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Ulcerative Colitis (UC) is an inflammatory bowel disease (IBD) that causes long-lasting inflammation in the part of the digestive tract affecting that affects the innermost lining, also known as the mucosa of the large intestine (colon) and rectum. As a result, the mucosa erodes and forms ulcers, which bleed and produce pus. The resulting ulcers and inflammation then cause frequent, urgent, and often loose bowel movements. According to the National Digestive Diseases Information Clearinghouse, UC can occur in people of any age. However, it usually develops between the ages of 15 and 30 and between the ages of 60 to 80. The disease affects men and women equally. People with a family member or first-degree relative with an IBD are at higher risk for developing UC, as are Caucasians and Ashkenazi Jews (of Eastern European descent). The Crohn’s and Colitis Foundation of America says that 700,000 people have the illness.
According to the Crohn’s and Colitis Foundation of America (CCFA) the cause of UC is not known. Medical experts are focusing on these factors:
According to the National Digestive Diseases Information Clearinghouse (NDDIC), UC is not caused by emotional distress, but the stress of living with UC may worsen symptoms. In addition, while sensitivity to certain foods or food products does not cause UC, it may trigger symptoms in some people.
According to the Mayo Clinic UC risk factors include:
Ulcerative colitis (UC) can be difficult to diagnose because it has symptoms similar to those of other intestinal disorders and to Crohn’s disease. The NDDIC says Crohn’s disease differs from UC in that Crohn’s disease causes inflammation deeper within the intestinal wall and can occur in other parts of the digestive system, including the small intestine, mouth, esophagus, and stomach.
Your doctor will make a diagnosis of ulcerative colitis based on the following:
During these procedures, your doctor may wish to obtain a sample of affected tissue, called a biopsy. Biopsied tissues are then sent to a laboratory to determine the presence of disease.
Most people diagnosed with UC have mild to moderate symptoms. About 10% have severe symptoms such as frequent fevers, bloody diarrhea, nausea, and severe abdominal cramps. Experts say that UC can also cause problems such as joint pain, eye irritation, kidney stones, liver disease, and osteoporosis. The exact reason for these complications isn’t known, but it may be the result of inflammation triggered by the immune system.
More common symptoms include:
UC tends to go between periods of flare-ups and periods of remission. About 10% of people have serious complications (such as perforation or massive bleeding) after their first flare-up. Approximately 10% never have another flare-up after their first one. Anywhere from 10% to 40% of patients with ulcerative colitis will require surgery to treat their disease. Surgery always involves the complete removal of the colon; partial removals are not done because the colitis will recur in the portion of the colon that remains.
Colon cancer develops in about 5% of people with UC. Risk is increased when the entire colon is affected over a period of years. According to the NDDIC, if only the lower colon and rectum are involved, the risk of cancer is no higher than that of a person without UC. Dysplasia, the accelerated growth of a concentration of abnormal cells, is often a precursor to colon cancer in patients with UC. UC patients are regularly monitored for dysplasia, and the removal of polyp growths can prevent the development of cancer in some cases.
In addition to taking medication as prescribed, there are a number of ways to help you live better with UC.
Diet is important for symptom management—though there is no one diet that either causes UC or eliminates it. But it may help to:
Stress doesn’t necessarily cause UC, but managing it may help to reduce the frequency of flare-ups. It may help to:
There are no known ways to present ulcerative colitis, and because of its relatively rare rates of occurrence, regular screening for the disease is not done across all practices. Those who visit the doctor and report experiencing any of the many symptoms of colitis may undergo diagnostic testing for the disease.
There is no known prevention for ulcerative colitis because the cause is unknown.
Even though there’s no known cure for UC, a combination of treatments including medications may be able to help you stay in control of the disease.
There are five major classes of medication used to treat ulcerative colitis:
Aminosalicylates (5-ASA) work on the level of the lining of the GI tract to decrease inflammation. A medication known as sulfasalazine (Azulfidine), combines sulfapyridine and 5-ASA, the NDDIC says. The sulfapyridine component carries the anti-inflammatory 5-ASA to the intestine. However, experts caution that sulfapyridine may lead to side effects such as nausea, vomiting, heartburn, diarrhea, and headache. 5-Asa can also be combined with other complimentary agents, such as olsalazine (Dipentum), mesalamine (Asacol, Canasa, Lialda, Rowasa), and balsalazide (Colazal), which cause fewer side effects and can be used by people who cannot take sulfasalazine. Depending on which parts of the colon and rectum are affected by UC, 5-ASAs can be given orally; through a rectal suppository, a small plug of medication inserted in the rectum; or through an enema—liquid medication put into the rectum. Unless the UC symptoms are severe, aminosalicylates are usually the first line of treatment for UC sufferers. These medications are also used when symptoms return after a period of remission.
Corticosteroids suppress the immune system and are used to treat moderate to severely active UC. Corticosteroids have a number of side effects, including weight gain, the growth of facial hair, mood swings, high blood pressure, type 2 diabetes, osteoporosis, bone fractures, glaucoma and a higher vulnerability to infections. These are usually prescribed only for patients with moderate to severe UC who haven’t responded to treatment, and aren’t for long-term use.
Immunomodulators modulate or suppress the body’s immune system response so it can no longer cause ongoing inflammation.. Immunomodulators may take several months to start working. These drugs include Azathioprine (Azasan, Imuran); mercaptopurine (Purinethol); Cyclosporine (Gengraf, Neoral, Sandimmune); infliximab (Remicade) and Adalimumab (Humira).
Antibiotics may be used when infections such as abscesses occur.
Anti-diarrheals. For severe diarrhea, loperamide (Imodium) may be effective. Use anti-diarrheal medications with great caution, however, because they increase the risk of toxic megacolon (a widening of the colon) that can cause septic shock and ultimately lead to perforation of the colon.
Pain relievers. For mild pain, your doctor may recommend acetaminophen (Tylenol, others). However, experts advise against using ibuprofen (Advil, Motrin, others), naproxen (Aleve) or aspirin. All these are likely to make symptoms worse.
Biologic therapies, also known as anti-TNF agents, are the latest class of therapy. Tumor necrosis factor (TNF) is a chemical produced by our bodies to cause inflammation. Antibodies are proteins produced to attach to these chemicals and allow the body to destroy the chemical and reduce the inflammation.
Surgery. About 25% to 33% of patients with UC are unresponsive to medical therapy or complications from treatment arise. Under these circumstances, surgery may be considered. This operation involves the removal of the colon (colectomy).
According to the National Center for Complementary and Alternative Medicine (NCCAM):
Mindfulness-based stress reduction (MBSR), a type of meditation, shows some promise as an approach to improve quality of life and decrease perceived stress in people with ulcerative colitis. These findings come from a small pilot study led by researchers at Rush University in Chicago.
Pineapple extract may help calm inflammation of the colon. The study showing the extract’s promise was funded by NCCAM, and led by researchers at Duke University.
Some dietary supplements are recommended because UC can potentially cause vitamin and mineral deficiencies, specifically:
Speak with your doctor before taking any supplements.
Though the disruptive symptoms of ulcerative colitis can be out of your control, there are things you can do to try to minimize the severity and impact of the symptoms. These include:
Call a doctor immediately if you have been diagnosed with ulcerative colitis and you have:
Based on your symptoms, your primary doctor will refer you to a gastroenterologist. This is a doctor who specializes in digestive disorders. If your condition requires a colostomy, you will be seen by a surgeon. A nutritionist or dietitian can help with a diet plan. You can also do some research of your own by visiting the website for the American Society for Gastrointestinal Endoscopy or the Society of American Gastrointestinal and Endoscopic Surgeons.
Receiving a diagnosis of ulcerative colitis can be scary. Feel free to discuss any questions you might have with your doctor. Here are some you may want to bring up:
World Crohn’s and Colitis Day is May 23rd. According to the Crohn’s and Colitis Foundation of America (CCFA) as many as 700,000 Americans may suffer with ulcerative colitis.
To get up-to-the-minute news on autoimmune diseases, including UC, sign up for a newsletter from: American Autoimmune Related Diseases Association, Inc. (AARDA).
You can get a global perspective on UC and other gastrointestinal disorders from the International Foundation for Functional Gastrointestinal Disorders (IFFGD). They also offers a library on digestive disorders.
For the latest federal statistics, studies and news about GI disorders, visit: National Institute of Diabetes, Digestive & Kidney Diseases, part of the National Institutes of Health.
If you’d like to find a good specialist in your town, or get in contact with an in-person or online support group, visit: Crohn’s and Colitis Foundation of America (CCFA).
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