INTRODUCTION:

Ulcerative colitis is an inflammatory disease in which the inner lining of the gastrointestinal tract is affected, leading to a severe condition. Ulcerative colitis can be seen in both men and women in which the men are most affected than women^1,2. Ulcerative colitis develops between 15 to 35,and it stays for 40 years. It is affected worldwide in many countries, with which Europe and USA being the most affected countries among them^3,4. The research shows that over 350,000 people have ulcerative colitis in Europe with a death toll of 130,000 in 2013, while in the USA, almost 400,000 people have ulcerative colitis with a death toll of 200,000 in 2013^4,5,6. The significant symptoms of ulcerative colitis arebloody diarrhoea, soft blood stools, abdominal pain,fatigue, mild fever, and sometimes anaemia⁷.

It is essential to identify the patients affected by UC to avoid the high risk of ulcerative colitis. UC mainly does not spread to transmission but develops in abdominal regions known as thegastrointestinal region, in which the inner lining is inflamed. Diagnosis is the only treatment for ulcerative colitis. The most used diagnosis is colonoscopy and surgery^8,9. Ulcerative colitis will develop due to our distinctive lifestyle and dietary requirements, and many countries in the world are suffering from this disease,especially developing countries.We must control and prevent the disease through proper health mad diet^10,11.

Prevalence:

Ulcerative colitis has increased in the few decades. As the number of cases of ulcerative colitis increases, it is challenging to control the disease^12.13,14. Many researchers have said that ulcerative colitis is more evident in developing countries. The mortality ratio of ulcerative colitis patients has decreased in recent years. To avoid the risk of ulcerative colitis, people should not regularly smoke, and the appendectomy^15,16,17. Appendectomy means a surgical operation in which the vermiform appendix is removed. Ulcerative colitis causes can be detected or cured at the easy stage of developing the disease^18,19,20. If Ulcerative colitis develops, this treatment is very effective and cannot be cured. Here are some measures of the rate of disease per 100000 people inEurope in recent years, as shown in (Figure-1).

Figure 1: Ulcerative colitis ratio of both sexes in Europe.

CAUSES AND RISK FACTORS^21.22

Ulcerative colitis occurs when a person's immune system makes a mistake or nor work adequately. It will first occur as a common cold in the body. White blood cells (WBC) mainly help protect against the attack on the colon's lining. This will lead to inflammation and ulcer. Genes play a significant role in this process to protect from ulcerative colitis. Some Risk factors are shown in (Table-1).

Colon cancer develops when the person's healthy cells change their DNA. The DNA cell will guide a person to do work. These cells will grow and divide, keeping the body regular for functioning. If the cell is damaged, it leads to cancerous cells,which will continue to divide if new cells are not formed. Furthermore, these cancerous cells will travel to various other body parts and be storedthere²⁹.

SYMPTOMS:

Colon cancer can occur for many years without any initial symptoms. The symptoms develop according to where the tumour's large intestine is located³⁰. The standard part of the large intestine to develop colon cancer is the right side, and this can grow in large size and become an abdominal symptomdevelop³¹. This right-side cancer may lead to Iron deficiency anaemia due to the slow loss of blood for a long time. The left colon is thinner than the right colon. Therefore, the left colon cancer cause may be cured quickly, and left colon symptoms include constipation, narrowed stools, bloody diarrhoea,and abdominal pain³². If the person has any of the above symptoms forfour weeks more, it is their responsibility to seek the doctor as soon as possible to avoid the growth of cancerous cells and leave a peaceful life³³.

Table 1: Risk Factors of Ulcerative colitis

Risk factors	Reason and Range
Age²³	Ulcerative colitis occurs between the age of 15 to 30 years old, and the duration is of 40 years
Family history²⁴	There are 35% chance of getting ulcerative colitis if the person's close family members are in the condition of ulcerative colitis.
Diet^25,26	If your food content is less in fiber, having high saturated fats and more animal protein may have chances of developing ulcerative colitis
Physical health²⁷	If the person is not maintaining the physical activity, the risk of getting ulcerative colitis will be more
Smoking²⁸	Regularly smoking and taking alcohol also increase the risk of ulcerative colitis.

Treatment:

Ulcerative colitis treatment depends on the type and stage of cancer andthe patient's age, and even physical health. There are many ulcerative colitis treatments, not a single for any cancer³⁴. The standard treatment used in ulcerative colitis issurgery, radiation therapy, and chemotherapy. This process removes the cancer cells and spreads, prevents, and reduces the symptoms(Table-2).

Prevention:

There are several methods of lifestyle to reduce the risk of getting ulcerative colitis. Here are a few measures to prevent the getting ulcerative colitis.The prevention parametersare shown in (Table-3).

Table-3 Prevention Parameters

Prevention Parameters	Methods of Lifestyle
Regular screening³⁹	A person who has had ulcerative colitis before and has crossed 50 years, had any family history, and has any symptoms should regularly go for screening to prevent getting ulcerative colitis.
Nutrition⁴⁰	To prevent ulcerative colitis, the person should regularly maintain a balanced diet plan and eat healthy food rich in fibres, some fruits, and vegetables, and red or processed meats. Moreover, patients Should not take any highly saturated fat-containing food.
Workout or yoga³⁹	It has been proved that doing workouts or exercises decreases the risk of getting ulcerative colitis and lowers the effects of ulcerative colitis.

DISCUSSION:

Ulcerative colitis is also called colon cancer or rectal cancer, which develops in the colon or rectum, and it will depend on where the cancer is started⁴⁰. Colon and rectal cancer (ulcerative colitis) can combine because they are similar and have similar symptoms. Cancer or neoplasia means developing new uncontrolled growth of cells in the body that will destroy the tissue. Cancer can develop in any part of body cells and spread to various parts of the body. The disease generally onset during young age and the chronic nature of Ulcerative colitis. The average disease duration is about 40years. Corticosteroids, amino salicylates, and immunomodulators are recommended for the treatment. The disease is more common in Caucasians than blacks, and both sexes are equally affected. Here are a few examples of how ulcerative colitis starts⁴¹.

How does ulcerative colitis start?

Growth of adenomatous polyp in ulcerative colitis and polyp will start and grow on the inner lining of the colon or rectum. Theseare called polyps. As time changes, the types of polyps also change into the cancer cell,which will depend on polyps types, but not all polyps will convert into cancer cells⁴².

The two most critical used types of polyps are:

Adenomas polyps are pre-cancerous cells, and sometimes they will change into cancer cells as time changes.Hyperplasicare not pre-cancerous cells;these are common polyps, and many people suffer from this type of polyps⁴³.

How ulcerative colitis spreads?:

If cancer is present in the form of polyps, it will grow on the inner lining walls of the colon or rectal along with time. These walls are made up of many layers of cells. If the cancer cells are present on the walls, they will develop into blood vessels or lymph vessels, and from blood vessels, they travel to closely attached lymph nodes or several body parts⁴⁴.

Where does ulcerative colitis grow?:

Many cells are used to make the organ, and that cell is used as colon or rectal. The colon and rectum cells are used to make up the large intestine. The large intestine is anessential part of the digestive system, also called the gastrointestinal system. This large intestine comprises many cells of the colon and rectal and many muscular tubers. The entry of food from the trachea to the large intestine can be done through various sections⁴⁵. The food from the mouth will enter the trachea. It will come to the stomach and transfer to the ascending loop; the undigested food from the small intestine will reach the large intestine. Then in the second section Transverse loop, the food movement will occur from the right to the left side of the stomach. In the third section Descending loop, the food will travel down from the left side of thestomach⁴⁶. In the fourth section, the Sigmoid colon is usually S-shaped in which the food falls, and it also joins the rectum and connects to the anus. The combination of ascending and transverse loops is the proximal colon, and the combination is descending and sigmoid colon, known as the distal colon⁴⁷.

What will ulcerative colitis do in the colon and rectum?:

The colon absorbs water and salts from the remaining food matter and enters the small intestine. The remaining waste matter will travel into the rectum and be stored in the body until it passes through the anus in the formof stools^48,49.

CONCLUSION:

It is the patient's responsibility to see and check with the doctor in the early stages of this disease, and it has a more remarkable ability to cure, and if it grows more or enters a higher stage, it should have to go for a very costly screening programgo for diagnosis. Many patients are going for diagnosis at the early stages, which is frequent cancer,and few patients will makea diagnosis in the advanced stages, which is not required. This ulcerative colitis disease is marked as a most apparent epidemiological and nutritional transition. There are many new treatments for ulcerative colitis. Many theories are in the process of more information about ulcerative colitis. The great researchers are studying this disease profoundly and coming up with new ideas to prevent and diagnose hope this information will recover the new treatment to control the disease. As the new theories are in progress, our responsibility is to learn and go for experiments on them and save our lives.

CONFLICT OF INTEREST:

All authors have equal contribution

ACKNOWLEDGEMENT:

We take this opportunity to express our gratitude and respectful thanks to Dr. S.N.V.L.Narasimha Raju, Honorable Chairman, The Oxford Educational Institutions Bangalore, and I want to thank Dr. Padmaa M. Paarakh, Principal, The Oxford College of Pharmacy and Bangalore.

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Received on 28.06.2021 Modified on 19.04.2022

Research J. Pharm. and Tech 2023; 16(12):6050-6054.

DOI: 10.52711/0974-360X.2023.00982

Common treatment	Purpose and rational
Body weight³⁵	If the person's body weight is more or is obese, there will be chances of getting ulcerative colitis and many cancers, so it is essential to maintain body weight.
Surgery³⁶	Colectomy means removing the affected part of the colon. The doctor or surgeon will remove the colon during this process, which contains cancer, and some closely affected area. It will remove to spreading the risk of cancer. Then they re-join the healthy portion of the colon or make a stoma. A surgical opening of the wall in the abdomen is called a stoma. A few types of surgeries are Endoscopy, laparoscopic and palliative surgery.
Chemotherapy³⁷	During this process, a cancer care team will administer the medication to avoid the division of cells, and during the process, they disrupt the protein of DNA to damage and kill the cancer cells and inhibit the rapid division of cells.
Radiation therapy³⁸	In this process, the radiation therapy will Directly kill all the cancer cells with the help of high-energy gamma rays, and in this process, a cancer care team will administer the medications externally, and the radioactive materials are brought near to site of cancer in the form of seed.