Recently, Japanese Prime Minister Shinzo Abe announced his resignation due to a recurrence of ulcerative colitis. Diagnosed at age 17, Abe has lived with the condition for nearly 50 years without a cure.
Is ulcerative colitis truly an "incurable disease"? Professor Wang Lingyun from the Department of Gastroenterology at Sun Yat-sen Memorial Hospital, Sun Yat-sen University, explains that while ulcerative colitis is a chronic condition with a prolonged course, it is not a terrifying affliction. With strict adherence to specialist guidance, consistent medication, and regular follow-ups, most patients achieve favorable outcomes.
Ulcerative colitis is difficult to diagnose and is often confused with these conditions
Ulcerative colitis (UC) is a chronic inflammatory bowel disease of unknown cause. Its onset is thought to be associated with multiple factors including environmental influences, genetics, gut microbiota, and immune imbalance.Patients typically experience persistent or recurrent diarrhea, abdominal pain, and mucus-containing bloody stools. Some may develop systemic symptoms like severe anemia, hypoalbuminemia, weight loss, or fever. Extracolonic manifestations may include peripheral arthritis or recurrent oral ulcers.
Professor Wang Lingyun explains that ulcerative colitis lacks a definitive diagnostic standard. Diagnosis typically requires comprehensive systemic and local investigations, including hematological tests, imaging studies (CT/MRI), endoscopic examinations (gastroscopy, colonoscopy, capsule endoscopy), histopathological analysis, and microbiological testing. Diagnosis is made by integrating recurrent or persistent symptoms such as diarrhea, abdominal pain, and bloody mucus-containing stools,along with typical endoscopic findings and pathology. This process involves ruling out other conditions with similar clinical presentations, such as infectious colitis, Crohn's disease, ischemic bowel disease, radiation enteropathy, and colorectal cancer. Occasionally, even after thorough and detailed examinations, a definitive diagnosis remains elusive, necessitating prolonged follow-up observation for confirmation.
Neglecting healthy eating habits may lead to ulcerative colitis
Ulcerative colitis was previously more prevalent in Western developed countries like Europe and North America, with relatively low incidence and rarity in China. However, changes in diet, lifestyle, and environment have led to a steady increase in its prevalence across Asia and China, making it a common digestive disorder.Limited domestic epidemiological data indicates significant regional variations in ulcerative colitis incidence, which correlates positively with local economic development levels.
Professor Wang Lingyun notes that current Chinese data shows the peak age of onset is 20–49 years, though it can also affect children or the elderly, with no significant gender difference.In Western countries, studies indicate that excessive intake of animal protein, linoleic acid, sugar, fat, and alcohol increases the risk and recurrence of ulcerative colitis. Reduced dietary fiber intake, along with increased consumption of processed foods and saturated fatty acids, is associated with ulcerative colitis. Conversely, increasing intake of vegetables, fruits, and high-fiber foods can reduce the risk and progression of the disease.Additionally, temperature fluctuations and negative emotions (depression, pessimism) may also contribute to ulcerative colitis recurrence. Low-intensity aerobic exercise can improve intestinal inflammatory responses in remission patients and reduce relapse.
Patients with ulcerative colitis often experience malnutrition, which hinders disease remission. Given the close relationship between ulcerative colitis and diet, patients should place high importance on daily nutrition. A diet low in fat, high in dietary fiber and vitamins, and moderate in high-quality protein is recommended. Avoid seafood, dairy products, supplements like ginseng and deer antler, as well as highly irritating or difficult-to-digest foods.
A disease duration exceeding 20 years increases the risk of colon cancer by 10-15 times!
Professor Wang Lingyun notes that ulcerative colitis is a chronic condition. Most patients experience recurrent flare-ups and require long-term medication to maintain remission. Inappropriate diet, infections, and negative emotions may trigger relapse or exacerbation. Patients with mild disease or sustained remission generally have a favorable prognosis.Medical management is the first-line treatment for ulcerative colitis. Surgery is indicated for patients unresponsive to medical therapy, those with severe complications like massive bleeding, intestinal perforation, toxic megacolon, or those at risk of cancerous transformation. After controlling acute flare-ups, physicians tailor maintenance regimens based on individual patient conditions. The duration of maintenance therapy depends on the specific disease status but generally lasts no less than 4 years.
Regarding disease extent, extensive colon involvement carries the highest risk of malignancy, followed by left-sided colitis. In terms of onset age and disease duration, patients with early-onset disease (before age 20) and prolonged disease duration (over 8 years) exhibit significantly increased cancer risk.Data indicates that patients with a disease duration exceeding 20 years face a 10-15 times higher risk of developing colorectal cancer compared to the general population. Therefore, it is recommended that patients with extensive colitis for 8-10 years and those with left-sided colitis for over 15 years undergo surveillance colonoscopy every two years.Additionally, patients with ulcerative colitis complicated by primary sclerosing cholangitis exhibit markedly elevated cancer risk and significantly earlier onset of malignancy. Enhanced colorectal cancer screening is crucial for this population.The peak age for ulcerative colitis coincides with the peak childbearing years, creating a dilemma between treatment and fertility for many patients. During disease flare-ups, infertility rates increase, the risk of adverse pregnancy outcomes rises, and medication safety decreases. Therefore, conceiving during active disease is not recommended. However, patients in remission show no significant difference in fertility compared to the general population and may choose to conceive under specialist guidance.
Professor Wang Lingyun cautions that MTX (methotrexate) and thalidomide have established teratogenic effects and should be avoided during family planning. It is recommended to discontinue these medications 3-6 months prior to conception. Regarding biologics, extensive research on infliximab (IFX) generally indicates its safety for use during female preconception planning.For those experiencing unplanned pregnancies, discontinuing medication due to concerns about drug side effects is not advised. Adverse pregnancy outcomes resulting from active disease or disease progression far exceed those caused by most medications themselves. Therefore, developing a medication plan under specialist guidance is recommended.