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DESCRIPTION
Ulcerative colitis and Crohn's disease are the most common types of inflammatory bowel disease (IBD). IBD is a general name for diseases that cause inflammation in the in the small intestine and colon (large intestine). The large bowel (colon) is the 5 to 6 foot segment of intestine that begins in the right-lower abdomen, extends upward and then across to the left side, and downward to the rectum. It dehydrates the liquid stool that enters it and stores the formed stool until a bowel movement occurs.
Ulcerative colitis can be difficult to diagnose because its symptoms are similar to other intestinal disorders and to Crohn's disease, another type of IBD. Ulcerative colitis affects only the colon and rectum. The colon is the part of the digestive system where waste material is stored. The rectum is the end of the colon adjacent to the anus. Crohn's disease differs because it can affect any part of the digestive tract, causing inflammation deeper within the intestinal wall and can occur in the small intestine, mouth, esophagus, and stomach.
Ulcerative colitis is a chronic disorder in which the mucous membranes lining of the colon and rectum become inflamed and develop ulcers (sores) where inflammation has killed the cells that usually line the colon, causing rectal bleeding, bloody diarrhea (inflammation causes the colon to empty frequently), abdominal pain, gas, bloating, and, at times, hard stools. Ulcerative colitis usually affects only the innermost lining of the colon and the rectum. It occurs only through continuous stretches of your colon, unlike Crohn's disease, which occurs in patches anywhere in the digestive tract and often spreads deep into the layers of affected tissues. With ulcerative colitis, the colon muscles then have to work harder to move these hardened stools through the colon. This can cause the mucous lining of the colon wall to bulge out into small pouch-like projections called diverticula. This usually occurs in the lower left section of the large intestine called the sigmoid (S-Shaped) colon, although it can occur in any part of the colon. Enteritis and ileitis are types of inflammation of the small intestine often associated with colitis.
When the inflammation occurs in the rectum and lower part of the colon (the rectum) it is called ulcerative proctitis. If the entire colon is affected it is called pancolitis (universal colitis). If only the left side of the colon is affected it is called limited or distal colitis.
Ulcerative colitis and Crohn's diseases are chronic conditions that can last years to decades. They affect approximately 500,000 to 2 million people In the United States. Men and women are affected equally. Ulcerative colitis and Crohn's disease most commonly begin during adolescence and early adulthood, but they also can begin during childhood and later in life.
Ulcerative colitis can occur in people of any age, but it usually starts between the ages of 15 and 30, and less frequently between 50 and 70 years of age. It affects men and women equally and appears to run in families, with reports of up to 20 percent of people with ulcerative colitis having a family member or relative with ulcerative colitis or Crohn's disease. It is found worldwide, but is most common in the United States, England, and northern Europe. A higher incidence of ulcerative colitis is seen in Whites and people of Jewish descent. Ulcerative colitis is rarely seen in Eastern Europe, Asia, and South America, and is rare in the black population. For unknown reasons, an increased frequency of this condition has been recently observed in developing nations.
Like Crohn's disease, ulcerative colitis can be debilitating and sometimes can lead to life-threatening complications. There is no known cure for ulcerative colitis, but therapies are available that may dramatically reduce the signs and symptoms of ulcerative colitis and even bring about a long-term remission.
RELATED LINKS
MoonDragon's Health & Wellness: Crohn's Disease
FREQUENT SIGNS & SYMPTOMS
Ulcerative colitis can range from relatively mild to severe. About half of the people diagnosed with ulcerative colitis have mild symptoms. The symptoms can range from simple diarrhea to the more severe types of symptoms associated with ulcerative colitis. Others suffer frequent fevers, bloody diarrhea, nausea, and severe abdominal cramps. It usually affects the lower section (sigmoid colon) and the rectum. But it can affect the entire colon. In general, the more of the colon that is affected, the worse the symptoms will be. Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs. For these reasons, health care providers often classify ulcerative colitis according to its location. Ulcerative colitis can affect people of any age, but most people who have it are diagnosed before the age of 30.
The main and common symptoms of ulcerative colitis are:
- Abdominal (belly) pain, often described as cramps. The abdomen may be sore when touched.
- Inflammation. Ulceration of the intestinal wall. If the ulcerated intestinal wall leaks, peritonitis can result.
- Rectal pain and significant rectal bleeding.
- Chronic bloody diarrhea and mucus. In some severe cases, people may have diarrhea 10 to 20 times per day. (People with Crohn's disease may or may not have blood in their stools.)
- An urgent need to have a bowel movement (empty the bowels). The urge to go to the bathroom may wake you up at night.
- Constipation. This symptom may develop depending on what part of the colon is affected. Constipation is much less common than diarrhea.
- In severe cases some people also may have a fever or other symptoms that affect the entire body may develop. (See More Serious Problems & Symptoms, below.)
- Loss of appetite. People with ulcerative colitis may not feel hungry. Because of pain, diarrhea and other symptoms, the person with ulcerative colitis may dread eating.
- Weight loss. Ongoing (chronic) symptoms, such as loss of appetite and diarrhea, can lead to loss of weight. Malabsorption and malnutrition may result in ongoing (chronic) symptoms, such as loss of fluids and nutrients from diarrhea, can lead to weight loss (of more than 5 pounds in a few days). Nutritional deficiencies, such as lowered levels of vitamin B-12, folic acid, iron, and fat-soluble vitamins, because the intestines may not be able to absorb nutrients from food.
- Iron deficient anemia may result with too few red blood cells. Some people develop anemia because of low iron levels caused by chronic bleeding, bloody stools, frequent diarrhea and intestinal inflammation.
MORE SERIOUS PROBLEMS & SYMPTOMS
ulcerative colitis sometimes leads to more serious problems with other symptoms may develop outside the digestive tract. However, some of these problems are generally more common in Crohn's disease, the other major inflammatory bowel disease. These symptoms may include:
- Nausea and/or vomiting. Persistent vomiting accompanied by a cessation of bowel movements.
- Fatigue. General malaise (feeling ill).
- Skin lesions or skin rash.
- Joint pain.
- Arthritis.
- Osteoporosis.
- Growth failure (specifically in children).
- Eye inflammation and problems.
- Colon cancer. People who have ulcerative colitis for 8 years or longer have a greater chance of getting colon cancer. Talk to your health care provider about your need for cancer screening. Screening tests help find cancer early, when it is easier to treat.
- Scarring of the bile duct. This can lead to liver damage.
- Liver disease.
- In rare cases, severe disease causes the colon to swell to many times its normal size (toxic megacolon). This can be deadly and needs emergency treatment.
It is not known why these problems occur outside the colon. Researchers think these complications may be the result of inflammation triggered by the immune system. Some of these problems go away when the colitis is treated. In most people, the symptoms come and go. Some people go for months or years without symptoms (remission). Then they will have a flare-up. About 5 to 10 out of 100 people with ulcerative colitis have symptoms all the time.
SIGNS & SYMPTOMS DEPENDING ON CLASSIFICATION
Variability of symptoms reflects differences in the extent of disease (the amount of the colon and rectum that are inflamed) and the intensity of inflammation. Generally, patients with inflammation confined to the rectum and a short segment of the colon adjacent to the rectum have milder symptoms and a better prognosis than patients with more widespread inflammation of the colon. The different types of ulcerative colitis are classified according to the location and the extent of inflammation:
- Ulcerative Proctitis: In this form of ulcerative colitis, inflammation is confined or limited to the rectum and for some people, mild intermittent rectal bleeding may be the only sign of the disease. Others with more severe rectal inflammation may, in addition, have rectal pain, a feeling of urgency (sudden feeling of having to defecate and a need to rush to the bathroom for fear of soiling) or tenesmus (an ineffective, painful inability to move the bowels in spite of the urge to do so).
- Left-Sided Colitis: As the name suggests, inflammation that starts with and extends from the rectum up the left side through the sigmoid and descending colon. Signs and symptoms include bloody diarrhea, left-sided abdominal cramping and pain, and weight loss.
- Proctosigmoiditis: Proctosigmoiditis involves inflammation of the rectum and the sigmoid colon (a short segment of the colon contiguous to the rectum). Symptoms of proctosigmoiditis, like that of proctitis, include rectal bleeding, urgency, and tenesmus. Some patients with proctosigmoiditis also develop bloody diarrhea and cramps.
- Pancolitis: Pancolitis or universal colitis refers to inflammation affecting the entire colon (right colon, left colon, transverse colon and the rectum). Symptoms of pancolitis include bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue, fever, weight loss and night sweats. Some patients with pancolitis have low-grade inflammation and mild symptoms that respond readily to medications. Generally, however, patients with pancolitis suffer more severe disease and are more difficult to treat than those with more limited forms of ulcerative colitis.
- Fulminant Colitis: This rare, severe, life-threatening form of colitis affects the entire colon and people with fulminant colitis are extremely ill. Fulminant colitis causes severe abdominal pain, profuse (protracted) diarrhea with bleeding and, sometimes, dehydration and shock. People with fulminant colitis are at risk of serious complications including colon rupture (perforation) and toxic megacolon, which occurs when the colon becomes severely distended due to severe inflammation. People with fulminant colitis and toxic megacolon are treated in the hospital with potent intravenous medications. Unless they respond to treatment promptly, surgical removal of the diseased colon is necessary to prevent colon rupture.
The course and intensity of ulcerative colitis varies, with periods of acute illness often alternating (waxing and waning) with periods of remission. But over time, the location, severity, and extent of the disease usually remains the same and constant. Therefore, when a patient with ulcerative proctitis develops a relapse of his disease, the inflammation usually is confined to the rectum. Only a small percentage of people (less than 10 percent) with a milder condition, such as ulcerative proctitis or proctosigmoiditis, go on to develop more severe signs and symptoms associated with left-sided colitis or even pancolitis.
Other conditions with symptoms similar to ulcerative colitis include Crohn's disease, diverticulitis, irritable bowel syndrome (IBS), and colon cancer.
ULCERATIVE COLITIS & CROHN'S DISEASE
Ulcerative colitis is similar to Crohn's disease in many respects. Both involve loss of appetite, abdominal pain, general malaise, weight loss, diarrhea, and rectal bleeding. Crohn's disease is more likely than ulcerative colitis to cause vague symptoms of abdominal pain, fatigue, and weight loss. The primary difference between the two conditions is the degree of involvement of the wall of the intestinal tract. Ulcerative colitis is limited to the mucosa and submucosa, the first two layers of the lining of the bowel, whereas Crohn's disease affects these layers and the adjacent tissues which also involves the next two layers, the muscular layer and the connective tissue layer below it.
Areas of the intestine that are ulcerated may be next to areas that are normal. This gives the intestinal lining a characteristic cobblestone appearance that health care providers use to diagnose Crohn's disease. The pattern results from repeated ulceration and healing.
Crohn's Disease VS Ulcerative Colitis
The most common disease that mimics the symptoms of Crohn's disease is ulcerative colitis, as both are inflammatory bowel diseases that can affect the colon with similar symptoms. It is important to differentiate these diseases, since the course of the diseases and treatments may be different. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis.
Comparisons of various factors in Crohn's disease and ulcerative colitis:
Crohn's Disease Ulcerative Colitis Terminal ileum involvement. Commonly. Seldom. Colon involvement. Usually. Always. Rectum involvement. Seldom. Usually. Involvement around the anus. Common. Seldom. Bile duct involvement. No increase in rate of primary sclerosing cholangitis. Higher rate. Distribution of Disease. Patchy areas of inflammation (Skip lesions). Continuous area of inflammation. Endoscopy. Deep geographic and serpiginous (snake-like) ulcers. Continuous ulcer. Depth of inflammation. May be transmural, deep into tissues. Shallow, mucosal. Fistulae. Common. Seldom. Stenosis. Common. Seldom. Autoimmune disease. Widely regarded as an autoimmune disease. No consensus. Cytokine response. Associated with Th1. Vaguely associated with Th2. Granulomas on biopsy. Can have granulomas. Granulomas uncommon. Surgical cure. Often returns following removal of affected part. Usually cured by removal of colon. Smoking. Higher risk for smokers. Lower risk for smokers.
CAUSES
Experts are not sure what causes ulcerative colitis. Many theories exist about what causes ulcerative colitis. Ulcerative colitis is not contagious.
THE IMMUNE SYSTEM
The immune system is composed of immune cells and the proteins that these cells produce. These cells and proteins serve to defend the body against harmful bacteria, viruses, fungi, and other foreign invaders. Activation of the immune system causes inflammation within the tissues where the activation occurs. Inflammation is, in fact, an important mechanism of defense used by the immune system. Normally, the immune system is activated only when the body is exposed to harmful invaders. In patients with Crohn's disease and ulcerative colitis, however, the immune system is abnormally and chronically activated in the absence of any known invader. The continued abnormal activation of the immune systems causes chronic inflammation and ulceration.
POSSIBLE CAUSES & CONTRIBUTORS
People with ulcerative colitis have abnormalities of the immune system, but health care providers do not know whether these abnormalities are a cause or a result of the disease. Some researchers speculate that ulcerative colitis may be caused by the immune system over-reacting to normal bacteria in the digestive tract, or possibly other kinds of infectious agents, such as bacteria and viruses, or possibly an unidentified invading microorganism (pathogen) that may cause or be responsible for the disease. The digestive tract becomes inflamed when the immune system tries to fight off the organism. This type of colitis is often associated with the over-use of antibiotics, which alter the normal bowel flora and permit microorganisms that are normally held in check to proliferate.
Ulcerative colitis might be caused by a defect in the immune system in which the body's antibodies actually injure the colon. Inflammation may stem from an autoimmune reaction in which the body mounts an immune response even though no pathogen is present.
It is probable that a combination of factors, including heredity, may be involved in the cause. You are more susceptible to abnormal activation of the immune system, causing chronic inflammation and ulceration and development of ulcerative colitis if other people in your family (such as a parent, children, or sibling) have the disease. Scientists suspect that genetic makeup may play a contributing role and research into which genetic mutations might increase susceptibility to ulcerative colitis is ongoing.
Ulcerative colitis is not caused by emotional distress, as people once thought, but if you have ulcerative colitis, stress can make it worse. The stress of living with ulcerative colitis may also contribute to a worsening of symptoms.
Ulcerative colitis is not caused by sensitivity to certain foods or food products, but poor eating habits and food allergies or sensitivities may be contributing factors or may trigger symptoms in some people.
Interestingly, smoking cigarettes (nicotine influence) increases the risk of Crohn's disease but lowers the risk of ulcerative colitis.
DISEASE COURSE
The course of ulcerative colitis varies greatly from one person to another. Some people may have only mild symptoms, and others may have severe symptoms or complications that, in unusual cases, may be life-threatening.
Ulcerative colitis may be mild, moderate, or severe. It may be described as dependent on corticosteroids, unresponsive to steroids, or not active (in remission).
Ulcerative colitis also may be defined by the part of the large intestine affected: the rectum (proctitis), the left side of the colon (left-sided colitis), or the entire colon (pancolitis). One out of every two adults with ulcerative colitis has proctitis. Pancolitis is the most common form of ulcerative colitis in children, affecting about half.
Most people with ulcerative colitis have periods of remission that may last up to several years. These periods are interrupted by occasional flare-ups of moderate symptoms. Between 5-10 percent of people have symptoms all the time.
Children may have the same symptoms as adults. In addition, children with ulcerative colitis may grow more slowly than normal and go through puberty later than expected.
COMPLICATIONS & LONG TERM EFFECTS
Inflammation and scarring of the bile ducts (primary sclerosing cholangitis) may occur. A bile duct is a passage that carries fluid produced in the liver to the small intestine.
Severe inflammation and ulceration sometimes irritate muscles in the colon, causing colon walls to stretch. The colon may swell to many times its normal size, a condition known as toxic megacolon. This is an emergency that requires immediate treatment, but is rare.
Narrowed areas of the intestine (strictures) may occur in ulcerative colitis, causing difficulty in passing stools. Abnormal connections or openings (fistulas) between parts of the intestine or between the intestine and other organs are rare because ulcerative colitis does not affect the deeper intestinal tissues.
Your risk of cancer of the colon and rectum is higher than average if you have had ulcerative colitis for 8 years or longer. With regular screening, some cancers can be detected early and treated successfully.
Ulcerative colitis can cause rare complications such as scarring of the pancreas and inflammation of the membrane surrounding the heart (pericarditis).
Some people who have ulcerative colitis also have irritable bowel syndrome (IBS), which is not as serious as ulcerative colitis. IBS causes abdominal pain along with diarrhea or constipation.
Most women who have ulcerative colitis are able to become pregnant and usually have healthy babies. Symptoms may become worse during the first 3 months of pregnancy. Some medicines to treat the disease can be used during pregnancy.
See more about complications below.
RISK FACTORS
You have an increased risk of developing ulcerative colitis if you:
You are at higher risk if you have a family history of ulcerative colitis. Your risk increases if an immediate family member or a close relative, such as a parent, child, brother, or sister has the disease.
Ethnicity. Although whites have the highest risk of the disease, it can strike any ethnic group. If you are Jewish and of European decent, Ashkenazi Jewish ancestry, you are 4 to 5 times as likely to have ulcerative colitis. Ashkenazi Jewish Genetic Panel (AJGP).
Age. Ulcerative colitis can strike at any age, but you are most likely to develop the condition when you are young. Ulcerative colitis often strikes people in their 30s, although a small number of people may not develop the disease until their 50s or 60s.
Where you live. If you live in an urban area or in an industrialized country, you are more likely to develop ulcerative colitis. People living in Northern climates also seem to have a greater risk of ulcerative colitis.
Other environmental factors, such as a diet high in fat or refined foods, also may play a role.
Inflamed bile ducts. This condition, called primary sclerosing cholangitis, causes inflammation of the bile ducts of the liver, and is associated with ulcerative colitis. If you have this condition, you health care provider may look for ulcerative colitis even if you do not have signs or symptoms.
Isotretinoin (Accutane) use. Isotretinoin (Accutane) is a powerful medication sometimes used to treat scarring cystic acne or acne that does not respond to other treatments. Although cause and effect has not been proved, studies have reported the development of inflammatory bowel disease with isotretinoin use.
COMPLICATIONS
Most patients with this disease respond well to treatment and go about their lives with few interruptions. However, some attacks may be quite severe, requiring a period of bowel rest, hospitalization and intravenous treatment.
Patients with ulcerative colitis limited to the rectum (proctitis) or colitis limited to the end of the left colon (proctosigmoiditis) usually do quite well. Brief periodic treatments using oral medications or enemas may be sufficient. Serious complications are rare in these patients. In those with more extensive disease, blood loss from the inflamed intestines can lead to anemia and may require treatment with iron supplements or even blood transfusions. Rarely, the colon can acutely dilate to a large size when the inflammation becomes very severe. This condition is called toxic megacolon.
TOXIC MEGACOLON
The most serious acute complication of ulcerative colitis is toxic megacolon. People with toxic megacolon are extremely ill with fever, abdominal pain and distension (swelling), fever, weakness, dehydration, and malnutrition. This occurs when your colon becomes paralyzed, preventing you from having a bowel movement or passing gas. You might also become disoriented or groggy. Unless a person improves rapidly with medication, surgery usually is necessary to prevent colon rupture. If toxic megacolon is not treated, your colon may rupture, causing peritonitis, a life-threatening condition requiring emergency surgery.
COLON CANCER
Both ulcerative colitis and Crohn's disease increase your risk of colon cancer. Despite this increased risk, however, more than 90 percent of people with inflammatory bowel disease never develop cancer. About 5 percent of people with ulcerative colitis develop colon cancer.
The risk of cancer increases with the duration of the disease and how much the colon has been damaged. For example, if only the lower colon and rectum are involved, the risk of cancer is no higher than normal. However, if the entire colon is involved, the risk of cancer may be as much as 32 times the normal rate. In people with colitis limited to the left side of the colon, the risk of colon cancer is increased but not as high as in people with chronic pancolitis. Your risk is greatest if you have had inflammatory bowel disease for at least eight to 10 years and if it has spread through your entire colon. You are less likely to develop cancer if only a small part of your colon is diseased.
The current estimates for the cumulative incidence of colon cancer associated with ulcerative colitis are 2.5 percent at 10 years, 7.6 percent at 30 years, and 10.8 percent at 50 years. People at higher risk of cancer are those with positive family histories of colon cancer, long durations of colitis, extensive colon involvement, and primary sclerosing cholangitis (PSC), another complication of ulcerative colitis.
Since these cancers have a more favorable outcome when diagnosed and treated at an earlier stage, yearly colon examinations may be recommended after eight years of known extensive disease. During these examinations, samples of tissue (biopsies) can be taken to search for pre-cancerous changes in the lining cells of the colon. When pre-cancerous changes are found, removal of the colon may be necessary to prevent colon cancer.
Sometimes pre-cancerous changes occur in the cells lining the colon. These changes are called "dysplasia." People who have dysplasia are more likely to develop cancer than those who do not. Health care providers look for signs of dysplasia when doing a colonoscopy or sigmoidoscopy and when examining tissue removed during these tests.
In general, practitioners recommend that once you have had ulcerative colitis for eight to 10 years, be sure to have a colonoscopy every one or two years to look for early signs of colon cancer if your disease has spread farther than the rectum.
According to the 2002 updated guidelines for colon cancer screening, people who have had IBD throughout their colon for at least 8 years and those who have had IBD in only the left colon for 12 to 15 years should have a colonoscopy with biopsies every 1 to 2 years to check for dysplasia. Such screening has not been proven to reduce the risk of colon cancer, but it may help identify cancer early. These guidelines were produced by an independent expert panel and endorsed by numerous organizations, including the American Cancer Society, the American College of Gastroenterology, the American Society of Colon and Rectal Surgeons, and the Crohn's & Colitis Foundation of America.
PREGNANCY
If you have ulcerative colitis, talk to your health care provider before becoming pregnant or fathering a child. Some medications used to treat IBD have the potential to cause birth defects or can be passed to the baby through breast milk. Active ulcerative colitis increases the risk of fetal death or preterm labor. If you are already pregnant, be sure you are cared for by a practitioner who has experience with IBD and pregnancy.
ARTHRITIS & JOINT INFLAMMATION
Inflammation in the joints may occur in 10 to 15 percent of people with ulcerative colitis. Some people may develop colitis-related arthritis, which may resemble rheumatoid arthritis. In people who have ulcerative colitis, some have low back pain due to arthritis inflammation limited to the lower sacroiliac joints of the spine (sacroilitis). This is more common than ankylosing spondylitis, another type of arthritis that affects the spine and lower back.
INFLAMMATION OF THE SKIN & EYES
Rarely, people may develop painful, red, skin nodules (erythema nodosum). Skin conditions such as painful nodular lesions - usually on the legs - that are thought to be an allergic or immune reactions, ulcers on the legs that heal without scarring, and mouth ulcers. These problems occur in less than 10 percent of people.
Yet others can have painful, red eyes. Eye problems occur in less than 10 percent of people with IBS diseases. Eye problems include cataracts, ulcers on the cornea, inflammation of the iris (uveitis), and episcleritis. Because these particular complications can risk permanent vision impairment, eye pain or redness are symptoms that require a health care provider's evaluation.
LIVER DISEASE
Diseases of the liver, gall bladder (including gallstones - more likely in Crohn's disease than in ulcerative colitis), and bile ducts may also be associated with ulcerative colitis. cirrhosis of the liver, bile duct inflammation and scarring (sclerosing cholangitis), or bile duct cancer (rare but more likely in ulcerative colitis than in Crohn's disease).
For example, people with a rare condition called sclerosing cholangitis, repeated infections and inflammation in the bile ducts can lead to recurrent fever, yellowing of skin (jaundice), cirrhosis, and the need for a liver transplant.
URINARY TRACT PROBLEMS
Urinary tract complications, which are more common in Crohn's disease than in ulcerative colitis. Kidney stones may develop because of changes in how the body absorbs nutrients, such as calcium or oxalate, from the intestines.
GROWTH PROBLEMS
Growth problems in children. Affected children may not grow as quickly or as tall as they would if they did not have the disease. Children with any IBD need attention to their diet to ensure that they get enough nutrients.
OTHER POSSIBLE COMPLICATIONS
Other possible complications of ulcerative colitis include:
- Perforated colon.
- Severe dehydration.
- Problems with blood clots in the legs or other areas of the body.
PREVENTION
You cannot prevent ulcerative colitis because the cause is unknown. However, you can take steps to reduce the severity of the disease.
Medications taken regularly may reduce acute attacks and keep the disease in remission.
Most experts recommend acetaminophen (Tylenol) for pain relief rather than non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. NSAIDs have been linked to flare-ups of inflammatory bowel disease (IBD).
Antibiotics may make ulcerative colitis symptoms worse and should only be used when necessary.
DIAGNOSIS & TREATMENT
To diagnose ulcerative colitis, health care providers ask about the symptoms, do a physical exam, take a medical history (family and personal) and perform a number of diagnostic tests. Testing can help the practitioner rule out other problems that can cause similar symptoms, such as Crohn's disease, irritable bowel syndrome, or diverticulitis.
MEDICAL EXAMS & TESTS
The symptoms of ulcerative colitis and Crohn's disease may be similar, but there are features of each disease that can help health care providers diagnose which condition you have.
- Ulcerative colitis is relatively easy to diagnose, because it normally affects the colon and rectum. It often causes an obvious change in daily bowel habit, such as blood or mucus in stools and more frequent stools. The colon and rectum can be examined with flexible sigmoidoscopy or colonoscopy.
- Crohn's disease can be difficult to diagnose. Early symptoms or its only symptoms may consist of joint aches and a general feeling of fatigue. Because symptoms usually come on gradually, Crohn's disease may go undiagnosed for years.
HISTORY & PHYSICAL EXAM
The medical history includes questions about your bowel function, including how many bowel movements you have per day or per week, whether you have constipation or diarrhea, blood or mucus in your stool, and recent changes in bowel habits or the shape of your stools. You will be questioned whether your bowel movement patterns have any relationship to your abdominal pain (if passing a stool relieves your pain); family history of similar symptoms; laxative and antacid use; increased risk factors of an intestinal infection (foreign travel, untreated water, antibiotic use); and your sexual history regarding sexually transmitted diseases. The standard physical exam consists of: feeling the abdomen; a digital rectal exam; listening to bowel sounds with a stethoscope; examination of eyes, skin, joints, and inside of mouth; and a pelvic exam for women.
DIAGNOSTIC TESTS & PROCEDURES
Your health care provider will likely diagnose ulcerative colitis only after ruling out other possible causes for your signs and symptoms, including Crohn's disease, ischemic colitis, infection, irritable bowel syndrome (IBS), diverticulitis and colorectal cancer.
A series of diagnostic tests may be required to confirm ulcerative colitis. Blood tests may be done to check for anemia and/or a high white blood cell count. A health care provider may do an upper gastrointestinal x-ray series to look at the small intestine, or a colonoscopy, in which the health care provider inspects the interior of the large intestine using a long, flexible lighted tube linked to a computer and monitor. If the tests show the presence of ulcerative colitis or Crohn's disease, the health care provider may do more x-rays or diagnostic scans of both the upper and lower digestive tract to find out how much is affected by the disease. To help confirm a diagnosis of ulcerative colitis, you may have one or more of the following tests and procedures:BLOOD TESTS
- Standard blood and urine tests may be done to check for anemia, inflammation, or malnutrition. Depending on the symptoms, an erthrocyte sedimentation rate (ESR or sed rate) or C-reactive protein (CRP) blood test may be done. These tests can help determine if there is infection or inflammation. C-reactive protein is a substance produced by the liver as a result of inflammation in the body. A positive test for anemia could indicate bleeding in the colon or rectum. A high white blood count or elevated sedimentation rate could indicate a sign of ongoing inflammation somewhere in the body (including the colon). Two tests that look for the presence of certain antibodies can sometimes help diagnose which type of inflammatory bowel disease you have, but not everyone with ulcerative colitis has these antibodies. These tests are not sensitive enough for routine use, but may be helpful in specific circumstances.
SIGMOIDOSCOPY, COLONOSCOPY & ENDOSCOPY
A colonoscopy or sigmoidoscopy are the most accurate methods for making a diagnosis of ulcerative colitis and ruling-out other possible conditions, such as Crohn's disease, diverticular disease, or cancer. The health care provider will be able to see any inflammation, bleeding, or ulcers on the colon wall.
- Flexible sigmoidoscopy. The sigmoidoscope is a flexible lighted tube that is about 0.5 in (1.27 cm) wide and 2 ft (60.96 cm) long with hundreds of light-conducting fibers attached to a lighted lens system. This instrument allows the health care provider to see around bends in the colon. A flexible sigmoidoscope allows a more complete view of the last 2 feet of lower colon and usually makes the examination more comfortable than a rigid scope. The test usually takes just a few minutes. The flexible sigmoidoscope has generally replaced the rigid sigmoidoscope. Your health care provider may also a remove small growths and collect samples (biopsy) through the sigmoidoscope. Sigmoidoscopy requires the use of enemas or laxatives (or both) to empty the colon before the test is done. It is somewhat uncomfortable, and there is a slight risk of perforating the colon wall. It may also miss problems higher up in your colon.
- Colonoscopy. The colonoscope is a thin, flexible scope that ranges from 48 inches (121.92 cm) to 72 inches (182.88 cm) long. A small video camera is attached to the colonoscope so that photographic, electronic, or videotaped images of the large intestine can be made. The colonoscope may use fiber optics or digital video technology. The colonoscope can be used to view the entire colon as well as a small portion of the lower small intestine. A biopsy may be taken during the procedure.
- Upper Gastrointestinal Endoscopy. Endoscopy allows the health care provider to look at the interior lining of the esophagus, stomach, and the first part of the small intestine through a thin, flexible viewing instrument called an endoscope. The tip of the endoscope is inserted through the mouth and then is gently moved down the throat into the esophagus, stomach and upper duodenum (small intestine. Using the endoscope, your health care provider can look for gastric problems (ulcers, inflammation, tumors, infection or bleeding) and tissue biopsies can be collected, polyps removed, and bleeding treated. Endoscopy can reveal problems that do not show up on X-rays and may eliminate the need for exploratory surgery.
BARIUM ENEMA & X-RAY
- Abdominal X-ray. X-rays are a form of radiation that can be focused into a beam that can pass through most objects, including the human body. When X-rays strike a piece of photographic film, they can produce an image. Dense tissues, such as bones, will appear white, since they absorb (block) may of the X-rays. Less dense tissues, such as organs and muscles, block fewer X-rays (more pass through these structures) and appear as shades of gray. An abdominal X-ray provides pictures of structures such as the large and small intestines, stomach, liver, and spleen, and the diaphragm (the sheet of muscle that separates the abdomen from the thoracic portion of the body containing the lungs and heart). The abdominal X-ray may be one of the first tests used to investigate the symptoms of abdominal swelling, pain, nausea, and/or vomiting.
- Upper gastrointestinal (GI) series. The upper GI examines the upper and middle portions of the GI tract. This includes the esophagus, stomach, and the first part of the small intestine called the duodenum. The person being tested swallows a barium "shake" of barium, water, and gas producing crystals. Barium is a contrast material (dye) that allows the health care provider to tract the progress of the "shake" from the esophagus through the stomach and small intestine using fluoroscopy connected to a video monitor. Several X-rays are usually taken at different times and from different angles or directions. If you have allergies to barium, other common contrast material include iodine and gadolinium. The contrast material will allow the health care provider to see specific organs and types of tissue (tumors) more visible on the X-rays.
- Barium enema. The barium enema is a chalky contrast dye substance used in a lower GI exam that uses X-rays to diagnose problems that affect the colon (large intestine). Making the entire intestine visible on an X-ray involves filling the colon with a contrast material (barium) through a tube inserted into the anus (enema). Sometimes, air is added as well. The radiopaque barium fills and coats the lining of the bowel, creating a silhouette outline of your rectum, colon, and a portion of your small intestine. The barium blocks X-rays, causing the barium-filled colon to show up clearly on the X-ray picture. This procedure should show structural defects and inflammation of the colon that may be present in IBD.
Barium enema is not as accurate as colonoscopy, it does not allow your health care provider to take tissue samples, and it is not used in people with moderate to severe disease because of the risk of complications.
STOOL SAMPLE
- Stool analysis, including a test for blood in the stool is almost always done to look for blood, signs of bacterial, viral or parasitic infection, malabsorption, or the presence of white blood cells. White blood cells present in the stool sample indicates inflammation and infection but may or may not be a sign of ulcerative colitis or inflammatory disease. However, white blood cells in stool mean that you do not have IBS. Stool analysis may be done during a flare-up of ulcerative colitis if there is concern that new symptoms are caused by another problem. You may collect the stool sample or your health care provider may obtain a sample during sigmoidoscopy or colonoscopy.
CT SCAN
- Computed tomography (CT) scan. This is a special type of X-ray that can produce detailed pictures of structures inside the body. It is also called a computerized axial tomography (CAT) scan. The CT scanner directs a series of X-rays through the body that are analyzed by a computer to produce a detailed picture of a portion (slice) of an organ or area being examined. Each X-rays pulse last only a fraction of a second and it takes only a few seconds for the machine to record each slice. A CT scan produces clearer pictures than regular X-rays do. The information obtained from a CT scan can be saved and stored on a computer for further study and photographs of selected view can be made. For an abdominal CT scan, a contrast material is usually given orally (by mouth) prior to the test. A CT scan of the abdomen can help detect several conditions, including cysts, abscesses, infection, bleeding into the abdominal cavity, tumors, aneurysm, enlarged lymph nodes, foreign objects, diverticulitis, IBD, the spread of cancer, and appendicitis.
MAGNETIC RESONANCE IMAGING (MRI)
- Magnetic resonance imaging (MRI), which uses a magnetic field and pulses of radio wave energy to provide pictures of organs and structures inside the body.
TISSUE BIOPSY
- Biopsy of a sample of tissue from the lining of the intestine to view with a microscope. Biopsies are collected during upper endoscopy, sigmoidoscopy, or colonoscopy. A biopsy is done to confirm the diagnosis of IBD and to determine the type of inflammatory bowel disease you have (ulcerative colitis or Crohn's disease) and to assess the severity of the inflammation and tissue damage or to find out if a tumor is present. Sometimes a tissue sample can help confirm a diagnosis. If there are clusters of inflammatory cells called granulomas, for instance, it is likely you have Crohn's disease, because granulomas do not occur with ulcerative colitis. In about 10 percent of people who have symptoms, neither Crohn's disease nor ulcerative colitis can be diagnosed. These people have a form of inflammatory bowel disease called indeterminate colitis, which health care providers believe is a combination of Crohn's disease and ulcerative colitis.
Multiple biopsies for cancer screening often are done in people who have had ulcerative colitis for more than 8 to 10 years. Bowel biopsies are painless (other than the potential discomfort of the scope procedure) and involve removing only a tiny piece of tissue. Risks of this procedure include perforation of the colon wall and bleeding, especially when a biopsy is taken.
There is no early detection screening test for inflammatory bowel disease at this time. However, people who have had ulcerative colitis for 8 to 10 years or longer should discuss with their health care provider how often they will need screening tests for colon cancer, based on the extent of their disease and how long they have had it. For people who have ulcerative colitis or colon cancer, screening usually involves taking multiple-tissue biopsies during routine sigmoidoscopy or colonoscopy.
CONVENTIONAL MEDICAL TREATMENT
GENERAL IBD TREATMENT OVERVIEW
Inflammatory bowel disease (IBD) is a group of disorders that cause inflammation or ulceration of the digestive tract. The most common forms are ulcerative colitis and Crohn's disease. It is a chronic condition that may flare up many times during your life. You may have long periods without symptoms, or you may have only mild symptoms. A few people have symptoms that are more persistent and severe, in some cases requiring treatment with medications or surgery. Treatment depends on the severity of an attack and the person's age. Children and older people may have nutritional problems that require special care.
Ulcerative colitis affects everyone differently. Treatment for ulcerative colitis depends on the severity of the disease. Treatment is adjusted for each individual. Your health care provider will help you find treatments that reduce your symptoms and help you avoid new flare-ups. Since there is no cure for ulcerative colitis, the goals of treatment (for all types of IBD) include:
- Relieving symptoms caused by the disease and ending sudden (acute) attacks as quickly as possible.
- Relieve and control inflammation.
- Treat and correct complications, such as anemia, infection, or bowel problems, all of which can help keep Crohn's disease in remission. Treatment may include taking nutritional supplements to restore normal growth and sexual development in children and teens.
- Preventing or delaying new attacks.
Some people have remissions - periods when the symptoms go away - that last for months or even years. However, most patients' symptoms eventually return. If you do not have any symptoms of or if your disease is not active (in remission), you may not need treatment. Although IBD cannot be cured (except for surgical removal of the colon in ulcerative colitis), symptoms usually can be managed with medications that may help keep the disease in remission. It often is easier to keep the disease in remission than to try to treat a flare-up of symptoms. During relapses, symptoms of abdominal pain, diarrhea, and rectal bleeding worsen. During remissions, these symptoms subside. Remissions usually occur because of treatment with medications or surgery, but occasionally they occur spontaneously, that is, without any treatment.
Mild symptoms may respond to anti-diarrheal medications and changes in your diet. Anti-diarrheals should be used only in mild cases and after talking with your health care provider. Prescription medications may be used to treat mild symptoms and keep the disease in remission. Some people find that certain foods make their symptoms worse. If this happens to you, it makes sense to avoid those foods. But be sure to eat a healthy, varied diet to keep your weight up and stay strong.
Moderate to severe symptoms may require treatment with one or more prescription medications. A supplemental diet may be needed.
Severe, persistent symptoms that do not get better with first-line treatment may need more aggressive medications or surgery. Surgery is used only for people with severe symptoms that fail to respond to medication or who develop complications, such as bleeding or perforation of the intestine. In some cases, people who have precancerous changes in their intestines may need surgery to prevent cancer even if they have no symptoms.
Children with ulcerative colitis may feel self-conscious if they do not grow as fast as other children their age. Encourage your child to take medicine as prescribed. Offer your help with the treatment so that your child can feel better, start growing again, and lead a more normal life. Children tend to have a harder time managing ulcerative colitis than adults, so your support is especially important. Treatment may include taking nutritional supplements to restore normal growth and sexual development in children and teens.
It has long been observed that the risk of ulcerative colitis appears to be higher in non-smokers and in ex-smokers. In certain circumstances, patients improve when treated with nicotine (such as nicotine patches).
DRUG THERAPY
Several medications are used to treat the various types of inflammatory bowel disease, depending on the severity and location of the disease. The goal of drug therapy is to induce and maintain remission, and to improve the quality of life for people with ulcerative colitis. Several types of drugs are available. These medications may be used in combination for the most effective control of symptoms:
- Aminosalicylates. After your symptoms are under control, these medicines may help prevent flare-ups. Aminosalicylates, drugs that contain 5-aminosalicyclic acid (5-ASA), help control inflammation. Sulfasalazine is a combination of sulfapyridine and 5-ASA. The sulfapyridine component carries the anti-inflammatory 5-ASA to the intestine. However, sulfapyridine may lead to side effects such as nausea, vomiting, heartburn, diarrhea, and headache. Other 5-ASA agents, such as olsalazine, mesalamine, and balsalazide, have a different carrier, fewer side effects, and may be used by people who cannot take sulfasalazine. 5-ASAs are given orally, through an enema, or in a suppository, depending on the location of the inflammation in the colon. Most people with mild or moderate ulcerative colitis are treated with this group of drugs first. This class of drugs is also used in cases of relapse.
- Corticosteroids. Steroid medicines can help reduce or stop symptoms. Corticosteroids such as prednisone, methylprednisone, and hydrocortisone also reduce inflammation. They may be used by people who have moderate to severe ulcerative colitis or who do not respond to 5-ASA drugs. Corticosteroids, also known as steroids, can be given orally, intravenously, through an enema, or in a suppository, depending on the location of the inflammation. They are only used for short periods because they can cause side effects, such as bone thinning/bone mass loss (osteoporosis), weight gain, acne, facial hair, hypertension, diabetes, mood swings, and an increased risk of infection. For this reason, they are not recommended for long-term use, although they are considered very effective when prescribed for short-term use.
- Medications that affect the immune system (immunomodulators). You may need these if your disease is severe and aminosalicylates do not keep it from flaring up. Immunomodulators such as azathioprine and 6-mercapto-purine (6-MP) reduce inflammation by affecting the immune system. These drugs are used for patients who have not responded to 5-ASAs or corticosteroids or who are dependent on corticosteroids. Immunomodulators are administered orally, however, they are slow-acting and it may take up to 6 months before the full benefit. Patients taking these drugs are monitored for complications including pancreatitis, hepatitis, a reduced white blood cell count, and an increased risk of infection. Cyclosporine A may be used with 6-MP or azathioprine to treat active, severe ulcerative colitis in people who do not respond to intravenous corticosteroids.
- Antibiotics and other drugs may be given to relax the patient or to relieve pain, diarrhea, or infection. If your symptoms are mild, you may only need to use over-the-counter medicines for diarrhea (such as Imodium A-D). Talk to your health care provider before you take these medicines.
See "Medications below for more information.
HOSPITALIZATION
Occasionally, symptoms are severe enough that a person must be hospitalized. For example, a person may have severe bleeding or severe diarrhea that causes dehydration. In such cases the health care provider will try to stop diarrhea and loss of blood, fluids, and mineral salts. The patient may need a special diet, feeding through a vein, medications, or sometimes surgery.
SURGERY
If you have severe symptoms and medicines do not help, you may need surgery to remove part or all of your colon. Removing the entire colon cures ulcerative colitis. It also prevents colon cancer. But it does have some serious risks. Still, most people who have surgery are glad they did.
- Ileoanal anastomosis. The surgeon removes the colon and the lining of the rectum. The lower end of the small intestine (ileum) is made into a pouch that connects to the anus. The anal sphincter muscles are left intact, allowing for nearly normal bowel movements. This surgery has become standard because it cures ulcerative colitis and allows nearly normal bowel movements.
- Proctocolectomy and ileostomy. The large intestine, the rectum, and sometimes the anus are removed (proctocolectomy). The surgeon sews the anus closed and makes a small opening (stoma) in the skin of the lower abdomen. The ileum attaches to the opening in the abdomen. Stool empties into an ostomy bag that attaches to the stoma.
- Ileoanal anastomosis is the surgery that is most often done. This surgery is successful in 95 percent of people who have it. Most young people with ulcerative colitis have ileoanal surgery. Proctocolectomy is done for people with ulcerative colitis who cannot be under anesthesia for long periods of time because of illness or age.
See Surgery for more information.
LIVING WITH IBD
Ulcerative colitis can be hard to live with. During a flare-up it may seem like you are always running to the bathroom. This can be embarrassing and can take a toll on how you feel about yourself. Not knowing when the disease will strike next can be stressful. Stress may actually make the problem worse. Ulcerative colitis can drastically lower your quality of life, particularly if the disease is severe. Frequent diarrhea and abdominal pain may force you to limit work or social activities. Some people feel isolated or depressed.
If you are having a hard time, seek support from family, friends, or a counselor. Or look for an ulcerative colitis support group. It can be a big help to talk to others who are coping with this disease.
See Dietary, Herbal & Holistic Recommendations for more information about diet, herbs, and alternative therapy suggestions and recommendations to help you live with your condition and dealing with stress.
MEDICATIONS
THE GOAL OF MEDICAL TREATMENT
The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission. Ulcerative colitis treatment usually involves either drug therapy or surgery.
Medications usually are the treatment of choice for ulcerative colitis. They control or prevent inflammation in the intestines and help:
- Relieve symptoms.
- Promote healing of damaged tissues.
- Put the disease into remission and keep it from flaring up again.
- Postpone or prevent the need for surgery.
DRUG THERAPY & PREGNANCY
If you are pregnant, talk to your health professional about which medicines are safe for you to take. Usually, aminosalicylates and corticosteroids are safe, especially when your health care provider thinks that ulcerative colitis is more dangerous to the fetus than these medicines. Ask your health care provider whether you can take medicines that suppress the immune system. These are used only when the benefit outweighs the potential harm to the fetus. A health professional can recommend medicines based on the stage of the pregnancy and the severity of your symptoms.
MEDICATION CHOICES
The choice of medicine usually depends on the severity of the disease, the part of the colon affected, and whether complications are present.
Health care providers use several categories of drugs that control inflammation in different ways. But drugs that work well for some people may not work for others, so it may take time to find a medication that helps you. In addition, because some drugs have serious side effects, you will need to weigh the benefits and risks of any treatment.
Aminosalicylates are the most common medicines used to treat ulcerative colitis. Most of the time, these medicines are all a person needs to keep the disease in remission (a period of time with no symptoms). When aminosalicylates do not work, corticosteroids are most often the next medicine tried. Corticosteroids will only be used long enough to stop the inflammation in your colon. After the inflammation goes down, aminosalicylates will most likely be used to maintain remission.
If aminosalicylates are not strong enough to keep you in remission, or if corticosteroids do not work, your health care provider may have you try different medicines. These medicines include immunomodulators, cyclosporine, and infliximab. All of these medicines control the immune response in your body and will decrease the amount of inflammation in your intestine. The inflammation is what causes the symptoms of ulcerative colitis.
ANTI-INFLAMMATORY DRUGS
5-ASA Compounds (Azulfidine, Asacol, Pentasa, Dipentum)
5-ASA (5-aminosalicylic acid), also called mesalamine, is chemically similar to aspirin. Aspirin (acetylsalicylic acid) has been used for many years in treating arthritis, bursitis, and tendinitis (conditions of tissue inflammation). Aspirin, however, is not effective in treating ulcerative colitis. On the other hand, 5-ASA can be effective in treating ulcerative colitis if the drug can be delivered directly (topically) onto the inflamed colon lining. For example, Rowasa enema is a 5-ASA solution that is effective in treating inflammation in and near the rectum (ulcerative proctitis and ulcerative proctosigmoiditis). However, the enema solution cannot reach high enough to treat inflammation in the upper colon. Therefore, for most patients with ulcerative colitis, 5-ASA must be taken orally. When pure 5-ASA is taken orally, however, the stomach and upper small intestine absorb most of the drug before it reaches the colon. Therefore, to be effective as an oral agent for ulcerative colitis, 5-ASA has to be modified chemically to escape absorption by the stomach and the upper intestines. These modified 5-ASA compounds are sulfasalazine (Azulfidine), mesalamine (Pentasa, Rowasa, Asacol), and olsalazine (Dipentum).
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:
- Sulfasalazine (Azulfidine): Sulfasalazine can be effective in reducing symptoms of ulcerative colitis, but it has a number of side effects, including nausea, vomiting, heartburn and headache. Do not take this medication if you are allergic to sulfa medications.
Sulfasalazine (Azulfidine) has been used successfully for many years in inducing remission among patients with mild to moderate ulcerative colitis. Inducing remission means decreasing intestinal inflammation and relieving symptoms of abdominal pain, diarrhea, and rectal bleeding. Sulfasalazine has also been used for prolonged periods of time to maintain remissions. Sulfasalazine consists of a 5-ASA molecule linked chemically to a sulfapyridine molecule. (Sulfapyridine is a sulfa antibiotic). Connecting the two molecules together prevents absorption by the stomach and the upper intestines prior to reaching the colon. When sulfasalazine reaches the colon, the bacteria in the colon will break the linkage between the two molecules. After breaking away from 5-ASA, sulfapyridine is absorbed into the body and then excreted in the urine. Most of the active 5-ASA drug, however, remains in the colon to treat colitis.
Most of the side effects of sulfasalazine are due to the sulfapyridine molecule. These side effects include nausea, heartburn, headache, anemia, skin rashes, and, in rare instances, hepatitis and kidney inflammation. In men, sulfasalazine can reduce the sperm count. The reduction in sperm count is reversible, and the count usually returns to normal after discontinuing sulfasalazine or by changing to a different 5- ASA compound.
The benefits of sulfasalazine generally are dose related. Therefore, high doses of sulfasalazine may be necessary to induce remission. Some patients cannot tolerate high doses because of nausea and stomach upset. To minimize stomach upset, sulfasalazine generally is taken after or with meals. Some patients find it easier to take Azulfidine-EN (enteric-coated form of sulfasalazine). Enteric-coating helps decrease stomach upset. The newer 5-ASA compounds do not have the sulfapyridine component and have fewer side effects than sulfasalazine.
- Mesalamine (Asacol, Rowasa) & Olsalazine (Dipentum): These medications tend to have fewer side effects than sulfasalazine has. You take them in tablet form or use them rectally in the form of enemas or suppositories, depending on the area of your colon affected by ulcerative colitis. Mesalamine enemas can relieve signs and symptoms in more than 80 percent of people with ulcerative colitis in the lower left side of their colon and rectum. Olsalazine may cause or worsen existing diarrhea in some people.
Side Effects of 5-ASA Compounds: The sulfa-free 5-ASA compounds have fewer side effects than sulfasalazine and also do not impair male fertility. In general, they are safe medications for long-term use and are well-tolerated. Patients allergic to aspirin should avoid 5-ASA compounds because they are chemically similar to aspirin. Rare kidney inflammation has been reported with the use of 5-ASA compounds. These compounds should be used with caution in patients with known kidney disease. It also is recommended that blood tests of kidney function be obtained before starting and periodically during treatment. Rare instances of acute worsening of diarrhea, cramps, and abdominal pain may occur which is at times may be accompanied by fever, rash, and malaise. This reaction is believed to represent an allergy to the 5-ASA compound.
Asacol is a tablet consisting of the 5-ASA compound, mesalamine, surrounded by an acrylic resin coating. (Asacol is sulfa free). The resin coating prevents the 5-ASA from being absorbed as it passes through the stomach and the small intestine. When the tablet reaches the terminal ileum and the colon, the resin coating dissolves, thus releasing 5-ASA into the colon. Asacol is effective in inducing remissions in patients with mild to moderate ulcerative colitis. It also is effective when used for prolonged periods of time to maintain remissions. The recommended dose of Asacol to induce remission is two 400-mg tablets three times daily (total of 2.4 grams a day). Two tablets of Asacol twice daily (1.6 grams a day) is recommended for maintaining remission. Occasionally, the maintenance dose is higher. As with Azulfidine, the benefits of Asacol are dose-related. If patients do not respond to 2.4 grams a day of Asacol, the dose frequently is increased to 3.6 grams a day (and sometimes even higher) to induce remission. If patients fail to respond to the higher doses of Asacol, then alternatives, such as corticosteroids, are considered.
Pentasa is a capsule consisting of the 5-ASA compound mesalamine inside controlled-release spheres. Like Asacol, it is sulfa free. As the capsule travels down the intestines, the 5-ASA inside the spheres is slowly released into the intestines. Unlike Asacol, the mesalamine in Pentasa is released into the small intestine as well as the colon. Therefore, Pentasa can be effective in treating inflammation in the small intestine and the colon. Pentasa is currently the most logical 5-ASA compound for treating mild to moderate Crohn's disease involving the small intestine. Pentasa also is used to induce remission and maintain remission among patients with mild to moderate ulcerative colitis. Olsalazine (Dipentum) consists of two 5-ASA molecules linked together. It is sulfa free. The linked 5-ASA molecules travel through the stomach and the small intestine unabsorbed. When the drug reaches the terminal ileum and the colon, the normal bacteria in the intestine break the linkage and releases the active drug into the colon and the terminal ileum. Olsalazine has been used in treating ulcerative colitis and in maintaining remissions. A side effect unique to olsalazine is secretory diarrhea (diarrhea resulting from excessive production of fluid in the intestines). This condition occurs in 5-10 percent of patients, and the diarrhea sometimes can be severe.
Rowasa Enema: Rowasa is the 5-ASA compound mesalamine in enema form and is effective in ulcerative proctitis and ulcerative proctosigmoiditis (two conditions where active 5-ASA drugs taken as enemas can easily reach the inflamed tissues directly). Each Rowasa enema contains 4 grams of mesalamine in 60 cc of fluid. The enema usually is administered at bedtime, and patients are encouraged to retain the enema through the night.
The enema contains sulfite and should not be used by patients with sulfite allergy. Otherwise, Rowasa enemas are safe and well-tolerated. Rowasa also comes in suppository form for treating limited proctitis. Each suppository contains 500 mg of mesalamine and usually is administered twice daily.
While some patients improve within several days of starting Rowasa, the usual course of treatment is three to six weeks. Some patients may need even longer courses of treatment for optimal benefit. In patients who do not respond to Rowasa, oral 5-ASA compounds (such as Asacol) can be added. Some studies have reported increased effectiveness in treating ulcerative proctitis and proctosigmoiditis by combining oral 5-ASA compounds with Rowasa enemas. Oral 5-ASA compounds also are used to maintain remission in ulcerative proctitis and proctosigmoiditis.
Another alternative for patients who fail to respond to Rowasa or who cannot use Rowasa is cortisone enemas (Cortenema). Cortisone is a corticosteroid that is a potent anti-inflammatory agent. Oral corticosteroids are systemic drugs with serious and predictable long-term side effects. Cortenema is a topical corticosteroid that is less absorbed into the body than oral corticosteroids, and, therefore, it has fewer and less severe side effects.
- Balsalazide (Colazal): This is another formulation of mesalamine. Colazal delivers anti-inflammatory medication directly to the colon. The drug is similar to sulfasalazine, but uses a less toxic carrier and may produce fewer side effects.
Colazal (balsalazide) is a capsule in which the 5-ASA is linked by a chemical bond to another molecule that is inert (without effect on the intestine) and prevents the 5-ASA from being absorbed. This drug is able to travel through the intestine unchanged until it reaches the end of the small bowel (terminal ileum) and colon. There, intestinal bacteria break apart the 5-ASA and the inert molecule, releasing the 5-ASA. Because intestinal bacteria are most abundant in the terminal ileum and colon, Colazal is used to treat inflammation predominantly localized to the colon. Colazal recently has been approved by the FDA for use in the United States.
More clinical trials are needed to compare the effectiveness of Colazal to the other mesalamine compounds such as Asacol in treating ulcerative colitis. Therefore in the United States, choosing which 5-ASA compound has to be individualized. Some health care providers prescribe Colazal for patients who cannot tolerate or fail to respond to Asacol. Others prescribe Colazal for patients with predominantly left-sided colitis, since some studies seem to indicate that Colazal is effective in treating left-sided colitis.
- Corticosteroids: Corticosteroids have been used for many years for the treatment of ulcerative colitis and Crohn's disease in patients with moderate to severe disease and in patients who fail to respond to 5-ASA compounds, systemic (oral) corticosteroids can be used. Unlike the 5-ASA compounds, corticosteroids do not require direct contact with the inflamed intestinal tissues to be effective. Systemic corticosteroids (prednisone, prednisolone, cortisone, etc.) are potent and fast-acting anti-inflammatory agents for treating Crohn's ileitis, enteritis, ileocolitis, and ulcerative and Crohn's colitis. In critically ill patients, intravenous corticosteroids (such as hydrocortisone) can be given in the hospital. Corticosteroids are faster acting than the 5-ASA compounds. Patients frequently experience improvement in their symptoms within days of starting corticosteroids. Systemic corticosteroids are not effective in maintaining remission in patients with ulcerative colitis. Serious side effects can result from prolonged corticosteroid treatment.
Corticosteroids can help reduce inflammation, but they have numerous side effects. Side effects of corticosteroids depend on the dose and duration of use. Short courses of prednisone, for example, usually are well tolerated with few and mild side effects. Long term, high doses of corticosteroids usually produce predictable and potentially serious side effects. Common side effects include a puffy, rounding of the face (called moon face), acne, increased body hair, excessive facial hair, night sweats, insomnia, weight gain, muscle weakness, depression, mood swings, personality changes, irritability, and hyperactivity. More serious side effects include high blood pressure, type 2 diabetes, osteoporosis, increased risk of compression fractures of the spine and other bone fractures, cataracts, glaucoma, and an increased susceptibility to infections. Long-term use of these drugs in children can lead to stunted growth.
The most serious complication from long term corticosteroid use is aseptic necrosis of the hip joints. Aseptic necrosis means death of bone tissue. It is a painful condition that can ultimately lead to the need for surgical replacement of the hips. Aseptic necrosis also has been reported in knee joints. It is unknown how corticosteroids cause aseptic necrosis. The estimated incidence of aseptic necrosis among corticosteroid users is 3-4 percent. Patients on corticosteroids who develop pain in the hips or knees should report the pain to their health care providers promptly. Early diagnosis of aseptic necrosis with cessation of corticosteroids has been reported in some patients to decrease the severity of the condition and possibly help avoid hip replacement.
Prolonged use of corticosteroids can depress the ability of the body's adrenal glands to produce cortisol (a natural corticosteroid necessary for proper functioning of the body). Abruptly discontinuing corticosteroids can cause symptoms due to a lack of natural cortisol (a condition called adrenal insufficiency). Symptoms of adrenal insufficiency include nausea, vomiting, and even shock. Withdrawing corticosteroids too quickly also can produce symptoms of joint aches, fever, and malaise. Therefore, corticosteroids need to be gradually reduced rather than abruptly stopped.
Even after the corticosteroids are discontinued, the adrenal glands' ability to produce cortisol can remain depressed for months to two years. The depressed adrenal glands may not be able to produce enough cortisol to help the body handle stress such as accidents, surgery, and infections. These patients will need treatment with corticosteroids (prednisone, hydrocortisone, etc.) during stressful situations to avoid developing adrenal insufficiency.
Because corticosteroids are not useful in maintaining remission in ulcerative colitis and Crohn's disease and because they have predictable and potentially serious side effects, these drugs should be used for the shortest possible length of time.
Also, corticosteroids do not work for everyone who has ulcerative colitis. Health care providers generally use corticosteroids only if you have moderate to severe inflammatory bowel disease that does not respond to other treatments. Corticosteroids are not for long-term use and are generally prescribed for a period of three to four months. To minimize side effects, corticosteroids should be gradually reduced as soon as disease remission is achieved. In patients who become corticosteroid dependent or are unresponsive to corticosteroid treatment, surgery or immunomodulator treatments are considered.
Proper use of corticosteroids is important. Once the decision is made to use oral corticosteroids, treatment usually is initiated with prednisone, 40-60 mg daily. The majority of patients with ulcerative colitis respond with an improvement in symptoms. Once symptoms improve, prednisone is reduced by 5-10 mg per week until the dose of 20 mg per day is reached. The dose then is tapered at a slower rate until the prednisone ultimately is discontinued. Gradually reducing corticosteroids not only minimizes the symptoms of adrenal insufficiency, it also reduces the chances of abrupt relapse of the colitis.
They may also be used in conjunction with other medications as a means to induce remission. For example, corticosteroids may be used with an immune system suppressor - the corticosteroids can induce remission, while the immune system suppressors can help maintain remission. Occasionally, your health care provider may also prescribe steroid enemas to treat disease in your lower colon or rectum. These, too, are only for short-term use.
Many practitioners use 5-ASA compounds at the same time as corticosteroids. In patients who achieve remission with systemic corticosteroids, 5-ASA compounds such as Asacol are often continued to maintain remissions.
In patients whose symptoms return during reduction of the dose of corticosteroid, the dose of corticosteroids is increased slightly to control the symptoms. Once the symptoms are under control, the reduction can resume at a slower pace. Some patients become corticosteroid dependent. These patients consistently develop symptoms of colitis whenever the corticosteroid dose reaches below a certain level. In patients who are corticosteroid dependent or who are unresponsive to corticosteroids, other anti-inflammatory medications, immunomodulator medications or surgery are considered.
The management of patients who are corticosteroid dependent or patients with severe disease which responds poorly to medications is complex. Health care providers who are experienced in treating inflammatory bowel disease and in using the immunomodulators should evaluate these patients.
Preventing Corticosteroid-Induced Osteoporosis: Long-term use of corticosteroids such as prednisolone or prednisone can cause osteoporosis. Corticosteroids cause decreased calcium absorption from the intestines and increased loss of calcium from the kidneys and bones. Increasing dietary calcium intake is important but alone cannot halt corticosteroid-induced bone loss. Management of patients on long term corticosteroids should include:
- Adequate calcium (1000 mg daily if pre-menopausal, 1500 mg daily if post-menopausal) and vitamin D (800 units daily) intake.
- Periodic review with the health care provider on the need for continued corticosteroid treatment and the lowest effective dose if continued treatment is necessary.
- A bone density study to measure the extent of bone loss in patients taking corticosteroids for more than three months.
- Regular weight-bearing exercise, and stop smoking cigarettes.
- Discussion with the practitioner regarding the use of alendronate (Fosamax) or risedronate (Actonel) in the prevention and the treatment of corticosteroid induced osteoporosis.
IMMUNE-SYSTEM SUPPRESSORS
Immunomodulators are medications that weaken the body's immune system. The immune system is composed of immune cells and the proteins that these cells produce. These cells and proteins serve to defend the body against harmful bacteria, viruses, fungi, and other foreign invaders. Activation of the immune system causes inflammation within the tissues where the activation occurs. (Inflammation is, in fact, an important mechanism to defend the body used by the immune system.) Normally, the immune system is activated only when the body is exposed to harmful invaders. In patients with Crohn's disease and ulcerative colitis, however, the immune system is abnormally and chronically activated in the absence of any known invader.
Immunomodulator drugs reduce inflammation, but they target your immune system rather than treating inflammation itself. Immunomodulators decrease tissue inflammation by reducing the population of immune cells and/or by interfering with their production of proteins that promote immune activation and inflammation. Because immune suppressors can be effective in treating ulcerative colitis, scientists theorize that damage to digestive tissues is caused by your body's immune response to an invading virus or bacterium or even to your own tissue. By suppressing this response, inflammation is also reduced.
Generally, the benefits of controlling moderate to severe ulcerative colitis outweigh the risks of infection due to weakened immunity. Examples of immunomodulators include azathioprine (Imuran), 6-mercaptopurine (6-MP, Purinethol), cyclosporine (Sandimmune), and methotrexate (Rheumatrex, Trexall). Immunosuppressant drugs include:
- Methotrexate (Rheumatrex, Trexall) : Methotrexate is an immunomodulator and anti-inflammatory medication. Methotrexate has been used for many years in the treatment of severe rheumatoid arthritis and psoriasis. It has been helpful in treating patients with moderate to severe Crohn's disease who are either not responding to 6-MP and azathioprine or are intolerant of these two medications. Methotrexate also may be effective in patients with moderate to severe ulcerative colitis who are not responding to corticosteroids or 6-MP and azathioprine. It can be given orally or by weekly injections under the skin or into the muscles. It is more reliably absorbed with the injections.
One major complication of methotrexate is the development of liver cirrhosis when the medication is given over a prolonged period of time (years). The risk of liver damage is higher in patients who also abuse alcohol or have morbid (severe) obesity. Generally, periodic liver biopsies are recommended for a patient who has received a cumulative (total) methotrexate dose of 1.5 grams and higher. Other side effects of methotrexate include low white blood cell counts and inflammation of the lungs. Methotrexate should not be used in pregnancy.
- Azathioprine (Imuran) & Mercaptopurine [6-MP] (Purinethol): Azathioprine and 6-mercaptopurine (6-MP) are medications have been used to treat Crohn's disease for years, but their role in ulcerative colitis is only now being studied. Azathioprine (Imuran) and 6-MP (Purinethol) are drugs that weaken the body's immunity by reducing the population of a class of immune cells called lymphocytes. Azathioprine and 6-MP are related chemically. Specifically, azathioprine is converted into 6-MP inside the body. In high doses, these two drugs have been useful in preventing rejection of transplanted organs and in treating leukemia. In low doses, they have been used for many years to treat patients with moderate to severe Crohn's disease and ulcerative colitis and are increasingly recognized by health care providers as valuable drugs in treating these diseases. Some 70 percent of patients with moderate to severe disease will benefit from these drugs.
Because azathioprine and mercaptopurine act slowly (slow onset of action) and the potential for side effects, they are sometimes initially combined with a corticosteroid, but in time, they seem to produce benefits on their own, with less long-term toxicity. 6-MP and azathioprine are used mainly in the following situations:
- Ulcerative colitis and Crohn's disease patients with severe disease not responding to corticosteroids.
- Patients who are experiencing undesirable corticosteroid-related side effects.
- Patients who are dependent on corticosteroids and are unable to discontinue them without developing relapses.
When azathioprine and 6-MP are added to corticosteroids in the treatment of ulcerative colitis patients who do not respond to corticosteroids alone, there may be an improved response or smaller doses and shorter courses of corticosteroids may be able to be used. Some patients can discontinue corticosteroids altogether without experiencing relapses. The ability to reduce corticosteroid requirements has earned 6-MP and azathioprine their reputation as "steroid-sparing" medications.
In ulcerative colitis patients with severe disease who suffer frequent relapses, 5-ASA may not be sufficient, and more potent azathioprine and 6-MP will be necessary to maintain remissions. In the doses used for treating ulcerative colitis and Crohn's disease, the long-term side effects of azathioprine and 6-MP are less serious than long-term oral corticosteroids or repeated courses of oral corticosteroids.
Side effects can include allergic reactions, bone marrow suppression, increased vulnerability to infections, and inflammation of the liver (hepatitis), pancreas (pancreatitis) and bone marrow toxicity (interfering with the formation of cells that circulate in the blood).
The goal of treatment with 6-MP and azathioprine is to weaken the body's immune system in order to decrease the intensity of inflammation in the intestines; however, weakening the immune system increases the vulnerability to infections. For example, in a group of patients with severe Crohn's disease unresponsive to standard doses of azathioprine, raising the dose of azathioprine helped to control the disease, but two patients developed cytomegalovirus (CMV) infection. (CMV usually infects individuals with weakened immune systems such as patients with AIDS or cancer, especially if they are receiving chemotherapy, which further weakens the immune system.
Azathioprine and 6-MP-induced inflammation of the liver (hepatitis) and pancreas (pancreatitis) are rare. Pancreatitis typically causes severe abdominal pain and sometimes vomiting. Pancreatitis due to 6-MP or azathioprine occurs in 3 to 5 percent of patients, usually during the first several weeks of treatment. Patients who develop pancreatitis should not receive either of these two medications again.
Azathioprine and 6-MP also suppress the bone marrow. The bone marrow is where red blood cells, white blood cells, and platelets are made. Actually, a slight reduction in the white blood cell count during treatment is desirable since it indicates that the dose of 6-MP or azathioprine is high enough to have an effect; however, excessively low red or white blood cell counts indicates bone marrow toxicity. Therefore, patients on 6-MP and azathioprine should have periodic blood counts (usually every two weeks initially and then every 3 months during maintenance) to monitor the effect of the drugs on their bone marrow.
6-MP can reduce the sperm count in men. When the partners of male patients on 6-MP conceive, there is a higher incidence of miscarriages and vaginal bleeding. There also are respiratory difficulties in the newborn. Therefore, it is recommended that whenever feasible, male patients should stop 6-MP and azathioprine for three months before conception.
Patients on long-term, high dose azathioprine to prevent rejection of the kidney after kidney transplantation have an increased risk of developing lymphoma, a malignant disease of lymphatic cells. There is no evidence at present that long term use of azathioprine and 6-MP in the low doses used in IBD increases the risk for lymphoma, leukemia or other malignancies.
One problem with 6-MP and azathioprine is their slow onset of action. Typically, full benefit of these drugs is not realized for three months or longer. During this time, corticosteroids frequently have to be maintained at high levels to control inflammation. The reason for this slow onset of action is partly due to the way health care providers prescribe 6-MP. Typically, 6-MP is started at a dose of 50 mg daily. The blood count is then checked two weeks later. If the white blood cell count (specifically the lymphocyte count) is not reduced, the dose is increased. This cautious, stepwise approach helps prevent severe bone marrow and liver toxicity, but also delays benefit from the drug.
Studies have shown that giving higher doses of 6-MP early can speed up the benefit of 6-MP without increased toxicity in most patients, but some patients do develop severe bone marrow toxicity. Therefore, the dose of 6-MP has to be individualized. Scientists now believe that an individual's vulnerability to 6-MP toxicity is genetically inherited. Blood tests can be performed to identify those individuals with increased vulnerability to 6-MP toxicity. In these individuals, lower initial doses can be used. Blood tests can also be performed to measure the levels of certain by-products of 6-MP. The levels of these by-products in the blood help health care providers more quickly determine whether the dose of 6-MP is right for the patient.
Patients have been maintained on 6-MP or azathioprine for years without any important long-term side effects. Their health care providers, however, should closely monitor their patients on long-term 6-MP. There is data suggesting that patients on long-term maintenance with 6-MP or azathioprine fare better than those who stop these medications. Those who stop 6-MP or azathioprine are more likely to experience relapses, more likely to need corticosteroids or undergo surgery.
If you are taking either of these medications, you will need to follow up closely with your health care provider and have your blood checked regularly to look for side effects.
- Cyclosporine (Neoral, Sandimmune): Cyclosporine is a potent immunosuppressant drug that is normally reserved for people who do not respond well to other medications or who face surgery because of severe ulcerative colitis and Crohn's disease. It is used in preventing organ rejection after transplantation, for example, of the liver.
Because of the approval of infliximab (Remicade) for treating severe Crohn's disease, cyclosporine probably will be used primarily in severe ulcerative colitis. Cyclosporine is useful in fulminant ulcerative colitis and in severely ill patients who are not responding to systemic corticosteroids. Administered intravenously, cyclosporine can be very effective in rapidly controlling severe colitis and avoiding or delaying surgery.
In some cases, cyclosporine may be used to delay surgery until you are strong enough to undergo the procedure; in others, it is used to control signs and symptoms until less toxic drugs start working. Cyclosporine also is available as an oral medication, but the relapse rate with oral cyclosporine is high. Therefore, cyclosporine seems most useful when administered intravenously in acute situations.
Cyclosporine begins working in one to two weeks, but because it has the potential for severe side effects, including high blood pressure, impairment of kidney function, liver damage, fatal infections and an increased risk of lymphoma, tingling sensations in the extremities, and more serious side effects which include anaphylactic shock and seizures, you and your health care provider will want to talk about the risks and benefits of treatment.
- Infliximab (Remicade): This drug is specifically for adults and children with moderate to severe ulcerative colitis who do not respond to or cannot tolerate other treatments. Infliximab is an antibody that attaches to a protein called tumor necrosis factor-alpha (TNF-alpha). TNF-alpha is one of the proteins produced by immune cells that promote inflammation by stimulating other cells of the immune system to produce and release other proteins that promote inflammation. In Crohn's disease and in ulcerative colitis, there is continued production of TNF-alpha as part of the immune activation. By attaching to TNF-alpha, infliximab blocks its activity, neutralizing the protein, and in so doing decreases inflammation. Infliximab finds TNF in your bloodstream and removes it before it causes inflammation in your intestinal tract and contributes to the formation of infected sores called fistulas.
Infliximab has been used successfully for many years in effectively treating moderate to severe Crohn's disease patients who are not responding adequately to corticosteroids and immunomodulators such as 6-MP/azathioprine. In Crohn's disease patients, 65 percent experienced improvement in their disease after one infusion of infliximab. Some patients noticed improvement in symptoms within days of the infusion. Most patients experienced improvement within two weeks. In patients who respond to infliximab, the improvements in symptoms can be dramatic. Moreover, there can be impressively rapid healing of the ulcers and the inflammation in the intestines after just one infusion.
For many years health care providers were uncertain whether infliximab could be used and would not be beneficial in treating ulcerative colitis. Only recently, have health care providers begun to use infliximab as treatment for ulcerative colitis. Recent studies involving small numbers of patients with severe ulcerative colitis who are not responding to high dose steroids indicated infliximab may be beneficial in controlling disease and in decreasing the need for urgent removal of the colon. Placebo controlled studies involving larger number of patients will be conducted to determine the efficacy and safety of infliximab in ulcerative colitis. In one randomized placebo controlled study involving more than 700 patients with moderate to severe ulcerative colitis, infliximab (5 mg or 10 mg per kilogram body weight) given intravenously was more effective than placebo in inducing and maintaining remission.
Infliximab, generally, is well tolerated. There have been rare reports of side effects during infusions, including chest pain, shortness of breath, and nausea. These effects usually resolve spontaneously within minutes if the infusion is stopped. Other commonly reported side effects include headache and upper respiratory tract infection.
Infliximab, like immuno-modulators, increases the risk for infection. One case of salmonella colitis and several cases of pneumonia have been reported with the use of infliximab. There also have been cases of tuberculosis (TB) reported after the use of infliximab.
Some people with heart failure, people with multiple sclerosis, and people with cancer or a history of cancer cannot take Remicade. There are some reports of worsening heart disease in patients who have received Remicade. The precise mechanism and role of infliximab in the development of this side effect is unclear. As a precaution, individuals with heart disease should inform their health care provider of this condition before receiving infliximab. There have been rare reports of nerve damage such as optic neuritis (inflammation of the nerve of the eye) and motor neuropathy. Infliximab can aggravate and cause the spread of an existing infection. Therefore, it should not be given to patients with pneumonia, urinary tract infection or abscess (localized collection of pus). The drug has been linked to an increased risk of infection, especially tuberculosis, and may increase your risk of blood problems and cancer. You will need to have a skin test for tuberculosis before taking infliximab and a chest X-ray if you lived or traveled extensively where tuberculosis has been found. Patients who previously had TB should inform their health care provider of this before they receive infliximab. Infliximab can cause the spread of cancer cells, therefore, it should not be given to patients with cancer. Infliximab's effects on the fetus are not known. If you are currently taking Remicade, talk to your health care provider about the potential risks.
Infliximab, an antibody to TNF-alpha, is produced by the immune system of mice after the mice are injected with human TNF-alpha. The mouse antibody then is modified to make it look more like a human antibody, and this modified antibody is infliximab. Such modifications are necessary to decrease the likelihood of allergic reactions when the antibody is administered to humans. Infliximab is given by intravenous infusion over two hours. Patients are monitored throughout the infusion for adverse reactions. Because Remicade partly contains a mouse protein, some patients can develop antibodies against infliximab with repeated infusions. The development of these antibodies can decrease the effectiveness of the drug and can cause (induce) serious allergic (immune) reactions in some people, especially with repeated infusions. In addition to the side effects that occur while the infusion is being given, patients may develop a "delayed allergic reaction" - reactions that may be delayed for days to weeks after starting treatment. These reactions occurs 7 to 10 days after receiving the infliximab. This type of reaction may cause flu-like symptoms with fever, joint pain and swelling, and a worsening of Crohn's disease symptoms. It can be serious, and if it occurs, a health care provider should be contacted. Paradoxically, those patients who have more frequent infusions of Remicade are less likely to develop this type of delayed reaction compared to those patients who receive infusions separated by long intervals (6-12 months). The chances of developing these antibodies can be decreased by concomitant use of 6-MP and corticosteroids.
While infliximab represents an exciting new class of medications in the fight against Crohn's disease and ulcerative colitis, caution is warranted because of potentially serious side effects. Health care providers are using infliximab in moderate to severe ulcerative colitis not responding to other medications.
Although Remicade is only FDA approved for a single infusion at this time, patients should be aware that they are likely to require repeated infusions once Remicade therapy has been initiated. Once started, infliximab is often continued as long-term therapy, although its effectiveness may wear off over time.
Active research is also ongoing to find other anti-TNF agents that are potentially more effective with less side effects in treating ulcerative colitis.
Research in ulcerative colitis is very active, and many questions remain to be answered. The cause, mechanism of inflammation, and optimal treatments have yet to be defined. Researchers have recently identified genetic differences among patients which may allow them to select certain subgroups of patients with ulcerative colitis who may respond differently to medications. Newer and safer medications are being developed. Improvements in surgical procedures to make them safer and more effective continue to emerge.
NICOTINE PATCHES
Nicotine patches - the same kind smokers use - seem to provide short-term relief from flare-ups of ulcerative colitis for some people, especially people who formerly smoked. Several studies have shown that the nicotine patch may help treat active ulcerative colitis. How nicotine patches work is not exactly clear, and the evidence that they provide relief is contested among researchers. It is not yet known how long the benefits of the nicotine patch last or if the patch can help prevent flare-ups of ulcerative colitis. If the patch works, it most likely benefits people whose symptoms began or became worse after quitting smoking. However, due to the addictive power and other harmful effects of nicotine, most health care providers still prefer to use traditional medicines to treat ulcerative colitis before trying the nicotine patch. Talk to your health care provider before trying this treatment.
Do not take up smoking as a treatment for ulcerative colitis. The risks from smoking far outweigh any potential benefit.
OTHER MEDICATIONS
In addition to controlling inflammation, some medications may help relieve your signs and symptoms. Depending on the severity of your ulcerative colitis, your health care provider may recommend one or more of the following:
- Anti-Diarrheals: A fiber supplement such as psyllium powder (Metamucil) or methylcellulose (Citrucel) can help relieve signs and symptoms of mild to moderate diarrhea by adding bulk to your stool. For more severe diarrhea, loperamide (Imodium) may be effective. Use anti-diarrheal medications with great caution, however, because they increase the risk of toxic megacolon.
- Laxatives: In some cases, swelling may cause your intestines to narrow, leading to constipation. Talk to your health care provider before taking any laxatives, because even those sold over-the-counter may be too harsh for your system.
- Pain Relievers: For mild pain, your health care provider may recommend acetaminophen (Tylenol, others). Do not use non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen (Aleve). These are likely to make your symptoms worse.
- Iron Supplements: If you have chronic intestinal bleeding, you may develop iron deficiency anemia. Taking iron supplements may help restore your iron levels to normal and reduce this type of anemia once your bleeding has stopped or diminished. Some people may experience constipation side effects with iron supplements. Do not take iron supplements unless you have been diagnosed with anemia.
MEDICINAL CONSIDERATIONS
People with inflammatory bowel diseases should avoid using non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen). Studies may have linked the pain relievers with flare-ups of IBD. Discuss it with your health care provider before taking these medications.
Drugs such as corticosteroids and sulfasalazine (Azulfidine), which are prescribed for inflammatory bowel diseases, and cholestyramine (Questran), which is prescribed to lower cholesterol levels, increase the need for nutritional supplements. Corticosteroids depress protein synthesis and inhibit normal calcium absorption by increasing excretion of vitamin C in the urine. Deficiencies of other nutrients, such as zinc, potassium, vitamin B-6 (pyridoxine), folic acid, and vitamin D, decrease bone formation and slow healing. Sulfasalazine inhibits the transport of folic acid and iron, causing anemia.
Most people with ulcerative colitis and Crohn's disease are initially treated with drugs, particularly corticosteroids, such as Budesonide, to help control inflammation. This newer drug has fewer side effects than the older corticosteroids. Drugs that suppress the immune system are also used, but they can increase susceptibility to infection. Currently, the drugs methotrexate (Rheumatrex) and cyclosporine (Neoral, Sandimmune, SangCya) are being tried along with the traditional immunosuppressive drugs.
The Food and Drug Administration (FDA) has now approved under an accelerated program a genetically engineered product called infliximab (Remicade). Remicade is an intravenously administered drug for people with moderate-to-severe inflammatory bowel disease who have not responded to traditional treatments. Remicade works specifically against a protein that promotes inflammation and has been shown to reduce intestinal inflammation. In drug trials, one dose relieved many of the symptoms for 2 to 4 weeks, after which the benefits waned. Because the long-term toxic effects of the drug are unknown, scientists are still trying to better define risks and benefits.
Anti-TNF (Anti-Tumor-Necrosis-Factor) is a substance that finds a protein in the bloodstream called TNF, then binds to and removes it. TNF may be a principle cause of inflammation. Anti-TNF has been particularly successful in the treatment of fistulas.
SURGERY
If diet and lifestyle changes, drug therapy or other treatments do not relieve your signs and symptoms, your health care provider may recommend surgery. About 25 to 40 percent of ulcerative colitis patients must eventually have their colons removed because of massive bleeding, severe illness, rupture of the colon, or risk of cancer. Sometimes the health care provider will recommend removing the colon if medical treatment fails or if the side effects of corticosteroids or other drugs threaten the patient's health.
Surgery can often eliminate ulcerative colitis. But that usually means removing your entire colon and rectum (proctocolectomy). A proctocolectomy, is followed by one of the following:
- Ileostomy, in which the surgeon creates a small opening in the abdomen, called a stoma, and attaches the end of the small intestine, called the ileum, to it. Waste will travel through the small intestine and exit the body through the stoma. The stoma is about the size of a quarter and is usually located in the lower right part of the abdomen near the beltline. A pouch is worn over the opening to collect waste, and the patient empties the pouch as needed.
- In the past, after this surgery you would wear a small bag over an opening in your abdomen (ileostomy) to collect stool. But a procedure called ileoanal anastomosis eliminates the need to wear a bag. Ileoanal anastomosis, or pull-through operation, is a procedure which allows the patient to have normal bowel movements because it preserves part of the anus. In this operation, the surgeon removes the colon and the inside of the rectum, leaving the outer muscles of the rectum. The surgeon then attaches the ileum (small intestine) to the inside of the rectum and the anus, creating a pouch from the end of your small intestine. The pouch is then attached directly to your anus. Waste is stored in the pouch and passes through the anus in the usual manner. This allows you to expel waste more normally, although you may have as many as five to seven soft or watery bowel movements a day because you no longer have your colon to absorb water. Inflammation of the pouch (pouchitis) is a possible complication.
Not every operation is appropriate for every person. Which surgery to have depends on the severity of the disease and the patient's needs, expectations, and lifestyle. People faced with this decision should get as much information as possible by talking to their health care providers, to nurses who work with colon surgery patients (enterostomal therapists), and to other colon surgery patients. Patient advocacy organizations can direct people to support groups and other information resources.
If you have surgery, your health care provider may discuss whether an ileostomy or an ileoanal pouch is right for you. Between 25 percent and 40 percent of people with ulcerative colitis eventually need surgery.
THE SURGERY DECISION
Ulcerative colitis affects only the large intestine, so surgery that removes the entire large intestine can cure the disease. Some people who have ulcerative colitis in the entire colon (pancolitis) eventually need surgery to remove the colon.
People may need surgery for ulcerative colitis in several situations, such as when other therapy fails to manage symptoms, when holes develop in the large intestine, or if dysplasia is found during colonoscopy or biopsy.
SURGERY CHOICES
Removal of the colon to cure ulcerative colitis involves one of these surgeries:
- In ileoanal anastomosis, the surgeon removes some or all of the large intestine (colon) and the diseased lining of the rectum. Then the end of the small intestine (the ileum) is connected to the anal canal. The anal sphincters are saved and this allows you to have bowel movements without an ostomy.
- In proctocolectomy and ileostomy, the large intestine and rectum are removed, leaving the lower end of the small intestine (the ileum). The surgeon sews the anus closed and makes a small opening called a stoma in the skin of the lower abdomen. The ileum is connected to the stoma, creating an opening to the outside of the body. Stool empties into a small plastic pouch called an ostomy bag that is applied to the skin around the stoma.
- In continent ileostomy, the surgeon removes the large intestine (colon) and creates a pouch and a valve from the lower end of the small intestine (the ileum). The surgeon then connects the valve to an opening (stoma) in the skin of the lower abdomen. After this surgery, you can insert a tube into the valve to release stool from the intestines.
THINKING ABOUT SURGERY
Ileoanal anastomosis is performed most often. Proctocolectomy with ileostomy is preferred for people who cannot tolerate anesthesia for a long period of time because of illness or age.
Both children and adults may have ileoanal anastomosis, which may be done in stages to reduce the risk of complications. A temporary ileostomy is created first, with the ileum pouch completed 3 to 6 months later. Surgery can improve a child's well-being and quality of life and restore normal growth and sexual development.
In the past, many people who had surgery for IBD had an ileostomy and wore an ostomy bag outside the abdomen. Newer surgeries like ileoanal anastomosis or continent ileostomy can eliminate the need for an ostomy bag with fairly good results when they are done by a trained surgeon. Traditional ostomy surgery is easier and may have fewer risks and complications than the newer procedures, but some people may be less satisfied with the results.
People with ulcerative colitis may choose to have their colon removed because their symptoms cause a poor quality of life. They also may want the surgery to prevent the possibility of colon cancer.
In most cases, surgery can be scheduled at your convenience. Emergency surgery usually is not needed unless an acute attack causes toxic megacolon, severe uncontrolled bleeding, or a spontaneous rupture in the intestine. The risk of complications after surgery can be high if surgery is done during a severe or rapidly worsening attack or if emergency surgery is needed. If toxic megacolon has developed, surgery may be the only option to save a person's life.
REASONS TO HAVE SURGERY
- Medications are not controlling your symptoms.
- Medications such as corticosteroids are causing side effects such as cataracts or osteoporosis.
- Your activities continue to be interrupted by frequent urgency, pain, and diarrhea.
- You have complications outside the colon, such as problems with your joints, eyes, or liver; however, some complications may not go away with surgery.
- Your quality of life is suffering from symptoms and limitation of activities.
- You have precancerous changes (dysplasia) in the colon or you have concern about your risk of colon cancer.
Are there other reasons why you might want to have surgery?
REASONS NOT TO HAVE SURGERY
Surgeries to remove the colon have a significant risk of complications, including:
- Blockage (obstruction) of the small intestine.
- Inflammation in the pouch (pouchitis) created from the small intestine.
- Leakage of stool.
- Depending on the type of surgery, you may need to wear an ostomy bag to remove waste.
- You may not need surgery now. Screening for colon cancer usually does not begin until you have had ulcerative colitis for 8 years.
Are there other reasons why you might not want to have surgery?
SURGERY DECISION WORKSHEET
Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having surgery for ulcerative colitis. Discuss the worksheet with your health care provider.
Circle the answer that best applies to you.
Medications are not controlling my symptoms. Yes No Unsure I have troublesome side effects from my medications. Yes No Unsure My quality of life is poor with my current treatment. Yes No Unsure I have complications from IBD. Yes No Unsure I have to severely limit my activities because of my condition. Yes No Unsure I have had signs of precancerous changes (dysplasia) in my colon. Yes No Unsure I do not have dysplasia, but I am worried I will develop cancer. Yes No Unsure I am concerned about how my body will look if I have an ileostomy. Yes No Unsure I know complications sometimes occur with surgery, but curing my disease is worth the risk. Yes No Unsure
Use the following space to list any other important concerns you have about surgery or ulcerative colitis.
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have surgery.
Check the box below that represents your overall impression about your decision.
Leaning toward having surgery. Yes No Unsure Leaning toward NOT having surgery. Yes No Unsure
SUMMARY
Most people with ulcerative colitis lead normal, active lives with few restrictions. Although there is no cure (except by surgery), the disorder can be managed with present treatments. For a few patients, the course of the disease may be more difficult and complicated, requiring more testing and intensive therapy. Surgery sometimes is required. In all cases, follow-up care with the health care provider is essential to monitor the disease and prevent and treat any complications that arise.
DIETARY, HERBAL & HOLISTIC RECOMMENDATIONS
LIFESTYLE RECOMMENDATIONS
STRESS MANAGEMENT
Although stress does not cause inflammatory bowel disease, it can make your signs and symptoms much worse and may trigger flare-ups. Stressful events can range from minor annoyances to a move, job loss or the death of a loved one. When you are stressed, your normal digestive process changes. Your stomach empties more slowly and secretes more acids. Stress can also speed or slow the passage of intestinal contents. It may also cause changes in intestinal tissue itself. Although it is not always possible to avoid stress, you can learn ways to help manage it. Some of these include:
- Exercise: Even mild exercise can help reduce stress, relieve depression and normalize bowel function. Talk to your health care provider about an exercise plan that is right for you.
- Biofeedback: This stress-reduction technique helps you reduce muscle tension and slow your heart rate with the help of a feedback machine. You are then taught how to produce these changes yourself. The goal is to help you enter a relaxed state so that you can cope more easily with stress. Biofeedback is usually taught in hospitals and medical centers.
- Regular Relaxation & Breathing Exercises: An effective way to cope with stress from ulcerative colitis is to regularly relax and exercise. You can take classes in yoga and meditation or practice at home using books or tapes.
You can also practice progressive relaxation exercises. These help relax the muscles in your body, one by one. Start by tightening the muscles in your feet, then concentrate on slowly letting all the tension go. Next, tighten and relax your calves. Continue until the muscles in your body, including those in your eyes and scalp, are completely relaxed.
Deep breathing also can help you relax. Most adults breathe from their chests. But you become calmer when you breathe from your diaphragm - the muscle that separates your chest from your abdomen. When you inhale, allow your belly to expand with air; when you exhale, your abdomen naturally contracts. Deep breathing can also help relax your abdominal muscles, which may lead to more normal bowel activity.
- Hypnosis: Hypnosis may reduce abdominal pain and bloating. A trained professional can teach you how to enter a relaxed state and then guide you as you imagine your intestinal muscles becoming smooth and calm.
- Other Techniques: Set aside at least 20 minutes a day for any activity you find relaxing such as listening to music, reading, playing computer games or just soaking in a warm bath.
ALTERNATIVE MEDICINE
Many people are interested in non-traditional approaches to healing, especially when standard treatments produce intolerable side effects or are not able to provide an improvement. They may turn to alternative therapies because there is no complete cure other than removal of the colon. Other reasons for seeking complementary medicine include:
- Coping with the difficult side effects from standard medicines.
- Dealing with the emotional strain caused by chronic disease.
- Dealing with the negative impact that severe disease has on daily life.
The various complementary therapies include:
- Special diets or nutritional supplements, such as probiotics.
- Fatty acids found in oily fish, such as salmon and tuna.
- Vitamin supplements, such as vitamins D and B-12.
- Herbs, such as aloe and ginseng.
- Massage.
- Stimulation of the feet, hands, and ears to try to affect parts of the body (reflexology).
- Chiropractic therapy.
Probiotics and fatty acids are the most promising complementary therapies being studied for ulcerative colitis.
To address this interest, the National Institutes of Health established the National Center for Complementary and Alternative Medicine (NCCAM), which provides guidance and research.
Most alternative and complementary therapies do not simply address a problem with the body. Instead, they focus on the entire person - body, mind and spirit. As a result, they can be especially effective at reducing stress, alleviating the side effects of conventional treatments and improving quality of life.
Studies have found that more than half the people with either ulcerative colitis or Crohn's disease have used some form of alternative or complementary therapy. The most common complementary therapies tried were nutritional supplements, probiotics and fish oil. Side effects and ineffectiveness of conventional therapies are primary reasons for seeking alternative care. Only about two-thirds report their alternative or complementary therapy use to their health care providers, however.
Before using any alternative, complementary, or herbal therapy, you should consult with your health care provider or Naturopathic practitioner (trained in the use of these types of therapies). Herbs can have side effects and cause dangerous interactions when used with some medications.
NCCAM's findings are available on its Web site. You can also talk to information specialists at the center's clearinghouse by calling 888-644-6226 between 8:30 a.m. and 5 p.m. Eastern time.
COPING & SUPPORT
Ulcerative colitis does not just affect you physically - it takes an emotional toll as well. If signs and symptoms are severe, your life may revolve around a constant need to run to the toilet. In some cases, you may barely be able to leave the house. When you do, you might worry about an accident, and this anxiety only makes your symptoms worse.
Even if your symptoms are mild, gas and abdominal pain can make it difficult to be out in public. You may also feel hampered by dietary restrictions or embarrassed by the nature of your disease. All of these factors - isolation, embarrassment and anxiety - can severely alter your life. Sometimes they may lead to depression.
SUPPORT GROUPS
One of the best ways to feel more in control is to find out as much as possible about ulcerative colitis. Organizations such as the Crohn's and Colitis Foundation of America (CCFA) have chapters set up across the country to provide information and access to support groups. Your health care provider, nurse or dietitian can locate the chapter nearest you, or you can contact the organization directly.
Crohn's & Colitis Foundation of America (CCFA) Web Site
Although support groups are not for everyone, they can provide valuable information about your condition as well as emotional support. Group members frequently know about the latest medical treatments or integrative therapies. You may also find it reassuring to be among people who understand what you are going through.
COUNSELING
Some people find it helpful to consult a psychologist or psychiatrist who is familiar with inflammatory bowel disease and the emotional difficulties it can cause. Although living with ulcerative colitis can be discouraging, the outlook is brighter than it was even just a few years ago.
You may want to seek professional counseling or social support from family, friends, or clergy. Ulcerative colitis can affect every aspect of your life. Research has shown that strong social support can reduce psychological stress and disease activity.
OTHER SUGGESTIONS & RECOMMENDATIONS
Do not wear clothing that is too tight around the waist.
Check stools daily for bleeding.
As much as possible, avoid stress. Our thoughts, nervous systems, and bodily functions are deeply interconnected. Our bodies are affected by our thoughts and moods. During an attack, rest is important.
Make sure the bowels move daily, but do not use harsh laxatives. Gentle enemas made by adding a dropperful of alcohol-free herbal extract and 1 teaspoon of non-dairy acidophilus powder to 2 quarts of lukewarm water are good. Accumulations of toxic body wastes often become breeding grounds for parasitic infestation. Toxins can also be absorbed into the bloodstream through the colon wall. Psyllium husks should be used daily for fiber; this aids in removing toxins before they are absorbed. Note: Always take supplemental fiber separately from other supplements and medications.
Do not use rectal suppositories that contain hydrogenated chemically prepared fats.
If you are constipated, use a cleansing enema. Use a heating pad to reduce abdominal pain. A cleansing enema is made from 2 quarts of lukewarm water. This helps to rid the colon of undigested foods and relieve pain. Use wheatgrass juice as a retention enema. For severe gas and bloating, use a B. bifidus enema.
Herbal Remedies: Wheatgrass Supplements & Products
Herbal Remedies: Primadophilus Bifidus, Nature's Way, 71 mg, 180 VCaps
Herbal Remedies: Acidophilus & Bifidus, 8 Billion, NOW Foods, 60 Caps
Follow a fasting program once a month to give your colon a restful break.
HERBS
Aerobic Bulk Cleanse (ABC) from Aerobic Life Industries contains healing herbs that cleanse the colon. Take it mixed with half fruit or vegetable juice and half aloe vera juice, before meals. Note: Always take this product separately from other supplements and medications.
Alfalfa, taken in capsule or liquid form, supplies vitamin K and chlorophyll, needed for healing. Take it as directed on the product label 3 times daily.
Herbal Remedies: Chlorophyll With Alfalfa Powder, NOW Foods, 100 mg, 90 Caps
Herbal Remedies: Alfa Max, Alfalfa Extract, Nature's Way, 525 mg, 100 Caps
Herbal Remedies: Alfalfa Powder, Whole Food Supplement, NOW Foods, 1 lb.
Herbal Remedies: Alfalfa Leaves, Nature's Way, 405 mg, 100 Caps
Herbal Remedies: Alfalfa, NOW Foods, 650 mg, 500 Tabs
Herbal Remedies: Alfalfa Tincture, 2 fl. oz.
Aloe Vera is beneficial for healing of colon, thereby relieving pain. Aloe vera softens stools and has a healing effect on the digestive tract. Drink 1/2 cup of aloe vera juice in the morning and again in the evening at bedtime.
Herbal Remedies: Aloe Vera Concentrate, NOW Foods, 100% Organic, 4 oz.
Herbal Remedies: Aloe Vera Gel & Juice, Wild Berry Flavor, Premium Quality, Nature's Way, 1 Liter
Herbal Remedies: Aloe Vera Gel & Juice, 99.7% Pure, Certified Organic, Nature's way, 1 Liter
Herbal Remedies: Aloe Vera Juice, Herbal Aloe Force, Organically Grown, Unprocessed Whole Raw Aloe Vera, 33.8 fl. oz.
Herbal Remedies: Aloe Vera Gel, NOW Foods, 32 oz.
There are many combination herbal products designed to offer gastrointestinal relief. Enzymatic Therapy, Olympian Labs, and Solaray are recommended sources.
Boswellia (Frankincense), Bromelain, Buchu Leaves, and Turmeric (Curcumin) reduce inflammation.
Herbal Remedies: Boswellia (Frankincense) Powder, 4 oz. Bulk
Herbal Remedies: Boswellia Tincture, 2 fl. oz.
Herbal Remedies: Boswellia Extract Herb Tincture, Herbal Remedies USA, 2 oz.
Herbal Remedies: Boswellia Extract (Frankincense), Standardized, Nature's Way, 307 mg, 60 Tabs
Herbal Remedies: Bromelain 2000 GDU, NOW Foods, 500 mg, 90 Tabs
Herbal Remedies: Buchu Leaves Tincture, Alternative Health & Herbs Remedies, 2 fl. oz.
Herbal Remedies: Buchu Herb, Urinary / Kidney Herb, African Red Tea Imports, 2 fl. oz.
Herbal Remedies: Turmeric Extract (curcuma Longa), Standardized to 95% Curcuminoids, Nature's Way, 500 mg, 120 Tabs
Herbal Remedies: Turmeric Extract, Source Naturals, 50 Tabs
Herbal Remedies: Curcumin (Turmeric), NOW Foods, 665 mg, 60 VCaps
Herbal Remedies: Turmeric Powder (Curcuma Longa), 4 oz. Bulk
Herbal Remedies: Turmeric Root Powder, Certified Organic, Banyan Botanicals, 1/2 lb.
Herbal Remedies: Turmeric Tincture, 100% Organic, 2 fl. oz.
Burdock Root, Milk Thistle, and Red Clover aid in cleansing the blood. Milk Thistle also improves liver function. Red clover tea is beneficial for colitis.
Herbal Remedies: Burdock Root Powder (Arctium Lappa), 4 oz. Bulk
Herbal Remedies: Burdock Root, Nature's Way, 540 mg, 100 Caps
Herbal Remedies: Thisilyn Milk Thistle Extract, Vegetarian, Nature's Way, 175 mg, 100 VCaps
Herbal Remedies: Milk Thistle Seed Powder (Silybum Marianum), 4 oz. Bulk,
Herbal Remedies: Milk Thistle Seed Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Red Clover Herb, Nature's Way, 500 mg, 100 Caps
Herbal Remedies: Red Clover Herb Powder (Trifolium Pratense), 4 oz. Bulk
Herbal Remedies: Red Clover Tincture, 100% Organic, 2 fl. oz.
Chamomile, Dandelion, Feverfew, Papaya, Slippery Elm, and Yarrow extract or herbal tea are beneficial for colitis, as is Pau D'Arco tea. Cautions: Do not use Chamomile on an ongoing basis and avoid it completely if you are allergic to ragweed. Do not use Feverfew during pregnancy.
Herbal Remedies: Chamomile Flowers Herb, German Chamomile, Nature's Way, 350 mg, 100 Caps
Herbal Remedies: Chamomile Extract, Standardized, Nature's Way, 345 mg, 60 Caps
Herbal Remedies: Chamomile Tea, Organic, Caffeine Free, Yogi Tea, 16 Tea Bags
Herbal Remedies: Chamomile Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Dandelion Root Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Dandelion Tea, NOW Foods, Organic, 30 Tea Bags
Herbal Remedies: Organic Roasted Dandelion Root Tea, Kosher, Traditional Medicinals, 16 Tea Bags
Herbal Remedies: Dandelion Root, Nature's Way, Vegetarian, 540 mg, 180 VCaps
Herbal Remedies: Dandelion Root Powder (Taraxacum Officinale), 4 oz. Bulk
Herbal Remedies: Feverfew Leave, Nature's Way, 380 mg, 180 Caps
Herbal Remedies: Feverfew Extract, Standardized, Nature's Way, 325 mg, 60 Caps
Herbal Remedies: Feverfew Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Papaya Juice, Natural Kosher, Dynamic Health, 16 fl. oz.
Herbal Remedies: Fermented Papaya Juice With Noni & Vitamin C, Dynamic Health, 16 fl. oz.
Herbal Remedies: Dried Papaya Spears, Low Sugar, NOW Foods, 12 oz.
Herbal Remedies: Papaya Enzyme With Mint & Chlorophyll, Chewable, NOW Foods, 23 mg, 360 Lozenges
Herbal Remedies: Slippery Elm Bark Powder (Ulmus Rubra), 4 oz. Bulk
Herbal Remedies: Slippery Elm Lozenges, Thayer's, Tangerine Flavor, 24 Lozenges
Herbal Remedies: Slippery Elm Lozenges, Thayer's, Original Flavor, 24 Lozenges
Herbal Remedies: Slippery Elm Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Slippery Elm Bark, 370 mg, 100 Caps
Herbal Remedies: Yarrow Tincture (Achillea Millefolium), 100% Organic, 2 fl. oz.
Herbal Remedies: Yarrow Flowers Herb, 325 mg, 100 Caps
Herbal Remedies: Pau D'Arco Tea, Incan Purple Lapacho, 48 Tea Bags
Herbal Remedies: Pau D'Arco Tea, 25 Tea Bags
Herbal Remedies: Pau D'Arco Extract Liquid, 100% Natural, 4 fl. oz.
Herbal Remedies: Pau D'Arco Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Pau D'Arco Powder (Tabebuia Impetiginosa), 4 oz. Bulk
Herbal Remedies: Pau D'Arco Inner Bark, Nature's Way 545 mg, 180 Caps
Lobelia tea is good to drink. Also use it as an enema for inflammation of the colon. It gives quick relief. Caution: Do not take Lobelia internally on an ongoing basis.
Herbal Remedies: Lobelia Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Lobelia Herb, Nature's Way, 425 mg, 100 Caps
Nettle and Quercetin aid in inhibiting allergic reactions.
Herbal Remedies: Nettle Herb, Nature's Way, 435 mg, 100 Caps
Herbal Remedies: Nettle Leaf Powder (Urtica Dioica), 4 oz. Bulk
Herbal Remedies: Nettle Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Nettle Extract Tincture, Herbal Remedies USA, 2 fl. oz.
Herbal Remedies: Nettle Leaf Tea, Organic, NOW Foods, 30 Tea Bags
Herbal Remedies: Quercetin, NOW Foods, 500 mg, 100 VCaps
Herbal Remedies: Quercetin With Bromelain, Hypoallergenic, Bioflavonoid, NOW Foods, 800 mg, 120 VCaps
Herbal Remedies: Activate Quercetin Bioflavonoid Complex, Source Naturals, 50 Tabs
DIETARY RECOMMENDATIONS
Sometimes you may feel helpless when facing ulcerative colitis. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups. It may be a trial and error approach to find what foods work with you and what foods you should avoid. Every person is different and some may be able to tolerate certain foods better than others.
There is no firm evidence that what you eat causes inflammatory bowel disease. But certain foods and beverages can aggravate your symptoms, especially during a flare-up in your condition. It is a good idea to try eliminating from your diet anything that seems to make your signs and symptoms worse. Here are some suggestions that may help:
Limit dairy products. Like many people with inflammatory bowel disease, you may find that problems, such as diarrhea, abdominal pain and gas, improve when you limit or eliminate dairy products. You may be lactose intolerant - that is, your body cannot digest the milk sugar (lactose) in dairy foods. If so, try substituting yogurt or low-lactose cheeses, such as Swiss and cheddar, for milk. Or use an enzyme product, such as Lactaid, to help break down lactose.
In some cases, you may need to eliminate dairy foods completely. If you need help, a registered dietitian can help you design a healthy diet that is low in lactose. Keep in mind that with limiting your dairy intake, you will need to find other sources of calcium, such as supplements.
During a flare-up, consume only soft foods until the pain has subsided. Put oat bran or steamed vegetables through a blender. Add 1 tablespoon of oat or rice bran daily to cereals and juice to add the bulk needed for cleansing the colon. Or add 1 tablespoon of Aerobic Bulk Cleanse to juice and drink it on an empty stomach on arising.
Herbal Remedies: Oat Bran Extract, Standardized 54% Beta Glucan, Vegetarian, Nature's Way, 60 VCaps
Experiment with fiber. For most people, high-fiber foods, such as fresh fruits and vegetables and whole grains, are the foundation of a healthy diet. But if you have inflammatory bowel disease, fiber may make diarrhea, pain and gas worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them. Do not eat fruit on an empty stomach.
Herbal Remedies: Fiber Information
Herbal Remedies: Fiber Supplements & Products
During an acute attack, eat organic baby foods, steamed vegetables, and well-cooked brown rice, millet, and oatmeal.
Try eating junior baby foods for two weeks. Baby foods are easy to digest. You can make your own by using a blender or food processor or you can use a good organic baby food, such as Earth's Best brand. These may be available in many health food stores and supermarkets. While on a baby-food diet, take extra fiber such as Glucomannan.
Glucomannan should be taken 1/2 hour to 1 hour before meals with a large glass of water. Note: Always take supplemental fiber separately from other supplements and medications.
Herbal Remedies: Glucomannan (Amorphophallus Konjac) Powder, 4 oz. Bulk
Herbal Remedies: Glucomannan (Konjac Fiber), Nature's Way, 665 mg, 180 Caps
Herbal Remedies: Glucomannon, NOW Foods, 575 mg, 180 Caps
Herbal Remedies: Glucomannan / Konjac Fiber / Amorphophallus Konjac Information
Herbal Remedies: Glucomannan Supplements & Products
Earth's Best Baby Foods
Eat plenty of dark green leafy vegetables. These are a rich source of vitamin K. Vitamin K deficiency has been linked to ulcerative colitis.
Herbal Remedies: Vitamin K Information
Herbal Remedies: Vitamin K Supplements & Products
Eat a diet daily consisting mainly of non-acidic fresh or cooked vegetables such as broccoli, Brussels sprouts, cabbage, carrots, celery, garlic, kale, spinach, and turnips. Some people may have more problems with foods in the cabbage family, such as broccoli and cauliflower, and with very crunchy foods such as raw apples and carrots. If these foods bother you, either avoid them or steam, broil, boil, or bake your food.
Avoid problem foods. Eliminate any other foods that seem to make your symptoms worse. These may include "gassy" foods such as beans, cabbage and broccoli, raw fruit juices and fruits - especially citrus fruits - spicy food, popcorn, alcohol, caffeine, and foods and drinks that contain caffeine, such as chocolate and soda.
Eat small meals. You may find you feel better eating five or six small meals rather than two or three larger ones.
Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best, herbal teas, and fresh juices. Fresh cabbage juice is very beneficial.
Avoid alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
For acute pain, try drinking a large glass of water. This aids in flushing out particles caught in the crevices of the colon, relieving pain.
Do stretching exercises and take proteolytic enzymes to improve digestion and to help control inflammation.
Herbal Remedies: MetabolicZyme, Hypoallergenic, Allergy Research Group / Nutricology, 900 Tabs
To keep your intestinal flora good, take a good probiotic supplement. This will help digestion, and maintain a healthy immune system.
Herbal Remedies: Probiotic Defense, NOW Foods, 90 Caps
Herbal Remedies: Gr8-Dophilus Probiotic, NOW Foods, 60 VCaps
Herbal Remedies: GI Support, Dr. Recommended, NOW Foods, 90 Caps
Consider taking multi-vitamins and dietary supplements. Because ulcerative colitis can interfere with your ability to absorb nutrients and because your diet may be limited, vitamin and mineral supplements can play a key role in supplying missing nutrients. They do not provide essential protein and calories, however, and should not be a substitute for meals.
Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.
Add a papaya to your diet. Chew a couple of the seeds to aid digestion.
Avoid refined carbohydrates. Do not consume such foods as boxed dry cereals or anything containing any form of sugar. Diets high in refined carbohydrates have been associated with IBD. These foods must be eliminated from the diet.
DIET FOR COLITIS
Ulcerative colitis can be an extremely painful and even temporarily disabling condition. Diet is probably the most significant factor in achieving and maintaining remission. The following dietary guidelines have been recommended by a nutritionist for people with colitis.
The most important thing to do is keep a daily record of what you eat and what symptoms you experience. This way you can see which foods have aggravated or improved your condition. Some people are sensitive only to certain foods, such as yeast products, wheat products, or dairy products. By checking your daily record, you can see which food or foods have caused flare-ups or made you feel better.
Eat a low-carbohydrate, high-vegetable-protein diet. Include Alfalfa or Barley in the diet. Baked or broiled fish, chicken, and turkey (without the skin) are acceptable sources of protein.
Eat lots of vegetables. If you cannot tolerate raw vegetables, steam them.
Eat a high-fiber diet. Oat bran, brown rice, barley and other whole grains, lentils, and related products such as rice cakes are good. Be sure grains are well cooked.
Keep fats and oils out of your diet, and stay away from high-fat milk and cheeses. Fats and oils exacerbate the diarrhea that comes with colitis.
Include Garlic in the diet for its healing and antibiotic properties.
Eat cooked foods that are broiled or baked, not fried or sautéed. Avoid sauces made with butter.
Avoid carbonated soft drinks, spicy foods, and anything containing caffeine. These substances can irritate the colon. Also avoid red meat, sugar, and processed foods.
Try soy-based cheese instead of dairy cheese. Try soymilk or rice milk instead of cow's milk. If you do eat dairy foods, use nonfat types. If you have a lactose intolerance, try lactose-free milk. Many lactose-intolerant people can tolerate low-fat yogurt.
Drink plenty of liquids, at least ten 8-ounce glasses of water daily to make up for the fluid lost with diarrhea. Carrot and cabbage juices and "green drinks" are also good. Or, add chlorophyll liquid to juices.
Do not eat fruit on an empty stomach. Eat it between meals instead. avoid acidic fruits such as oranges and grapefruit. Fruit juices should be diluted with water and taken during or after meals.
DIETARY CONSIDERATIONS
Crohn's disease and ulcerative colitis are types of inflammatory bowel disease. They cause inflammation and sores (ulcers) in the digestive tract. This can lead to symptoms such as diarrhea, belly pain, loss of appetite, fever, bloody stools, and weight loss. Often symptoms are worse after eating.
If you have an inflammatory bowel disease, it may be hard to get important nutrients such as vitamins, minerals, and protein. Your intestines may not be able to take all the nutrients from the food you eat. You may lose nutrients through diarrhea. This can lead to problems such as anemia or low levels of vitamins, such as vitamin B-12 and folic acid.
It is important to eat a healthy, varied diet to help you keep your weight up and stay strong. To control their symptoms, some people eat only bland foods, like pasta, and they avoid fruits and vegetables. But you need to eat a variety of foods to get the nutrients you need for good health.
Some foods can make symptoms worse. Avoiding these foods may help reduce your symptoms. No one diet is right for everyone with an inflammatory bowel disease. Keep a food diary to find out which foods cause problems for you. Then you can avoid those foods but choose others that supply the same nutrients.
A food sensitivity test is advised for anyone who suffers from colitis. We have seen many people with colitis do well once they make changes in their diet and lifestyle.
Because you may not be absorbing all the nutrients from the food you eat, you will need to eat a high-calorie, high-protein diet. This may be easier to do if you eat regular meals plus 2 or 3 snacks each day. You may need to take vitamin and mineral supplements to help you get the nutrients you need.
When magnesium is given intravenously with vitamin B-6, it relaxes the muscles in the walls of the bowels and can control an attack of spastic colon.
Vitamin K deficiency has been linked to ulcerative colitis. Sulfa drugs and mineral oil deplete vitamin K.
There are not consistent dietary rules that apply to everyone, but people with ulcerative colitis are generally encouraged to eat a healthy diet to help the body replace lost nutrients. Moreover, some nutrients, such as essential fatty acids and the amino acid glutamine, have been show to help maintain a state of remission.
It is important that nutrition deficiencies be corrected for healing. Persons with inflammatory bowel disorders require as much as 30 percent more protein than normal. If chronic diarrhea is present, electrolyte and trace mineral deficiencies should be considered. Chronic steatorrhea (fatty stools resulting from improper digestion of fats) may result in deficiencies of calcium and magnesium.
Antioxidants have been shown to decrease the risk of developing inflammatory bowel disease. The intestinal walls normally contain small amounts of the antioxidant enzymes superoxide dismutase (SOD), catalase, and glutathione peroxidase, but their ability to fight free radicals may be overwhelmed during periods of active inflammation, resulting in tissue damage.
To reestablish a proper healing environment, it is necessary to maintain a generally alkaline bodily pH (greater that 7.0 bodily pH).
Adhering to an allergen-free diet, replacing lost nutrients, and using selected herbs can speed healing and may prevent future disturbances. Studies have proven that when a person who has achieved remission goes back to his or her former diet, inflammatory bowel disease returns. Other things that have been implicated in this disorder include prolonged stress, trauma, and psychosomatic and vascular factors.
Nutritional deficiencies resulting from malabsorption may weaken the immune system, in turn prolonging the time required for the inflammation and ulcers to heal.
NUTRITIONAL SUPPLEMENTS
Unless otherwise specified, the following recommended doses are for adults over the age of 18. For a child between 12 and 17 years, reduce the dose to 3/4 the recommended dose. For a child between 6 and 12 years old, use 1/2 the recommended dose, and for a child under 6, use 1/4 the recommended dose.
COLITIS / ULCERATIVE COLITIS SUPPLEMENTS & PRODUCTS
Supplements and products for Colitis, a chronic inflammatory bowel disease (IBD) that usually causes inflammation and ulcer formation in the mucous membranes lining the colon and rectum.
5-HTP Hydroxy Tryptophan, Vegetarian, NOW Foods, 100 mg, 120 VCaps
5-HTP also known as Hydroxy Tryptophan is an Amino Acid and precursor to serotonin, a brain chemical responsible for regulating mood, appetite, behavior, and sleep. 5HTP may help elevate mood, control appetite, and promote better sleep.5-HTP Hydroxy Tryptophan, Natural Serotonin With Vitamin B-6 & C, Nature's Way, 50 mg, 60 Tabs
Nature's Way 5 HTP Supplement is available in an easy to swallow enteric coated tablet.Acne & Skin Disorders Formula Tincture, 2 fl. oz.
This herbal remedy for acne and skin disorders contains herbs that are helpful for eczema and psoriasis as well.Alive! Whole Food Energizer Multi-Vitamin With Mineral, Nature's Way, 18 mg of Iron Added, 90 Tabs
Nature's Way Alive multi-vitamin with mineral is better absorbed into your blood stream because its tablets disintegrate up to 5X faster than other leading brands. No other supplement contains more life-giving nutrients than ALIVE, which is just the way it will make you feel.Alive! Whole Food Energizer Multi-Vitamin With Mineral, Nature's Way, With Naturally Occurring Iron (No Iron Added), 90 Tabs
No other supplement contains more life-giving nutrients than Nature's Way ALIVE Multi Vitamin. ALIVE Multi Vitamin is better absorbed into your blood stream because its tablets disintegrate up to 5X faster than other leading brands.Amalaki, Detoxification & Rejuvenation, Banyan Botanicals, 90 Tabs
Amalaki is said to stimulate the production of red blood cells, enhance cellular regeneration, increase lean body mass and support proper function of the liver, spleen, heart and lungs. It has also been used to purify the blood, improve eyesight, strengthen the bones and teeth, and cause hair and nails to grow.Barley Grass Powder (Hordeum Vulgare), 100% Organic, Vegetarian, NOW Foods, 2 lb.
NOW Foods Barley Grass Powder can help heal stomach and colon disorders as well as pancreatitis, and is an effective anti-inflammatory.Bee Pollen Tincture, 2 fl. oz.
Bee Pollen is among the oldest known dietary supplements. Bee Pollen is sometimes called Mother Nature's natural energy booster. Its use as a rejuvenator and medicine date back to the early Egyptians and ancient Chinese, in fact, the Greeks called it the "nectar of the gods".Bee Propolis Extract, NOW Foods, 500 mg, 100 Caps
Bee Propolis Extract is a natural antibiotic used for colds, flu, fever, and digestive disorders. A substance collected by honey bees containing phytotonizides is believed to contain immunity factors that stimulate the body and gives it a natural resistance to diseases.Black Walnut Green Hull Extract (Juglans Nigra) Tincture, Natural Fungal Remedy, Extra Strength, New Action, 1 fl. oz.
Black Walnut Bark contains a chemical that is a natural fungal remedy for conditions like ringworm, jock itch and athletes foot.Black Walnut Hull (Juglans Nigra) Powder, 4 oz. Bulk
Black Walnut is used to treat acne, thyroid disease, colitis, eczema, hemorrhoids, ringworm, sore throats, tonsillitis, skin irritations, and wounds and is a mild laxative.Boswellia Extract (Frankincense), Standardized, Nature's Way, 307 mg, 60 Tabs
Nature's Way Standardized Boswellia extract has been formulated to meet the dosage used in clinical studies on Boswellic Acids and their health benefits.Boswellia / Frankincense Powder (Boswellia Serrata), 4 oz. Bulk
Boswellia is known as a natural bursitis and arthritis treatment.Boswellia Tincture, 2 fl. oz.
Boswellia is known as a natural bursitis and arthritis treatment.Cat's Claw Extract, Standardized, Nature's Way, 335 mg, 60 Caps
Nature's Way Cat's Claw extract, also known as Una de Gato is derived from the bark of plants wild-harvested in Peru and Brazil.Colon & Liver Cleanser, Truman's CAC Tea, Loose Leaf, 1/2 lb.
Use of this cleansing tea has many additional benefits: improves overall digestion; strengthens the immunity; helps to prevent cancer; makes the skin more emollient and flexible: clears the eyes; and provides an overall tonic effect on the body.Colon Health - The Key To A Vibrant Life, By Dr. Norman W. Walker
Presents a complete program for rejuvenating the entire body and for reviving ailing health through colon cleansing and nourishment.Comfrey Leaf Powder, 4 oz. Bulk
One of the most well-known healing plants, especially for its ability to heal tissue and bone.Comfrey Leaf Tincture, 2 fl. oz.
Comfrey contains allantoin, which promotes the growth of connective tissue, bone, cartilage, and is easily absorbed through the skin.Detoxify Formula Bowel & Liver Cleanser Tincture, 100% Organic, 2 fl. oz.
Use Bowel & Liver Cleanser for travel, especially when going to other countries.Eating For IBS: 175 Delicious, Nutritious, Low-Fat, Low-Residue Recipes To Stabilize the Touchiest Tummy By Heather Van Vorous
Eating for IBS confirms what every IBS sufferer instinctively knows: that diet plays a direct role in gut function, and that the abdominal pain, diarrhea, constipation, and bloating from bowel disorders can be directly controlled through diet. This is true not just for Irritable Bowel Syndrome, but also for inflammatory bowel diseases (IBD) such as Crohn's and Ulcerative Colitis, plus diverticulosis and diverticulitis. The Eating for IBS diet can make the difference between living a normal, happy, outgoing life versus spending every day stuck in the bathroom enduring pain, bowel dysfunction, and misery.Echinacea Herb, Nature's Way, 400 mg, 180 Caps
Echinacea herb supports the immune system and promotes general well-being in cold and flu season.Enzymes, All Complete, 250 mg, 90 Caps
All Complete Enzymes, dietary supplement, is an important combination of critical enzymes that help support normal digestive function, cholesterol levels, fat metabolism and more, all in one convenient tablet.Flax Seed Oil, Super Cold Pressed, 100% Organic, 20% Lignan, Nature's Way, 16 fl. oz.
Super Lignan Flax Seed Oil is a rich, vegetarian source of omega-3 and omega-6 essential fatty acids beneficial for many ailments.Garlicin HC, Healthy Circulation Formula, With Odor Free Garlic Supplement, Nature's Way, 90 Enteric Coated Tabs
Garlicin HC garlic supplement supports cardiovascular health with the help of Hawthorn, Cayenne and Vitamin E.Goldenseal Herb, Nature's Way, 400 mg, 180 Caps
Goldenseal herb (hydrastis canadensis), a perennial wild native American herb, is also called Yellow Root. Native Americans used Goldenseal both internally and externally and also derived a dye from the root. Golden Seal is a very important traditional herb.Heather's Tummy Fiber, Organic Acacia Powder, Heather's Tummy Care, 1 lb.
Heather's Tummy Fiber Supplement Acacia is a natural, pure, certified organic, soluble dietary fiber produced from the gum of the Acacia tree (also known as gum arabic). Acacia is a natural plant water-soluble fiber that has been harvested for millennia in Africa; its recorded dietary use dates back to the Egyptian pharaohs.Hypo Allergenic Multiple Vitamin Mineral, 180 Caps
NutriBiotic Hypo-Allergenic Multivitamin Mineral is for people concerned about common food born antigens. This formula is a balanced blend of the purest bio-nutrients available.IntestinEase, TCM Intestines & Colon Formula, Zhushao Anchang, 100% Natural, 400 mg, 60 Caps
This famous IntestinEase, TCM Intestines and Colon Formula is made of extracts from atractylodes, common peony root, siler, cimicifuge and tangerine peel.Iron Ionic Mineral Supplement, Fully Absorbable, 20 +/- ppm, 16 fl. oz.
WaterOz Ionic Iron is a pure liquid Iron supplement. Iron is called the "energy giver." It attracts oxygen and builds blood.Kombucha 2000, Concentrated Kombucha, 30 Caps
Concentrated Kombucha Capsules are new to the market, but Kombucha 2000 is one of the very first successful kombucha tea producers in the United States.Kombucha Tea, 100% Organic, Original Flavor, Ready To Drink, 12 fl. oz, Case of 24
Kombucha Tea, 100% Organic, Original Flavor, Ready To Drink, 25.4 fl. oz, Case of 12
Kombucha Tea, 100% Organic, Original Flavor, Ready To Drink, 64 fl. oz, Case of 6
People from all over the world claim drinking Kombucha Tea provides relief from many physical ailments. Kombucha Tea offers many people the physical resistance they need to maintain and restore health.Kombucha Tea Extract, Certified 100% Organic, Case of 12, 1 fl. oz. Tincture
People from all over the world claim drinking Kombucha Tea provides relief from many physical ailments. Kombucha Tea Extract drops are very convenient and portable. Take them anytime, anyplace; work, traveling or at home.L-Glutamine, Amino Acid Supplement, NOW Foods, 1000 mg, 120 Caps
L-Glutamine is an important amino acid that helps brain function, as it converts quickly into glucose, the only source of energy to the brain. L-Glutamine promotes better thinking ability, and increases the amount of GABA, another amino acid that aids in proper brain function.Licorice Root Tincture, 100% Organic, 2 fl. oz.
Licorice Root is taken orally (DGL form) for ulcers, heartburn (esophageal reflux), and mouth sores.Liquid Multi-Vita-Mineral, Orange Mango, Trace Minerals, 32 fl. oz.
The most complete all-in-one liquid vitamin daily supplement that combines the benefits of multiple vitamins with the advantages of ionic minerals and trace minerals to replace those needed minerals not found in processed foods.Marshmallow Root (Althaea Officinalis) Powder, 4 oz. Bulk
The German Commission E approved the internal use of marshmallow root for irritation of the oral and pharyngeal mucosa and associated dry cough, and for mild inflammation of the gastric mucosa.Marshmallow Root Tincture, 100% Organic, 2 fl. oz.
The primary use of Marshmallow root is to relieve digestive and respiratory problems, such as coughs, colds, sore throats and asthma.MSM (Methylsulfonylmethane), Pure Lignisul, with Vitamin C, 875 mg / 100 mg, 120 Caps
MSM with Vitamin C offers support for allergies, connective tissue, joint flexibility, immune function, arthritis, osteoporosis, digestive disorders, circulation, bruising, carpal tunnel syndrome, and antioxidant protection.Natural Remedies For Intestinal Health By Conrad LeBeau
Information on increasing appetite and rebuilding mucosal membranes and conditions such as candidiasis, acid-reflux, colitis, Crohn's disease and leaky gut syndrome.Noni Juice, Trace Minerals, 32 fl. oz.
Trace Minerals Noni Juice product may provide nutritional support for Bio-Electric Health and Body Mineral Balancing.Noni Juice Concentrate (Morinda citrifolia), 1 fl. oz.
Noni comes from the family Rubiaceae making it a relative of Samento or Uncaria Tomentosa and complimentary in use.Pain Formula Tincture, 2 fl. oz.
Use the Pain Formula to alleviate pain naturally.Omega 3 Fish Oil, NOW Foods, Lemon Flavored, All Natural, 7 oz.
Omega 3 Fish Oil is important for mental and cardiac development.Pitta Digest, Promotes Healthy Digestion, Banyan Botanicals, 90 Tabs
Pitta Digest is a dynamic combination of herbs designed to strengthen digestion without aggravating pitta. Excess pitta causes increased heat, sharpness and oiliness in the digestive tract. These qualities aggravate and inflame the digestive fire, creating acidic conditions, which can lead to discomfort. Cooling and soothing to the internal membranes, Pitta Digest neutralizes acid and removes excess heat from the system.Samento (Uncaria Tomentosa), Extra Strength (100 Times More Effective Than Regular Cat's Claw), 0.5% POA, 600 mg, 30 Caps
Samento is beneficial in the treatment of a wide range of immune system related conditions; these include but are not limited to cancer, arthritis, bursitis, rheumatism, allergies, ulcers, systemic candidiasis, all forms of herpes, diabetes, lupus, chronic fatigue syndrome, intestinal disorders and HIV infection.Samento Liquid Extract (Uncaria Tomentosa), 0.5% POA, 1 fl. oz.
Beneficial in the treatment of a wide range of immune system related conditions; these include but are not limited to cancer, arthritis, bursitis, rheumatism, allergies, ulcers, systemic candidiasis, all forms of herpes, diabetes, lupus, chronic fatigue syndrome, intestinal disorders and HIV infection.Seabuckthorn Seed Oil, 100% Natural, 500 mg, 60 Softgels
A rare source of vitamin E, Seabuckthorn Oil also provides other vitamins including Vitamins A, C, D, K, etc, carotenoids, flavonoids, phytosterols, amino acids, serotonin and 28 trace elements: iron, zinc, calcium, magnesium, selenium, iodine, etc.Slippery Elm Bark Powder (Ulmus Rubra), 4 oz. Bulk
Slippery Elm Bark is a soothing nutritive demulcent which is perfectly suited for sensitive or inflamed mucous membrane linings in the digestive system.Slippery Elm Tincture, 100% Organic, 2 fl. oz.
Slippery Elm is used as a cough lozenge and is widely available in pharmacies.Stabilized Oxygen OxyDrops, Liquid Electrolytes, Sodium Chloride Solution, 4 fl. oz.
WaterOz stabilized oxygen is the highest quality, strongest and most stable of all the liquid electrolytes of oxygen available on the market.Stomach Fortifier, Balanceuticals, TCM Formula, 100% Natural, 60 Caps
Chinese medicine uses it to strengthen the spleen and stomach, normalize peristalsis of the stomach and intestines, promote absorption of water and chlorine ion, improve metabolism, nurture the lung, balance bowel movement and increase energy.Super Digestive Enzymes, 90 Caps
Super Digestive Enzymes contain a complete and balanced digestive enzyme formula.Sutherlandia (Sutherlandia Frutescens), 300 mg, 60 VegiTabs
Sutherlandia powerfully assists the body to mobilize its own immunological physiological resources to cope with diverse physical, mental and chemical stressors.The Miracle of MSM: The Natural Solution for Pain By Stanley W. Jacob M.D., Ronald M. Lawrence MD & Martin Zucker
Learn how to stop the pain of numerous ailments with MSM. How much, when, with what food and in what form to relieve pain in its many forms. Helpful against pain and allergies, this supplement is safe, natural and side-effect-free.True Focus, Targeted Amino Blend, NOW Foods, 90 VCaps
True Focus, an amino acid supplement, is an advanced nutriceutical complex that employs the latest neurotransmitter research to support proper brain chemistry balance.Vitamin A, 100% Natural, Nature's Way, 10,000 IU, 100 Softgels
Nature's Way vitamin A is 100% natural from fish liver oil. It contains no artificial ingredients or preservatives.Vitamin B-50 Complex With B-2 Coenzyme, 100% Natural, 330 mg, 100 Caps
B Vitamins, as found in a Vitamin B Complex, are precursors of coenzymes involved in the conversion of cellular energy, manufacture of hormones and proteins, and repair and maintenance of nerve structures.Vitamin C 1000 with Bioflavonoids, 100% Natural, 1000 mg, 250 VCaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.Whole Leaf Aloe Vera Juice, 99.7% Pure, Certified Organic, Nature's Way, 1 Liter
Nature's Way Whole Leaf Aloe Vera Juice offers you the rich benefits of the most potent part of the aloe plant. Whole Leaf Aloe Vera Juice contains an abundance of advantageous components not found in most aloe gel filler products.Zinc Lozenges With Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges
Nature's Way Zinc lozenge boosts cold season defense with zinc, widely recognized as an important nutritional support during the cold season, and echinacea pupurea, clinically shown to support the immune system, and Vitamin C, a vitally important vitamin for general health maintenance.
Herbal Remedies: Colitis / Ulcerative Colitis Information
Herbal Remedies: Colitis / Ulcerative Colitis Supplements & Products
Herbal Remedies: Crohn's Disease Information
Herbal Remedies: Crohn's Disease Supplements & Products
NOTIFY YOUR HEALTH CARE PROVIDER IF...
You experience a persistent change in your bowel habits.
You or a family member have not been diagnosed with IBD and you have symptoms of ulcerative colitis, Crohn's disease or any other inflammatory bowel disease such as:
- Abdominal pain.
- Blood in your stools.
- Frequent diarrhea that does not respond to over-the-counter (OTC) medications.
- An unexplained fever lasting more than a day or two.
Although ulcerative colitis usually is not fatal, it is a serious disease that, in some cases, may cause life-threatening complications. Putting off visiting your health care provider if you have these symptoms is not appropriate as delaying the diagnosis and treatment may make the disease worse and increase your risk of complications.
People who have ulcerative colitis usually known their normal pattern of symptoms and often have a good sense of how severe their symptoms are. Notify your health care provider if there is a change in your usual symptoms or if your symptoms get significantly worse than usual. If you have persistent diarrhea for more than 2 weeks or have lost weight, notify your health care provider.
Call your health care provider immediately if you have been diagnosed with ulcerative colitis or any other IBD, your disease may have worsened significantly if you have any of the following symptoms:
- Fever over 101°F (38.33°C) or shaking chills.
- Lightheadedness, passing out, or rapid heart rate.
- Stools that are bloody for the first time.
- Severe dehydration.
- Severe abdominal pain or severe pain with or without bloating.
- Evidence of pus draining from the area around the anus/rectum, or pain and swelling around the anal/rectal area.
- Repeated vomiting.
- Not passing any stools or gas.
If you have these symptoms and you have been diagnosed with ulcerative colitis, your disease may have gotten significantly worse. Some of these symptoms also may be signs of toxic megacolon. Inflammation and ulceration from ulcerative colitis or Crohn's disease sometimes weaken muscles in the colon. This can cause the colon to swell to many times its normal size. This condition is called toxic megacolon. Over time, tiny holes may develop in the colon, and fecal matter (stool) may spill into the abdominal cavity, causing a serious infection. Toxic megacolon is an emergency requiring immediate medical and surgical treatment. If it is not treated, toxic megacolon can be fatal. More people die from perforation of the colon than from any other complication of ulcerative colitis. A medication called neostigmine can be used to treat certain forms of toxic megacolon.
Even when in IBD is not active (in remission), your health care provider may want to see you regularly to check for complications, some of which can be hard to detect. It is always appropriate to call your health care provider's office for advice.
WATCHFUL WAITING
Watchful waiting is not appropriate when you have any of the above symptoms. If your symptoms are caused by ulcerative colitis, delaying the diagnosis and treatment may make the disease worse and increase your risk of complications. Even when the disease is in remission, your health care provider will want to see you regularly to check for complications, some of which can be hard to detect. It is always appropriate to call your health care providers's office for advice.
HOPE THROUGH RESEARCH
NIDDK, through the Division of Digestive Diseases and Nutrition, conducts and supports research into many kinds of digestive disorders, including ulcerative colitis. Researchers are studying how and why the immune system is activated, how it damages the colon, and the processes involved in healing. Through this increased understanding, new and more specific therapies can be developed. Currently, there are numerous clinical trials being conducted that are investigating ulcerative colitis. A complete listing of research studies on ulcerative colitis may be found at www.ClinicalTrials.gov.
INFORMATION & RESOURCES
Crohn's & Colitis Foundation of America
386 Park Avenue South, 17th floor
New York, NY 10016-8804
Phone: 1-800-932-2423 or 212-685-3440
Fax: 212-779-4098
Email: info@ccfa.org
Internet: www.ccfa.org
Crohn's & Colitis Foundation of America (CCFA) is a nonprofit, voluntary organization dedicated to finding the cure for Crohn's disease and ulcerative colitis. This organization sponsors basic and clinical research, offers educational programs for patients and health professionals, and provides supportive services.
Reach Out for Youth With Ileitis & Colitis Inc.
84 Northgate Circle
Melville, NY 11747
Phone: 631-293-3102
Fax: 631-293-3103
Email: reachoutforyouth@reachoutforyouth.org
Internet: www.reachoutforyouth.org
United Ostomy Association
19772 MacArthur Boulevard, Suite 200
Irvine, CA 92612-2405
Phone: 1-800-826-0826 or 949-660-8624
Fax: 949-660-9262
Email: info@uoa.org
Internet: www.uoa.org
National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)
National Institutes of Health
9000 Rockville Pike
Bethesda, MD 20892-2560
Phone: 1-800-860-8747 or (301) 496-3583
Web Address: www.niddk.nih.gov
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) provides information and conducts research on a wide variety of diseases as well as issues such as weight control and nutrition.
National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892-3570
Phone: 1-800-891-5389
TTY: 1-866-569-1162
Fax: 703-738-4929
Email: nddic@info.niddk.nih.gov
Internet: www.digestive.niddk.nih.gov
The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1980, the Clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.
American College of Gastroenterology
P.O. Box 342260
Bethesda, MD 20827-2260
Phone: (301) 263-9000
Web Address: www.acg.gi.org
The American College of Gastroenterology is an organization of digestive disease specialists. The Web site contains information about common gastrointestinal problems.
Pediatric Crohn's & Colitis Association
P.O. Box 188
Newton, MA 02468
Phone: (617) 489-5854
E-mail: questions@pcca.hypermart.net
This organization is a resource for families with children who have Crohn's disease or ulcerative colitis.
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HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
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