium – is another remedy that has a very close resemblance to the condition.

Merc sol – both have a very close relationship with the pathology of ulcerative colitis.

Apart from the treatment through the remedies, a lot of counseling and appropriate diet regimen is required.

Correction of dehydration and electrolyte losses through intravenous fluids may often be required which may not be possible at home and need admission to the hospital.