Ulcerative colitis and Homoeopathy: An Overview

Dr Sahana MB

Abstract:
Ulcerative colitis is a chronic, idiopathic inflammatory disorder confined to the colonic mucosa, presenting with continuous inflammation, friability and bleeding. Disease distribution varies with involvement ranging from the rectosigmoid region to extensive colonic areas. A progressive course is observed in a subset of patients, correlating with increased symptom severity. The disease follows a relapsing- remitting pattern and is more prevalent among nonsmokers and former smokers. Interestingly, active smoking and prior appendectomy before the age of 20 years appear to confer a protective effect. Understanding this general pattern is essential for appropriate clinical assessment and management.

Key words: ulcerative colitis, homoeopathy

Introduction :⁽¹⁾
Ulcerative colitis is an idiopathic, chronic inflammatory condition primarily affecting the mucosal layer of the colon. The disease typically presents with diffuse inflammation, mucosal friability and bleeding with varying anatomical involvement. While some patients have limited disease confined to the rectosigmoid area, others may show extension up to or beyond the splenic flexure. Disease progression and severity often correspond to the extent of colonic involvement. Ulcerative Colitis is characterised by recurrent flare-ups and remissions and is more commonly seen in nonsmokers. Notably, active smoking and a history of appendectomy at a young age are associated with a lower risk, suggesting a possible immunomodulatory role. These considerations provide important insights into disease aetiology and progression.

Disease Distribution ⁽²⁾: –

Proctosigmoiditis: About 25% of patients have disease confined to the rectosigmoid region.

Left-sided colitis: Approximately 50% have disease that extends to the splenic flexure

Extensive colitis: In about 25% of cases, the disease extends more proximally (beyond the splenic flexure).

Progression and Severity: –

• In patients with distal colitis, about 25% experience disease progression to more extensive colitis over time.
• There is some correlation between the extent of disease and symptom severity, with more extensive disease generally resulting in more severe symptoms.
• Ulcerative Colitis is typically characterized by periods of symptomatic flare-ups and remission.
• Around 15% of patients may have an aggressive disease course, which increases the risk of hospitalization and surgery.

Etiological Considerations ^(1,3,4,5):
Although the exact cause of ulcerative colitis remains unknown, it is widely regarded as an autoimmune condition. Several factors are believed to contribute to its development:

Genetic Predisposition:

A family history of ulcerative colitis significantly increases the risk of developing the disease. Approximately 20% of affected individuals report a positive familial background.

Immune System Dysfunction:

Ulcerative colitis is considered an autoimmune disorder wherein dysregulation of the immune response may lead to persistent inflammation. In some individuals, the immune system may continue to attack the colonic mucosa even after a triggering infection has resolved, resulting in chronic tissue damage to the colon and rectum.

Psychological Stress:

Emotional stress and mental tension have been observed to exacerbate disease symptoms and may contribute to the recurrence of flare-ups in susceptible individuals.

Medication Use:

Prolonged or excessive use of certain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and oral contraceptives may act as potential triggers for the onset or worsening of the condition.

Dietary Factors: 

Diets high in refined carbohydrates, sugars, and spicy foods are believed to increase susceptibility to ulcerative colitis in some individuals.

Environmental Influences:

Poor hygiene and living conditions have also been associated with a higher risk of developing ulcerative colitis, possibly due to altered microbial exposure and immune response.

Risk Factors and Protective Factors: –

– UC is more common in nonsmokers and former smokers. Interestingly, active smokers tend to have milder disease or lower disease severity, and UC may worsen in patients who stop smoking.

-Having an appendectomy before the age of 20 for acute appendicitis is associated with a reduced risk of developing UC.

• The disease course varies, with most patients experiencing periodic flare-ups and remissions, while a subset may have more severe and unrelenting disease requiring surgical intervention.

Clinical features ^(6,7)

The symptoms of ulcerative colitis depend on both the severity of inflammation and the specific region of the colon involved.

• Diarrhoea: Often the earliest and most persistent symptom, diarrhoea is typically accompanied by the passage of blood, mucus, or pus.
• Abdominal Pain and Cramping: Patients frequently experience lower abdominal cramping with a sudden and urgent need to defecate.
• Tenesmus: A constant feeling of incomplete bowel evacuation, or tenesmus, is commonly reported and may cause considerable discomfort.
• Nausea and Constipation: Though less common, some patients may also suffer from nausea and constipation. These symptoms often intensify in the early morning hours.
• Loss of Appetite and Weight Loss: Due to persistent gastrointestinal distress, patients may develop anorexia, resulting in reduced food intake, fatigue, and unintentional weight loss.
• Anaemia: Anaemia is a common complication of ulcerative colitis, primarily caused by chronic blood loss, inflammation, and nutritional deficiencies. Rectal bleeding leads to iron-deficiency anaemia, while ongoing inflammation can cause anaemia of chronic disease. Poor appetite, malabsorption, and medications may also contribute. Symptoms include fatigue, pallor, and breathlessness. Management involves iron supplementation and controlling inflammation.

These symptoms typically worsen during active disease phases and improve during remission. The severity and frequency of symptoms greatly influence the overall quality of life in individuals with ulcerative colitis.

Physical Examination ⁽⁸⁾: –

Volume status: Assessing the patient’s hydration and volume status is important, using orthostatic blood pressure and pulse measurements to detect dehydration or electrolyte imbalances.

Nutritional status: Malnutrition or weight loss may occur, particularly in severe cases.

Abdominal tenderness: The abdomen should be examined for tenderness, which may indicate active inflammation.

Peritoneal inflammation: Signs of peritonitis, such as rebound tenderness, may indicate complications like perforation.

Digital rectal examination: Red blood may be detected on a rectal exam, confirming the presence of rectal bleeding.

Disease Severity (Truelove-Witts Criteria): Patients are classified based on clinical and laboratory findings into mild, moderate, or severe categories, guiding treatment decisions.

Truelove-wits criteria
The Truelove and Witts criteria are commonly used to assess the severity of ulcerative colitis (UC). It is based on several clinical and laboratory parameters to classify the disease into mild, moderate, or severe categories.

Diagnosis ⁽⁹⁾:
Several tests can be performed to know the details such as blood tests, stool tests, colonoscopy, endoscopy, sigmoidoscopy, CT scan. All this will help us in getting internal details about the various parts such as oesophagus, stomach, small intestine, large intestine etc. Stool test will help in detecting the bacteria or parasites.

Complications ^(10,11):

1.Massive hemorrhage: – Severe bleeding from the colon can occur during a flare, potentially requiring emergency treatment.

2.Toxic megacolon:   – A life-threatening complication where inflammation spreads beyond the mucosa, leading to extreme dilation of the colon (transverse colon diameter >6 cm on a plain X-ray).

-Clinical features include: – Fever, Tachycardia, Leukocytosis, Abdominal tenderness and distension, If left untreated, it can lead to perforation of the colon.

3. Perforation: – The colon can rupture, leading to peritonitis (infection in the abdominal cavity), which is life-threatening. This can complicate toxic megacolon but may also occur in severe UC without it.

4. Strictures: – Benign strictures (narrowing of the colon) are rare in UC but may occur. These need to be monitored as they can cause bowel obstruction.

5. Colorectal carcinoma:

– The risk of developing colorectal cancer is elevated in patients with:

–  Long-standing UC (over 8-10 years of disease).

• Pancolitis (inflammation involving the entire colon).
• Young age of disease onset.

– Presence of primary sclerosing cholangitis (PSC), a liver disease that often accompanies UC.

– Surveillance colonoscopies are recommended to detect dysplasia (precancerous changes) early.

Several tests can be performed to know the details such as blood tests, stool tests, colonscopy, endoscopy, sigmoidoscopy, CT scan. All this will help us in getting internal details about the various parts such as oesophgus, stomach, small intestine, large intestine etc. Stool test will help in detecting the bacteria or parasites.

General Measures for Managing ⁽¹²⁾ :

1. Dietary Recommendations:  Patients with strictures (narrowing of the bowel) should avoid high-residue foods, such as raw fruits, vegetables, and high-fiber foods, to reduce the risk of bowel obstruction.

2. Nutritional Supplements: -Iron, calcium, and vitamin supplements may be needed, especially if there is evidence of malabsorption or deficiencies due to chronic inflammation, bleeding, or medication use (e.g., corticosteroids).

– Vitamin B12 supplementation is particularly important for patients who have undergone extensive terminal ileal resection since this part of the bowel is critical for vitamin B12 absorption.

3.Special Nutritional Considerations: – After extensive terminal ileal resection, patients may experience:

– Vitamin B12 deficiency: Due to impaired absorption.

– Fat malabsorption: As bile salts are not reabsorbed efficiently, leading to steatorrhea.

-Bile salt malabsorption: This can also result in diarrhea.

-For such patients, a low-fat diet and vitamin replacement (including fat-soluble vitamins A, D, E, and K) are recommended.

4.Parenteral Nutrition: – In cases of fulminant disease (severe, acute flare-ups), patients may require parenteral nutrition (IV feeding) if they are unable to meet their nutritional needs orally due to malabsorption, bowel rest, or severe inflammation.

These general measures aim to maintain optimal nutrition, manage complications, and address deficiencies that may arise due to malabsorption or disease treatment.

Homoeopathic approach ^{(13,14,15,16,17)}:
In homeopathy, ulcerative colitis is viewed as a dynamic disturbance of the vital force, often influenced by underlying miasms – particularly the destructive syphilitic miasm -along with emotional and mental stressors. Treatment is highly individualized, focusing on the totality of symptoms rather than the disease name,

and includes mental, emotional, and physical aspects. By selecting remedies based on the principle of “like cures like,” and addressing the patient’s constitutional makeup, homeopathy aims not only to relieve symptoms but also to restore balance to the vital force, thereby promoting long-term healing and reducing relapses.

1. Mercurius Corrosives:

Indications: Tenesmus with small quantities of blood and mucus; burning and cutting pain in rectum; worse at night.

2. Aloe Socotrina:

Indications: Profuse, gushing, jelly-like stools; urgency, cannot delay; sensation of weakness in rectum.

3. Baptisia tinctoria:

Indicated in cases with offensive, dark stools, low-grade septic conditions, and ulceration with foul discharges.

4. Nitricum acidum:

Useful for bright red blood in stool, sharp splinter-like pain in rectum, and the presence of fissures and ulcers.

5. Hydrastis canadensis:

Indicated when there is tenacious mucus, ulceration of mucosa, weak digestion, and a sinking feeling in the stomach.

6. Ratanhia: Effective in cases with violent burning in the anus after stool, fissures with dry, hard stools, and bleeding.
7. Terebinthina:

Indicated in bloody, offensive, tar-like stools with burning pain in the bowels and bladder, often with nephritic symptoms.

8. Acidum sulphuricum:

Used in cases of thin, offensive, sour-smelling diarrhea with rectal burning, worsened by coffee or alcohol.

9. Podophyllum:

Indications: Painless, profuse, offensive, watery stools with gurgling and weakness; worse in the morning.

10. Phosphorus:

Indications: Bloody, painless, offensive stools; marked weakness after stools; craving for cold drinks.

11.Nux Vomica

Indications: Frequent ineffectual urging to stool; small quantities passed each       time; associated with sedentary lifestyle, stimulants.

12.Kali bichromicum:

Characterized by jelly-like stools with stringy mucus and ulceration localized in patches.

Conclusion ⁽¹⁸⁾:
Ulcerative colitis is a chronic, relapsing inflammatory condition that significantly impacts a patient’s quality of life. While conventional treatment focuses on symptomatic relief and immune suppression, homeopathy offers a holistic approach by addressing the underlying causes, individual susceptibility, and emotional factors. Through the principles of individualization, miasmatic analysis, and the law of similar, homeopathy aims to restore harmony within the individual and support long-term remission. When integrated judiciously, homeopathic treatment can serve as a valuable complementary modality in managing ulcerative colitis, enhancing patient outcomes and overall well-being.

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Dr. Sahana M. B.
MD Scholar Department of Practice of Medicine
Guide: Dr. M. K. Kamath
Father Muller Homoeopathic Medical College, Mangalore
Email: sahanabhajantri75@gmail.com