Diagnostic and Treatment Methods for Ulcerative Colitis and Colitis-Associated Cancer: Natural Agents Therapy for Ulcerative Colitis – Elucidating the Mechanism of Action

1.1 Inflammatory Bowel Diseases (IBD) an Overview

Inflammatory bowel diseases (IBD) comprising of ulcerative colitis (UC) and Crohn's disease (CD) are severe chronic diseases affecting millions of people all over the globe with an increasing rate of incidence and have become more prevalent in the modern society (Molodecky et al., 2012). Earlier in the ancient times there are reports by physicians that people suffered from chronic diarrhea dating back to Greek antiquity. During 4^th Century BCE, Greek physician Hippocrates reported about patients suffered from diarrhea with symptoms of bloody, mucus-streaked stools (Tulchinsky, Hawley, & Nicholls, 2003). The Canon of Internal Medicine of ancient Chinese medicine described indications (abdominal pain, diarrhea, rectal bleeding) of a disease having resemblance like ulcerative colitis in Chinese population. In the first century CE, popular Roman physicians Aretaeus and Soranus reported about chronic diarrhea with bloody stools and an ulcerated bowel with a “distinct foul odour”, with high incidence in female population than male (Kornbluth & Sachar, 2010). Similarly, Prince Charles (1745) of England suffered from ulcerative colitis and adopted a diet free of milk to avoid the complications of UC (G. et al., 2014). Though reports of disease similar to UC were reported from a long time in literature, it was not termed as a distinct disease earlier to 1875.

In medical literature, the term ulcerative colitis was first reported in 1875 by two English physicians, Sir Samuel Wilks and Walter Moxon. Surprisingly for the first instance, they achieved to distinguish UC from other diarrheal diseases caused by pathogenic microbes from their case study conducted on a young woman who lost her life due to severe bloody diarrhea and her autopsy reports revealed ulceration and inflammation of the intestinal mucosa (Kirsner, 2001). Several reports of UC started to come from all over the regions of the world following the decades after 1909 and the UC was the major disease discussed at the Paris Congress of Medicine (1913).

1.2. Epidemiology of Inflammatory Bowel Disease

The prevalence of IBD has been in an alarming increase in developed nations since the mid of the 20th century, predominantly in the populations that adopted rapid changes in diet, hygiene and economy (Bager et al., 2012). Interestingly, when a new group of population is identified with inflammatory bowel disease, ulcerative colitis always precedes Crohn’s disease and has a higher rate of incidence. The prevalence of IBD is found to be least in the populations of continental Asia when compared to populations from western developed nations that have the highest incidence and prevalence of IBD. It is evident that the high prevalence of IBD in westernized environment is highly linked to the lifestyle attributes, which is associated with smoking, dietary content high in sugar and fat, frequent intake of medications having more side effects, mental stress, and high socioeconomic status (Danese & Fiocchi, 2006). Based on an article published in 2018 by Jobson Medical Information LLC, in United States the prevalence of CD was around 3.1 to 14.6 cases per 100,000 people annually and the incidence of UC was approximately 201 cases per 100,000 adults.