Ulcerative Colitis And Genetic Risk Factors
Ulcerative Colitis and Genetic Risk Factors
Ulcerative colitis is one of the known chronic disorders affecting the digestive system. The disorder is characterized by abnormal inflammation of the inner area of the colon and the rectum that covers large percentage of the long intestines. The inflammation caused by the disorder causes ulcers in the large intestines and causes recurring signs and symptoms.
Ulcerative colitis has no known cause but can affect any person. It has been known that one in every 5 people with ulcerative colitis have a close relative who has the same disorder. This means that there could be a genetic factor behind the disorder. The human leukocyte antigen (HLA) gene is responsible for this. The common theory behind this disorder is that a given factor triggers the immune system to bring about inflammation in the rectum and colon in people who are genetically at risk to develop the disorder.
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Studies done in the western part of the world indicate that the prevalence of ulcerative colitis in the whole world is about 1 to 1000 people. However, the incidence of ulcerative colitis is different between countries and different in different races. The areas that record the highest incidence rates include the regions of Northern Europe and North America. Australia also falls in this category because of the high incidence recorded in the country. It is estimated that about 13,000 Australians have ulcerative colitis. It has also been estimated that 61,000 Australians have either Crohns disease or ulcerative colitis. Ulcerative colitis has been found to affect people between the ages of 15 and 40 but it can develop at any age. In a study conducted by Wilson et.al, 76 new cases of inflammatory bowel disease (IBD) indicated that 29 cases were affected by ulcerative colitis, 45 were affected by Crohns disease and 2 were affected by indeterminate colitis (Wilson, Hair, Knight, Catto?Smith, Bell, Kamm & Connell, 2010, p. 1551).
Pathogenesis (cell and tissue level)
The pathogenesis of ulcerative colitis is not well understood to date. The introduction of culture-independent techniques to try to understand the disorder has indicated an essential reduction in firmicutes and bacteroidetes that leads to a reduced biodiversity and dysbiosis in patients who have ulcerative colitis. In patients who have ulcerative colitis, the intestinal barrier tissues have a reduced mucus thickness or a mucus composition that is altered.
Pathogenesis of ulcerative colitis involves breakdown of intestinal mucosal homeostasis because of miscommunication between commensal flora and the gut caused by immune system that is genetically determined. However, it is not clear whether the immune response is responsible for the disease or it occurs as a result of the disease. It is more likely that ulcerative colitis is not caused by one particular pathogen but by a combination of several factors. However, patients with ulcerative colitis reveal high level of microbes in their bodies (Bamias, Kaltsa & Ladas, 2011, p. 459).
Outcomes and other tissue effects if untreated
If ulcerative colitis is left untreated, patients are likely to develop a wide spectrum of chronic and life threatening complications. Some of the complications that can arise in case ulcerative colitis is not treated include excessive bleeding, colon perforation, colon cancer, mouth ulcers, liver damage, eye inflammation and osteoporosis among other complications. The most feared complications arising from untreated ulcerative colitis is toxic megacolon, which occurs because of inflammation extension beyond the submucosa part of the colon towards the smooth muscle layer in the colon wall. Regarding sclerosing cholangitis, an abnormal tissue forms in the bile ducts because of the chronic inflammation forcing the flow of the bile to be interrupted by the fibrous tissue (Thoeni & Cello, 2006, p. 624).
There are different treatment ways that can be applied to the patients with ulcerative colitis. There is no one universal treatment method that can work for all the patients thus a doctor may recommend a treatment option that works best for a particular patient. Despite the fact that is understood that ulcerative colitis is not wholly treatable, it can be sufficiently managed through several means (Garud & Peppercorn, 2009, p. 99).
First, anti-inflammatory medications can be given in different forms, such as topical appliances, injections and pills. The drugs include mesalamine, sulfazine, balsalazide and corticosteroids. Balsalazide and Mesalamine are prescribed as first line medication. These have fewer side effects compared to sulfazine. Secondly, suppressors for the immune system can also be given to reduce inflammation by targeting the immune system. These include medications, such as azathiprine and 6-mercaptopurine, which suppress the immune system and reduce the inflammation of the bowel. The third option is surgery that is used when the ulcerative colitis does not respond to other treatments. Between 25 and 30 percent of patients with ulcerative colitis go for surgery, which is mostly ileoanal anastomosis surgery. During this surgery, the inflamed rectal lining and the whole colon are removed from the body. Another surgery is proctocolectomy with ileostomy surgery. The colon and rectum are removed but a stoma is created outside the body where bodily waste is eliminated into a bag. This surgery can cause infections. Alternative therapies include the use of probiotics, fish oil and nicotine. Vitamins and supplements may also be required to address some bodily deficiencies in diet, for instance, adding calcium and vitamin D (Garud & Peppercorn, 2009, p. 107).
Current prognosis with therapy
Ulcerative colitis is characterized by flare-ups that are followed by remission periods. The goal of therapies is to reduce the flare-ups, increase remission periods and help the patients live healthier and longer life. The treatment and therapies applied to patients could have side effects but these depend on individual patients. For example, the use of sulfasalazine medication could have side effects that include diarrhea, headaches and heartburns. In other cases, prognosis includes kidney problems and pancreas problems (Garud & Peppercorn, 2009, p. 108).