Harmonizing Healing: Homeopathic Approaches to Ulcerative Colitis

Namith S Thontadarya
Dr. Pavankumar R Kollurkar

ABSTRACT
Ulcerative colitis is a relapsing and remitting disease that is increasing in incidence and prevalence. Management aims to achieve rapid resolution of symptoms, mucosal healing and improvement in a patient’s quality of life. This article is an attempt to unveil about the ulcerative colitis and its homoeopathic management.

KEYWORDS
ULCERATIVE COLITIS, INFLAMMATORY BOWEL DISEASE, PSEUDOPOLYP, CRYPT ABSCESS.

ULCERATIVE COLITIS : Ulcerative colitis is a condition in which the lining of the large intestine (colon) and rectum become inflamed. It is a form of inflammatory bowel disease (IBD). Crohn disease is another form of IBD.

INFLAMMATORY BOWEL DISEASE : Refers to two chronic diseases of unknown aetiology that cause inflammation of the intestine with extra intestinal manifestations.

ULCERATIVE COLITIS AND CROHNS DISEASE : Although the diseases have some features in common, there are some important differences

INTRODUCTION

• It is an inflammatory condition of rectum and colon of unknown aetiology perhaps related to STRESS, WESTERNIZED DIET, AUTOIMMUNE FACTOR, FAMILIAL TENDENCY, ALLERGIC FACTOR.
• Disease commonly starts in the rectum, spreads proximally to the colon and often in to the ileum as BACK WASH ILEITIS.

EPIDEMIOLOGY OF ULCERATIVE COLITIS

• Ulcerative colitis is more common in western and northern hemispheres with high incidence in USA & UK
• In past 2 decades, its incidence increased in middle east and asia and may be due to westernization of diet.
• UC is more common in women than in men.
• Age – 15-25 yrs, although disease can occur in any age group.
• UC is uncommon in persons younger than 10 yrs.

AETIOLOGY:

The cause is unknown, but several theories have been put forward of which the main ones

• INFECTIVE
• GENES
• NUTRITIONAL
• PSYCHOSOMATIC
• IMMUNOLOGICAL
• AUTOIMMUNE

INFECTIVE

Extensive studies in to the infective hypothesis have failed to demonstrate a pathogenic organism as the agent directly responsible, scattered reports suggests that

• CHLAMYDIA
• CYTOMEGALOVIRUS
• CLOSTRIDIAL TOXIN
• RNA VIRUS

Are responsible for producing ulcerative colitis

GENES
Genes may play a role, the diseases sometimes runs in families.

Researchers have found some genes that are potentially associated with condition, and between 15 and 20 percent of people with Crohn’s have relation with ulcerative colitis.

IMMUNE SYSTEM

• Ulcerative colitis happens when your immune system makes a mistake.
• WBC’s that usually protect you will attack the lining of your colon instead
• They cause the inflammation and ulcers

AUTOIMMUNE DISEASE

Characterised by T-cells infiltrating the colon.

PSYHOSOMATIC

• Psychological factors have long been thought to play a critical role in exacerbations of diseases.
• Various investigations have suggested that the subjects who develop ulcerative colitis have a characteristic personality and those personality factors were present long before the onset of colitis.

OTHERS

• Ingestion of animal fat can increase the occurrence of UC
• Consumption of milk products
• A history of APPENDICECTOMY is correlated negatively with occurrence of UC

PATHOPHYSIOLOGY
Due to causes

• Inflammation spreads up the rectum, colon and continuous pattern.
• Mucosa of colon hyperaemic and oedematous
• Multiple abscess and ulceration
• Destroy mucosal bleeding epithelium causing bleeding and diarrhoea.
• Granulation of tissue develops and mucosa becomes thickened, shortening in colon.
• Stricture of colon
• Permanently contracted colon (pipe stem colon)
• In between ulcers, epithelial thickening occurs which appears like polyps.

PSEUDOPOLYPS

MICROSCOPICALLY
The disease can be diagnosed through biopsies

The earliest lesion starts in the bases of crypts of lieberkuhn, where neutrophils pass between the lining cells to accumulate inside the crypt lumen forming CRYPT ABSCESSES, along with eosinophils, serum and red blood cells.

These crypt abscesses ultimately rupture through the mucosal surface forming tiny ulcers or may rupture in to the submucosa

Gradually more and more crypts of Lieberkühn are affected and producing bigger ulcers.

As the disease becomes chronic, lymphocytes, plasma cells and macrophages infiltrate both mucosa and submucosa.

PSEUDOPOLYP

CLASSIFICATION

1. ULCERATIVE PROCTITIS
2. PROCTOSIGMOIDITIS
3. LEFT SIDED COLITIS
4. EXTENSIVE COLITIS
5. PANCOLITIS

1.ULCERATIVE PROCTITIS

Inflammation is confined to the area closest to the anus(rectum) and bleeding per rectum may be the only sign of the disease.

2.PROCTOSIGMOIDITIS

• Inflammation involving the rectum and sigmoid colon – lower end of the colon
• Signs and symptoms include bloody diarrhoea, abdominal cramps, pain and tenesmus.

3.LEFT SIDED COLITIS

• Inflammation extends from the rectum up through the sigmoid and descending colon.
• Signs and symptoms include bloody diarrhoea, abdominal cramps, pain on left side, urging to defecate.

4.EXTENSIVE COLITIS

Involvement extending proximal to the splenic flexure

5.PANCOLITIS

• Universal colitis
• This type often affects the entire colon and causes bouts of bloody diarrhoea that may be severe.
• Abdominal cramps and pain, fatigue, and significant weight loss.

CLINICAL FEATURES:
UC can be divided in to 3 forms according to its clinical features.

• CHRONIC AND CONTINOUS
• CHRONIC-RELAPSING-REMITTING
• ACUTE FULMINANT

1.CHRONIC AND CONTINUOUS

• The onset is usually gradual in this case.
• DIARRHOEA gradually becomes worse for a considerable period
• LOWER ABDOMINAL CRAMPS almost always present in the earlier phases and when the bowel becomes thickened and shortened, cramping is less marked.
• Cramping is followed by urgency, tenesmus and painful passage of small watery stool consisting of mucus, blood and pus.
• Later cramping may not be present to warn of impending defaecation.
• At this stage defaecation occurs unexpectedly and patient becomes insecure
• Gradually there is weight loss and malnutrition.

2.CHRONIC-RELAPSING-REMITTING

• This is the commonest form seen in UC
• The course is variable and characterised by almost unpredictable exacerbations and remissions.
• Recurrences are associated with emotional stress and other acute illness and in women during menstruation and pregnancy.
• BLOODY DIARRHOEA is the predominant symptom occur during relapses.
• Diarrhoea and abdominal pain same as of chronic but only difference is that in remitting stage patient is almost free from disease.

3.ACUTE FULMINANT

• UNRELENTING DIARRHOEA preceded by lower abdominal cramps takes place DAY & NIGHT.
• TENESMUS AND URGENCY are marked.
• NO OF STOOLS are about 30-40 per day consisting of watery, mucus, blood and pus
• Systemic toxicity is the main feature of this type.
• FEVER goes up to 39-40c
• Extreme dehydration. Hypocalcaemia, anaemia, hypoproteinaemia, weight loss.
• Colonic PERFORATION, HAEMORRHAGE, AND TOXIC MEGACOLON always threaten this condition.

SIGNS

• Pallor may be evident
• Mild abdominal tenderness most localized in the hypogastrium or left lower quadrant.
• PR examination may disclose visible red blood.
• Signs of malnutrition
• Severe tenderness, fever, tachycardia suggests fulminant type.

DIFFERENTIAL DIAGNOSIS

• Crohn’s colitis
• Infectious colitis
• Ischaemic colitis
• Diversion colitis
• Segmental colitis
• Git malignancies
• IBS

INVESTIGATIONS

CBC – leucocytosis, anaemia, thrombocytosis

CMP – hypoalbuminemia, hypokalaemia, hypomagnesemia, elevated ALP >  125 U/L suggests PSC

INFLAMMATORY MARKERS – ESR & CRP correlates with disease activity.

OTHER INFLAMMATORY MARKERS –

FECAL CALPROTECTIN – can also be used to determine mucosal healing 3-6 months treatment after initiation.

Fecal lactoferrin and alpha-1-antitrypsin studies are used to exclude intestinal inflammation.

STOOL ASSAYS – used to exclude other causes and to rule out infectious enterocolitis.

Tests include-

• evaluation of fecal blood or leucocytes
• ova and parasite studies
• viral studies
• culture and bacterial pathogens
• clostridium difficile titer

SEROLOGICAL STUDIES-

• P ANCA
• m/c associated serological markers
• positive in 60-80% of patients
• helpful in predicting disease activity
• associated with an earlier need for surgery

COLONOSCOPY/ SIGMOIDOSCOPY

GROSS FINDINGS

• Abnormal erythematous mucosa with or without ulceration extending continuously from the rectum to a part or all of the colon
• Contact bleeding may also be observed with mucus identified in the lumen of bowel
• PSEUDOPOLYPS in patients with long standing disease.

IMAGING STUDIES

• Plain abdominal x-ray
• Useful predominantly in patients with severe fulminant colitis
• IMAGES MAY SHOW-
• Colonic dilatation with loss of haustral markings suggesting toxic megacolon.
• Evidence of perforation, obstruction or ileus.

BARIUM ENEMA

• It can be used for detecting active ulcerative disease, polyps or masses.
• The colon typically appears granular and shortened.

CT

• Helpful in diagnosing acute diverticulitis.
• Associated pericolic abscess
• To protect against perforation or peritonitis

COMPLICATIONS

• SEVERE HAEMORRHAGE
• TOXIC MEGACOLON
• COLORECTAL CANCER
• EXTRAINTESTINAL COMPLICATIONS
• POUCHITIS

TREATMENT:

CONSERVATIVE

SURGICAL

GENERAL MEASURES:

• Relieving pain
• Maintaining fluid intake
• Maintaining optimal nutrition
• Treatment of anaemia – Iron Supplements For Chronic Bleeding.
• Promoting rest
• Reducing anxiety
• Preventing skin breakdown
• Monitoring complications

SURGICAL INTERVENTION:

• LAPROSCOPIC APPROACH
• PROCTOCOLECTOMY AND CREATION OF IPAA-ILEAL POUCH ANAL ANOSTOMOSIS
• PROCTOCOLECTOMY WITH END ILEOSTOMY
• PROCTOCOLECTOMY WITH CONTINENT ILEOSTOMY

SURGERY IN ULCERATIVE COLITIS  WHY & WHEN?

• Uncontrollable colonic haemorrhage
• Failure to control severe attacks or toxic megacolon
• Colonic perforation
• Chronic symptoms despite of medical therapy
• Medications side effects without disease control
• Dysplasia or cancer
• Growth retardation

HOW CAN HOMOEOPATHIC TREATMENT HELP IN MANAGING ULCERATIVE COLITIS ?

• Homeopathy is extremely effective in treating Chronic Ulcerative colitis.
• Homeopathy helps in addressing the underlying pathology of Ulcerative Colitis. It helps in correcting the immune system which is responsible for ulcer formations in the intestinal tract. Hence, the homeopathic treatment targets the root cause of Ulcerative Colitis as well as its symptoms.
• Dependency on conventional medications can be tapered off gradually and may also be stopped eventually. Hence, homeopathy also helps keep the patient safe from long term side-effects of conventional medications.
• Homeopathic treatment is absolutely safe and free from side effects.
• Homeopathy helps in reducing the severity, frequency, and recurrence of Ulcerative Colitis, thereby, providing a long-term solution.
• Surgery can be avoided if timely homeopathic treatment is taken in the case of Ulcerative Colitis. Early cases of Ulcerative colitis show better improvement with homeopathy compared to the ones in the later stages.

COMMON HOMEOPATHIC REMEDIES FOR ULCERATIVE COLITIS

Mercurius Solubilis, Arsenicum Album, Carcinosin, Kali Bichromatum, Magnesium, Muriaticum, and Kali carbonicum are some of the few homeopathic remedies used for Ulcerative Colitis Treatment.

1.MERCURIUS SOLUBILIS (MERCURY):

• This remedy for treatment for ulcerative colitis benefits individuals with symptoms of tenesmus- a frequent desire to evacuate the bowels associated with profuse diarrhoea with mucus and blood. The patient does complain of pain in the abdomen, cramps, and a feeling of incomplete evacuation of stool.
• There is excessive mucus discharge along with stool which can be slimy or stringy in nature. Some individuals do suffer from fever along with chills and sweating.
• The symptoms of ulcerative colitis like diarrhea and pain worsen at night, Merc sol is indicated. Individuals requiring Merc sol feel fatigued and debilitated due to ongoing ulcerative colitis symptoms.
• The characteristic indication for this homeopathic medicine for ulcerative colitis is increased thirst, especially for cold drinks, this remedy is well suited.

2.ARGENTUM NITRICUM:

• It helps in treating patients who suffer from ulcerative colitis, diarrhoea , excessive formation of gas and anxiety.

3.PHOSPHORUS:

• This is suggested to the patients who suffer from diarrhoea and pass blood in the stools but pain is not experienced.
• It is given to the patients who are emotionally weak.

4. ARSENICUM ALBUM:

• Arsenicum album may be indicated in cases of Ulcerative colitis when there is profound weakness and exhaustion due to recurrent diarrhoea, especially after passing stools.
• There is a burning sensation in the abdomen and rectum.
• The pain could be severe with the sensation of heat all over the body.
• The stools are watery, foul smelling with burning pain.
• Arsenicum album is indicated in people who feel anxious and restless and have a lot of fear of health. When Arsenicum album is displayed, individuals may present with a distinct thirst pattern, preferring to consume small sips of water at frequent intervals.

5. CARCINOSINUM:

• Carcinosinum may be considered in cases of Ulcerative colitis when it is developed or symptoms of ulcerative colitis are worsened after suppressed emotions, especially resentment, anger, and grief—this homeopathic medicine for colitis targets to address the physical symptoms as well as the emotional imbalances.
• Carcinosinum is often considered when one experiences physical as well as mental exhaustion due to chronic ulcerative colitis symptoms.
• It is often indicated when the symptoms are persistent and not responding well to conventional treatments and also if there is a history of cancer in the family.
• In homeopathic practice, familial predispositions and genetic tendencies are often integral to remedy selection.

6. KALI BICHROMATUM:

• Ulcerative colitis homeopathy treatment, Kali Bichromatum is indicated when the stools are slimy, stringy, and difficult to pass.
• The stool is loose mixed with mucus and blood.
• The presence of ulcers causes pain and discomfort and may cause soreness, especially in the sigmoid colon region.
• Individuals who need kali bichromatum may experience worsening of symptoms in the morning.

7. MAGNESIUM MURIATICUM:

• It is indicated for ulcerative colitis with burning pain in the abdomen.
• Stools are watery with burning sensations.
• The patient does feel weak and exhausted, especially after passing stools.
• Individuals who require Magnesium muriaticum are chilly and feel better from warmth.

8.MURIATICUM ACIDUM:

• Individuals requiring Muriaticum acidum show symptoms of profuse, watery diarrhea and stools that are foul-smelling with blood.
• There may be a sensation of burning in the rectum and feels better from warm applications and worse from cold.

9.KALI CARBONICUM:

• Kali carb is useful for individuals who suffer from cutting pain in the abdomen because of ulcerative colitis.
• The stools are bloody, slimy, and offensive.
• The individuals who benefit from kali carb feel weak and exhausted particularly in the morning.

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Namith S Thontadarya – UG Scholar
Dr. Pavankumar R Kollurkar – PG Scholar
Father Muller Homoeopathic Medical College
Deralakatte, Mangalore -575018