Ulcerative Colitis and its Homeopathic Approach

Abstract

Ulcerative colitis is an inflammatory bowel disease (IBD) characterised by the inflammation and ulceration of the large intestine (colon) with bloody diarrhoea and occasional remissions and exacerbations due to some unknown cause.  Onset is acute as well as chronic.   [1]

Onset is usually gradual, in about 85-90% of the patients and rarely acute onset is seen in about 10-15% of the patients. Acute severe ulcerative colitis is a life-threatening medical emergency, which can be associated with significant morbidity and is preventable through prompt and effective management.

Homeopathic medicines are very effective in treating diseases related to the gastrointestinal tract and extremely effective in treating ulcerative colitis. Homeopathic medicines do not have any ill-effects and do not deteriorate the health of the individual, unlike conventional medicine.

The objective of homeopathy is not only to treat ulcerative colitis but also to address its underlying cause, pathology and individual susceptibility. This article emphasizes the aetiology, pathogenesis, clinical features and management of ulcerative colitis with discussion of homeopathic medicines indicated for the disease.

KEYWORDS – Inflammatory Bowel Disease [IBD], Ulcerative colitis [UC],  Homeopathic holistic treatment, Pathogenesis.

INTRODUCTION

Ulcerative colitis (UC) being an inflammatory condition affects the mucosal surface of the colon and rectum, and is chronic and relapsing in course. The majority of the patients tend to have a mild-moderate disease course but 20-25% of the patients may experience severe exacerbation requiring hospitalisation. According to the UK National IBD audit, mortality associated with acute severe UC (ASUC) is 1%. If the disease is limited to only the rectum it is called  – “Proctitis”.

Limited to rectum and sigmoid colon- proctosigmoiditis.

Involvement of whole colon- “Pancolitis”.

Involvement of ileum- “Backwash ileitis”.

The clinical course of UC is variable. Most patients will suffer a relapse within 1 year of the first attack, reflecting the recurrent nature of the disease. [5]

85% of the patients with UC have mild to moderate disease of an intermittent nature and can be managed without hospitalization. In approximately 15% of the patients, the disease becomes more fulminant and involves the entire colon. These patients are at risk of developing toxic dilation and perforation of the colon. [5]

TYPES OF ULCERATIVE COLITIS

Two types of presentations are seen:

1. Fulminant type (5% common) It is a severe form. Patient is ill and dehydrated It has high mortality and requires emergency surgery i.e. either colostomy or resection with ileostomy and later ileo anal anastomoses.
2. Chronic type (95%) Lasts for months to years with diarrhoea, blood loss, anaemia, invalidism, abdominal discomfort and pain. Severe malnutrition and hypoproteinaemia.

ETIOLOGY

• Unknown
• This may be a primary change followed by bacterial or viral invasion e.g., B-coli, yeast, mycobacterium, L monocytogens, measles virus etc.
• Westernized diet, red meat, less common in vegetarians.
• ‘Auto-immune’ phenomenon.
• It may be reaction to various antigens e.g., milk protein or polysaccharides.
• Psychological aspects, stress, lifestyle, personality disorders.
• The disease is common in non-smokers but may worsen when smokers stop smoking. The disease is also rare in cases whose appendectomy is done before 20 years.
• L- arginine and glutamines in food may in some way be related. [1] [2] [3] [4]

GENETIC FACTORS

• The inheritance pattern of ulcerative colitis is unknown.
• Even though this is not known a family member with ulcerative colitis increases the risk of developing the condition.
• In some cases, carcinoembryogenic antigen (CAE) has been found in the blood.
• Autoimmune factors- cytotoxic T lymphocytes against colonic epithelial cells and the presence of anticolon antibodies has been found.
• Association with HLADR2 is observed in ulcerative colitis – DR1501 is associated with less severe form, DR1502 is associated with more severe form. [1] [2] [3]

 CLINICAL FEATURES

• The disease is common in females.
• Bloody diarrhoea is the hallmark of the diagnosis.
• In mild cases there may be occasional loose stool with blood and mucous.
• Sometimes constipation is also seen in some patients.
• In severe cases patient is very ill, temperature is high, toxaemia is present along with tachycardia and dry coated tongue.
• Frequent loose stools with blood, pus and mucous are seen.
• Patient becomes anaemic and exhausted.
• Gradually there is weight loss.
• Anorexia, abdominal pain and distention are also seen.
• Due to much diarrhoea, dehydration with electrolyte imbalance may develop.
• Liver is palpable, soft and tender and diffuse rebound abdominal tenderness may be present.  [1] [2] [3] [4]

Clinical grading of ulcerative colitis:  [3]

COMPLICATIONS 

• Malignancy
• Pseudopolyposis – in between ulcers permanent epithelial thickening occurs which appear like polyps.
• Stricture formation.
• Toxic megacolon in transverse colon.
• Massive haemorrhage.
• Fistula in ano
• Perianal fistula
• Sclerosis of sacroiliac joint.
• Fatty liver
• Perforation
• Severe malnutrition
• Liver cirrhosis
• Skin lesions
• Uveitis , episcleritis, conjunctivitis.
• Arthritis , iritis, ankylosing spondylitis.
• Sclerosing cholangitis, carcinoma of bile duct. [1] [3]

INVESTIGATIONS

• Barium enema
• CBC – blood shows anaemis with leucocytosis and high ESR.
• Proctoscopy and Sigmoidoscopy may reveal superficial ulcers.
• Plain x-ray abdomen – useful in ruling out obstruction, perforation.
• C-reactive protein – significance is seen in acute phase.
• Serological tests – PACA (perinuclear antinuclear cytoplasmic antibody)
• Rectal Biopsy. [1] [2] [3] [4] [6]

MANAGEMENT

• In fulminant type bed rest is essential
• Dairy products should be avoided.
• Correction of anaemia
• Nutritional assessment and optimisation of nutritional status – high protein, carbohydrate, vitamin but low fat diet.
• Fluid and electrolyte supplementation.
• Blood transfusion may be considered on the basis of the case if absolutely necessary.
• Psychological counselling. [1] [2] [3] [4]

HOMEOPATHIC VIEWPOINT

• Homeopathy has a great scope in treating ulcerative colitis due to its holistic and individualistic approach of treatment. This is the method of treatment in which the state of complete health can be regained by removing all the signs and symptoms from which the patient is suffering. It has a great role in systemic changes and chronic afflictions as it establishes cure without bringing out any health issues or side effects on the patient.  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.

HOMEOPATHIC THERAPEUTICS [7-13]

1. Ignatia Amara –It is given when the emotional element of the person has got the upper hand. The relationship between this emotional and the physical irritation needs to be established. To resolve this emotional state, infrequent doses of high potency will be required intercurrently. All – gone sensation in the stomach with much flatulence and hiccough, worse from touch, jar and motion.
2. Natrum Muriaticum – it is the chronic of Ignatia Amara. Ill effects of grief, fright and anger, aggravation by consolation is a characteristic feature. cutting pain in the abdomen.
3. Staphysagria – it is a nervous personality with marked irritability and the irritability is reflected in the temper as well as the functions of the digestion. Peristalsis aggravates with emotional outburst.
4. Aurum Metallicum – it has a feeling of self-condemnation and utter worthlessness, along with profound despondency that affects digestion.
5. Nux Vomica – This remedy is extremely useful in the treatment of ulcerative colitis, both acute, as well as chronic state, when apparently indicated remedies fail to
6. Pulsatilla Pratensis- it is a great remedy for the management of fever that occurs due to underlying gastric disorders. The patient has mucous and blood in their stool. A feeling of chilliness even in a warm room.
7. Mercurius Corrosivus – it is recommended to those ho have a continuous and frequent urge to empty their bowel. Presence of green coloured vomit along with bloody and slimy stool. A sensation of bruising and pain in the abdomen.
8. Hydrastis Canadensis – this remedy primarily acts on the mucous membrane. Pain in the rectum while defecating.
9. Podophyllum – highly effective remedy for inflammation and pain in the digestive tract. A sinking feeling in the abdomen . Long – term diarrhoea, dysentery. Chills in the morning. All symptoms worsen in hot weather and early in the morning.
10. Sycotic compound bacillus – it is a bowel nosode having a close resemblance to the pathogenesis of ulcerative colitis. The person is of tubercular constitution, there is nervous anxiety and the patient is tense and tearful. There is chronic irritation of the alimentary tract, heartburn and hyperacidity, there is also an urgent desire for stool on waking up in the morning. Stools are loose and offensive.
11. Cynodon Dactylon –it is an indigenous remedy which was added to our remedy list few years back. It has gripping pains and dysenteric symptoms that are aggravated by anger and anxiety. It works better either with mercurius sol or nux vomica.
12. Aloe Socotrina – for abdominal pain. A feeling of fullness in the abdomen. Presence of mucous in the stool. Burning in the anus and rectum. Lumpy and watery stool. Pain in the rectum after defecation.
13. Lycopodium Clavatum – lycopodium patients are always belching. They have eructations that are sour and acrid. Sour stomach, sour vomiting, flatus, eructations, heartburn and water- brash, worse by cold and often relieved by warm drinks. Corresponds to Grauvogle’s carbo-nitrogenoid constitution.

REFERENCES

1. Das PC, Das PK. Textbook of medicine; 5^th edition; Current Book International, Kolkata.219,220,221
2. Davidson principles and practice of medicine- 23^rd edition .
3. SRB’S Manual of surgery – 5^th 890,891,892,893
4. Golwalla’s medicine for students – 25^th 42,43,44.
5. Harrison’s principles of international medicine- 19^th edition (Vol- 2). 1633,1634,1635.
6. Hutchinson’s clinical methods- 24^th edition
7. Boericke’s New Manual of Homeopathic MATERIA MEDICA with Repertory
8. Allen’s Keynotes – rearranged and classified with Leading Remedies of the Materia Medica with Bowel Nosodes.
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12. Homeopathic Therapeutics – The Classical Therapeutic Hints – Samuel LIienthal, M.D.
13. Lotus Materia Medica by Robin Murphy – 3^rd