Ülseratif Kolit
Özet
Ülseratif kolit, kolonun mukozal tabakasıyla sınırlı, rektumdan başlayarak proksimale kesintisiz uzanım gösteren, alevlenme ve iyileşme ataklarıyla seyreden kronik inflamatuar bir barsak hastalığıdır. Hastalığın etyopatogenezi tam olarak bilinmemekle birlikte; genetik olarak yatkın bireylerde immunolojik ve çevresel faktörlerin tetiklediği barsak inflamasyonu sonucunda geliştiği kabul edilmektedir. En yüksek insidans ve prevalansı Kuzey Avrupa ile Kuzey Amerika'da görülen hastalık, yetişkinlerde Crohn hastalığına kıyasla daha sık izlenir. Temel klinik semptomu mukuslu veya kanlı ishal olup, süreç içerisinde halsizlik, karın ağrısı ve çeşitli ekstraintestinal bulgular da eşlik edebilir. Tanı, kronik ishal varlığında klinik değerlendirme, laboratuvar testleri, endoskopik ve histopatolojik incelemelerle diğer kolit nedenlerinin dışlanmasıyla konur. Tedavi yaklaşımı, hastalığın yaygınlığına ve ciddiyetine (hafif, orta, ağır) göre değişkenlik göstererek; 5-ASA, lokal/sistemik steroidler, immün modülatörler ve anti-TNF biyolojik ajanları içerir. Medikal tedaviye dirençli olgularda veya displazi/kanser gelişimi gibi komplikasyonlarda total kolektomi küratif bir seçenek olarak uygulanır. Yaşam boyu süren bu hastalıkta mortalite genel popülasyondan yüksek olmasa da toksik megakolon ve uzun vadede artan kolorektal kanser riski yakından takip edilmelidir.
Ulcerative colitis is a chronic inflammatory bowel disease confined to the mucosal layer of the colon, typically presenting with alternating periods of relapse and remission while initiating in the rectum and extending proximally. Although its exact etiopathogenesis remains unknown, it is considered to develop from intestinal inflammation triggered by immunological and environmental factors in genetically susceptible individuals. The highest incidence and prevalence are observed in Northern Europe and North America, and it affects adults more frequently than Crohn's disease. The primary clinical symptom is bloody diarrhea with or without mucus, which can be accompanied by abdominal pain, fatigue, and various extraintestinal manifestations. Diagnosis is established based on clinical assessment, laboratory tests, and endoscopic and histopathological findings showing active inflammation during chronic diarrhea while excluding other causes of colitis. Medical management is tailored to the disease extent and severity, incorporating 5-ASA, topical or systemic steroids, immunomodulators, and biological anti-TNF agents. Surgical intervention, specifically total colectomy, serves as a curative option for patients with medically refractory disease or complications like dysplasia and carcinoma. While mortality is not higher than the general population, toxic megacolon and increased long-term colorectal cancer risks necessitate careful surveillance.
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