Ulcerative Colitis
Ulcerative colitis is a chronic inflammation of the colon causing bleeding and infected ulcers in the lining of the colon. The resulting symptoms include abdominal pain, diarrhea and blood in stools. Qualified medical attention is essential. Medicines can control the symptoms, treat complications and help prevent attacks if the condition is still mild. In other cases, surgery may be required.
Ulcerative colitis together with Chrohn’s disease is often referred to as inflammatory bowel disease (IBD), which affects up to 2 million people in the United States.
Susceptibility to ulcerative colitis can run in families (genetic factors) but the actual cause of the condition is unknown.
Signs and Symptoms of Ulcerative Colitis
The usual symptoms include:
- Persistent or recurrent diarrhea
- Abdominal pain
- Fever
The above symptoms are typical of many diseases and disorders of the colon, however.
Other symptoms include:
- Fatigue
- Loss of appetite
- Weight loss
- Joint pains
- Reddening or inflammation of the eye
- Skin lesions
- Sores inside the mouth
The precise causes of ulcerative colitis are unknown, though genetic and environmental factors seem to be the main causes.
People most at risk are characterized by:
- Family history of the condition, particularly in the immediate family.
- Ashkenazi Jewish ancestry
- Smoking or former smoking
When to See a Doctor
You need to consult your doctor immediately if you experience
- Cramping,
- Abdominal pain,
- Diarrhea with blood,
- Headache,
- Fever and/or
- Rash.
If diagnosed with ulcerative colitis, you are likely to be referred to an experienced gastroenterologist (a medically qualified specialist in diseases and disorders of the digestive system), preferably one certified by the Board of Internal Medicine. If surgery is being considered, you may be referred to a colon and rectal surgeon for evaluation.
Before submitting to surgery, investigate the experience and track record of the surgeon and of the relevant hospital. Find and choose the best option.
A cancer screening within 8 years of the onset of ulcerative colitis is advisable.
Screening and Diagnosis
Your doctor may refer you to a gastroenterologist (a medically qualified specialist in diseases and disorders of the digestive system) for further diagnosis1. The gastroenterologist examines your medical history, physical condition and performs various tests to rule out conditions with similar symptoms:
- Acute appendicitis
- Bowel cancer
- Crohn's disease
- Diverticulitis
- Intestinal inflammation
- Intestinal parasites
- or other conditions
Tests used to aid diagnosis may include some of the following :
Computed tomography (CT) scan uses X-rays to make detailed pictures of structures inside the body.
Gastroscopy employs a thin, flexible tubular optical probe with a light that is passed through the mouth, the esophagus and into the stomach and intestine, allowing the doctor to see the lining of the intestines.
Ultrasound scan uses sound waves to create a picture of the body’s internal organs.
Blood tests. An anaemic condition may be an important indication of a serious illness. The basic laboratory test for diagnosing anemia is to establish the number of red blood cells and their appearance (morphology).
Erythrocyte sedimentation rate is a measure of the settling of red blood cells in a tube of blood during one hour. This rate may indicate inflammation, disease or tissue damage.
Thyroid tests. The thyroid gland uses iodine absorbed from food to make two hormones, thyroxine and triiodothyronine. The thyroid gland stores these hormones and releases them when needed. Thyroid hormone blood tests include:
The thyroid-stimulating hormone (TSH) test measures the amount of TSH in the blood and doctors consider it to be the most reliable way to find a thyroid problem. If the TSH test yields abnormal results, your gastroenterologist must then test for thyroxine and triiodothyronine.
The thyroid antibodies test measures the presence of antibodies in thyroid tissue. Antibodies may mean that you have an autoimmune disease such as Hashimoto's thyroiditis or Graves' disease.
The thyroxine-binding globulin (TBG) test is not performed often. It measures the amount of TBG protein in the blood.
Other thyroid tests include a thyroid scan, an ultrasound and a thyroid biopsy.
Fecal occult blood test checks for blood hidden in a sample of faecal matter. Any blood found can then be analyzed.
Colonoscopy (sigmoidoscopy) involves passing a thin, flexible tubular optical probe with a light through the rectum and into the colon, allowing the doctor to see the lining of the colon.
Barium enema is an x-ray examination of the colon after it has been distended with a solution containing barium. You should consult your doctor regarding any safety worries you might have about the test, particularly if you might be pregnant.
Lactose intolerance test. Lactose intolerance is the inability to digest lactose (the predominant sugar in milk). If lactose remains undigested, it ferments in the large intestine causing abdominal pain, bloating and diarrhea.
There are 3 main lactose intolerance tests: lactose tolerance, hydrogen breath, and stool acidity. The lactose tolerance and hydrogen breath tests must not be given to infants younger than 6 months of age.
Important: You must tell your doctor if you are diabetic or hypoglycaemic.
Your doctor may apply some or all of the tests mentioned above. Much will depend on your medical history.
Treatment of Ulcerative Colitis
Ulcerative Colitis treatment depends upon the severity of the condition. For mild cases, controlling symptoms with various medications may suffice. Treatment aims to
- End acute attacks,
- Relieve symptoms,
- Treat complications and to
- Inhibit new attacks.
In addition. nutritional supplements and changes in diet may be recommended.
The risks involved with drug treatments are small but potentially unpleasant. For this reason many people look to natural remedies for gentle treatment of the symptoms of mild ulcerative colitis. Do not attempt self diagnosis. Consult your doctor concerning any such home treatment.
Severe cases require surgery.
Surgery
Surgery usually removes the threat of the spread of the disease or of the onset of cancer. As with any treatment, surgery involves some risk, depending partly on your condition and medical history.
Before seeing a surgeon, investigation of the surgeon's experience and track record and of the relevant hospital is advisable. Choose your best available options.
Because the cause is still unknown, you cannot prevent ulcerative colitis.
Certain medications may reduce the frequency of acute attacks and aid in keeping the disease in remission, however.
Self-Care
Herbal Treatments
Important: Tell your doctor if you are taking or intend to take any herbal products1 and follow your doctor’s recommendations2. Read the instructions on the package and be advised by your doctor regarding dosage.
Consult your doctor concerning :
- Allergies
- Possible interactions with medications
- Pregnancy and breast feeding
- Pharmaceutical alternatives
"The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects."
Consult a qualified herbalist concerning the quality of particular herbal products.
Listed below are the most important herbs for the treatment of mild ulcerative colitis symptoms.
Marshmallow Root (Althaea officinalis)
This is not the chewy white confection consumed at bonfires. The root of the herb Marshmallow (Althaea officinalis) gently soothes the digestive tract’s mucous membranes.
Liquorice (Glycyrrhiza glabra)
Liquorice is an important herb in the treatment of ulcers and consequently may reduce ulcerative colitis symptoms.
Chamomile (Matricaria recutita)
Chamomiile tea to helps digestion, relieves stress, decreases intestinal muscle spasms and reduces flatulence.
St. John’s Wort (Hypericum perforatum)
St. John’s Wort soothes anxiety, lifts depression, increases energy levels, improves appetite and has antiviral properties.
Astragalus (Astragalus membranaceus)
This invigorating herb improves stamina and possesses anti-bacterial and anti-viral properties.
Bibliography
Clark M, Colombel JF, Feagan BC, Fedorak RN, Hanauer SB, Kamm MA, et al. American gastroenterological association consensus development conference on the use of biologics in the treatment of inflammatory bowel disease, June 21-23, 2006. Gastroenterology. 2007 Jul;133(1):312-39.
Cornish J, Tan E, Teare J, Teoh TG, Rai R, Clark SK, et al. A meta-analysis on the influence of inflammatory bowel disease on pregnancy. Gut. 2007 Jun;56(6):830-7. Epub 2006 Dec 21.
Duerr RH, Taylor KD, Brant SR, Rioux JD, Silverberg MS, Daly MJ, et al. A genome-wide association study identifies IL23R as an inflammatory bowel disease gene. Science. 2006 Dec 1;314(5804):1461-3. Epub 2006 Oct 26.
Fischbach F. T., Dunning M.B. (2004) Manual of Laboratory and Diagnostic Tests, Philadelphia: Lippincott Williams and Wilkins. (III, eds.) 7th ed.
Lawson MM, Thomas AG, Akobeng AK. Tumour necrosis factor alpha blocking agents for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2006 Jul 19;3:CD005112.
Pagana K.D., Pagana T.J. (2006). Mosby’s Manual of Diagnostic and Laboratory Tests, St. Louis, Mosby. 3rd ed.
Rodemann JF, Dubberke ER, Reske KA, Seo da H, Stone CD. Incidence of Clostridium difficile infection in inflammatory bowel disease. Clin Gastroenterol Hepatol. 2007 Mar;5(3):339-44.
Links
Ulcerative Colitis
http://digestive.niddk.nih.gov/ddiseases/pubs/colitis/
CCFA.org: About Ulcerative Colitis & Proctitis
http://www.ccfa.org/info/about/ucp
Ulcerative Colitis Causes, Symptoms, Diagnosis, and Treatment by MedicineNet.com
http://www.medicinenet.com/ulcerative_colitis/article.htm
Ulcerative Colitis-Topic Overview
http://www.webmd.com/ibd-crohns-disease/colitis-guide/ulcerative-colitis-topic-overview
MedlinePlus: Ulcerative Colitis
http://www.nlm.nih.gov/medlineplus/ulcerativecolitis.html
Ulcerative colitis - MayoClinic.com
http://www.mayoclinic.com/health/ulcerative-colitis/DS00598
Abdomen: The space between the chest and pelvis containing the stomach, appendix, colon, rectum, kidneys, bladder gallbladder, spleen, liver and pancreas. [RETURN]
Acute: Sudden onset of a disease lasting a short time. [RETURN]
Anemia: Too few red blood cells to carry sufficient oxygen to other cells in the body. [RETURN]
Crohn’s disease: A chronic inflammatory bowel disease primarily of the small and large intestine. [RETURN]
Chronic: Persistent and long-lasting. [RETURN]
Colon: The part of the large intestine extending from the cecum to the rectum. [RETURN]
Complication: Unfavorable evolution or development of a disease. [RETURN]
Cramp: An involuntary forceful muscular spasm (contraction) that does not relax immediately. [RETURN]
Diarrhea: The opposite of constipation. Unusually frequent or liquid bowel movements. [RETURN]
Erythrocyte: Red blood cell. [RETURN]
Esophagus: The muscular tube between the pharynx at the back of the mouth and the stomach that passes food by muscular (swallowing) action. [RETURN]
Fecal: Refers to feces (stool). [RETURN]
Gastroenterologist: A doctor specializing in disorders of the gastrointestinal tract. [RETURN]
Inflammation: A type of nonspecific immune response by the body reacting to infection, irritation or injury. Characterized by redness, swelling and pain. [RETURN]
Intestine: The tube consisting of the small and large intestines extending from the stomach to the anus. [RETURN]
Lesion: A localized area of diseased or disordered tissue. [RETURN]
Rectum: The final portion of the large intestine, storing feces until discharge through the anus. [RETURN]
Stool: Vernacular for fecal matter (excrement). [RETURN]
Thyroid: A gland located beneath the voice box (larynx) that produces thyroid hormone. The thyroid helps regulate growth and metabolism. [RETURN]
Ulcerative colitis: A disease causing ulcers in the lining of the rectum and colon. It is one of a group of diseases called inflammatory bowel disease. [RETURN]
Ulcer: Corrosion of the lining of the stomach, duodenum, or esophagus. [RETURN]
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