The inflammation in ulcerative colitis (UC) and ulcerative proctitis (UP) is dynamic and the extent of the colon involved can change over time. UC and UP uniformly affect the rectum (the lowest part of the colon) and the inflammation extends for a variable length upwards through the colon. Studies of UP patients suggest that the disease moves further up to involve more of the colon in about 25% of patients after diagnosis. The probability of disease extension appears to increase over time, with cumulative probabilities of extension estimated to be 20% and 55% at 5 and 10 years, respectively. Why...
A common question from patients is: "Why is it recommended that non-steroidal anti-inflammatory medications (NSAIDS), such as ibuprofen, be avoided in IBD?" While NSAIDs can serve as potent anti-inflammatory medications to treat things such as joint pains and backaches, they can have a paradoxical pro-inflammatory effect on the GI tract. The reason this happens is that the GI tract needs multiple lines of defense to protect its inner lining (think of all things the GI tract must be able to withstand - food, stomach acid, bile, medications, alcohol). One of the defense mechanisms our body uses to protect the GI...
Kevin wrote into the blog recently to share his experience with probiotics in UC: "Just wanted to mention something that really has worked for me. I have pancolitis (entire colon affected). I seem to flare up every two years and need a round of steroids to get back in remission. This last time, I flared again when I had tapered down off the prednisone a bit. For me, what finally got me off the steroids was a probiotic (live bacteria and other helpful "bugs") called Primal defense. I have been almost as colitis free as before I was diagnosed. Primal...
One of my patients recently diagnosed with UC became quite tearful during her last office visit. When I inquired what had upset her, she replied that she had been seeking information about UC on the internet and was frightened by some of the stories she read. She encountered uncensored websites with postings that did not contain medically accurate information, as well as patient stories that seemed to indicate to her that a surgery was inevitable so she should start planning now. We had a long discussion about the wide spectrum of disease severity in UC and how "you should not...
One of the more unpleasant tasks for patients undergoing colonoscopy is having to take a bowel preparation to cleanse the colon. Among the most common complaints with bowel preps are nausea, vomiting, and feeling dehydrated (fatigued, lightheaded, dizzy). Some tips on how to minimize or eliminate these problems include the following: 1) Stay well hydrated before you begin your bowel preparation. Two days before your colonoscopy, be mindful of your fluid intake and losses. The 48 hours before your test, the average adult consume at least eight 8oz glasses of fluid. The day before the procedure, it is recommended that...
While ileal pouch-anal anastomosis surgery after colectomy provides individuals with a way to maintain continuity of the GI tract for defecation, pouches are not without problems. In a previous blog, the issue of pouchitis, or inflammation of the pouch was discussed. Another pouch problem encountered by some individuals is a recently recognized condition called "irritable pouch syndrome" or IPS for short. IPS is a condition of the pouch that is akin to irritable bowel syndrome (IBS) of the intestine. Symptoms of IPS are similar to pouchitis and include: change in stool consistency, abdominal pain or cramping, and perianal or pelvic...
Many individuals with UC identify stress as a trigger for colitis flares. While the mind-body connection remains somewhat elusive, there is strong evidence to suggest that stress contributes to physiologic changes in hormones and the immune system. As such, stress reduction is beneficial for maintaining an overall healthy balance in life. Some tips and ideas for management of stress from Helpguide.org include the following: 1) Learn how to adapt to stress - Many things that happen in life are out of our control. Instead stressing out over things you cannot control, try to focus on how you can adapt and...
A common question asked by patients is whether they need to change their diet after being diagnosed with UC. As discussed in previous blogs, there is no evidence that specific foods contribute to inflammation in IBD. While there is not a "colitis diet" that individuals need to adhere to, certain foods or their components may produce symptoms of loose stools or gas. Some general considerations regarding diet for UC patients: 1) Eating smaller more frequent meals may help alleviate cramping and gas associated with larger meals. 2) Dietary fiber intake may have differential effects depending on the segment of the...
Researchers are always on the hunt for novel therapies to treat UC and Crohn's. A recent study examined the effect of rosiglitazone, a drug used for management of type II diabetes mellitus, in mild to moderately active UC. How can a diabetes drug be useful for treating UC? The receptor that the drug affects is present both in fat cells and colon cells. It is hypothesized that the drug may act on the receptors on colon cells and send signals to decrease inflammation. In this study, 105 patients with mild to moderately active UC despite current medical therapy were randomized...
UC is a chronic gastrointestinal illness that follows a course of relapsing and remitting disease. Perhaps one of the most frustrating aspects of UC for patients is the abrupt onset and unpredictability of disease flares. A recent study suggested that the risk of relapse in UC is 40%, 57%, and 67%, at 2, 5, and 10 years, respectively. While there is no crystal ball to forewarn individuals when the next flare may arise, investigators have identified some factors which may be associated with a greater risk of relapse: 1) Relapse within the first year of diagnosis. Early relapse, defined as...
