Ulcerative Colitis

Ulcerative Colitis: Overview

This disease typically begins in the sigmoid colon and/or rectum, and then usually progresses until the entire colon is affected.  Ulcerative colitis involves only the colonic mucosa, and the lesions are uniform and continuous with no areas of normal tissue interspersed between the diseased mucosa.

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Both ulcerative colitis and Crohn's disease are chronic diseases that involve inflammation of the gastrointestinal tract.  However, ulcerative colitis only affects the colon (large intestine), while Crohn's disease can affect the entire digestive system, from the mouth to the anus.

Incidence

It is seen in both sexes equally, although white and Jewish people are more often affected.  A person is five times more likely to get it if one parent has the condition.  Peak occurrence is from 15-35 years of age, although any age is susceptible.

Signs and Symptoms

Ulcerative colitis primarily affects the colon and the rectum.  About half of patients with ulcerative colitis have mild symptoms.  Ulcerative colitis may also cause problems such as arthritis, inflammation of the eye, liver disease (fatty liver, hepatitis, cirrhosis, and primary sclerosing cholangitis), osteoporosis, skin rashes, anemia, and kidney stones.  No one knows for sure why problems occur outside the colon.  Scientists think these complications may occur when the immune system triggers inflammation in other parts of the body.  These problems are usually mild and go away when the colitis is treated.

Systemic and extracolonic symptoms include: skin changes; liver disease; posterior uveitis, etc.; decreased growth and development; and failure to thrive (in children).

Diagnosis and Tests

In order to confirm the diagnosis, testing may include barium X-rays of the upper and lower GI tract, flexible sigmoidoscopy, and sometimes colonoscopy.  During these tests, biopsies may be obtained.

Laboratory findings:

  • Definitive diagnosis requires a colonic mucosal biopsy
  • Normocytic anemia (acute blood loss) or microcytic anemia (iron deficiency due to chronic blood loss)
  • Gross or occult blood in stool; WBC in stool
  • Leukocytosis during acute exacerbation
  • Increased sedimentation rate – indicates active inflammation
  • Decreased serum K, Na CI – due to diarrheal loss
  • Decreased serum albumin due to loss of protein from the diseased bowel wall; the degree of hypoalbuminemia parallels the severity of the disease
  • Increased alkaline phosphatase, SGOT (AST) and bilirubin due to associated liver disease.

Treatment and Prevention

If candida or a bacterial overgrowth is present, further recovery in ulcerative colitis can be achieved by correcting the imbalance through antimicrobial or antifungal agents.

Complications

Carcinoma of the colon, gastrointestinal bleeding, arthritis.

Signs, symptoms & indicators of Ulcerative Colitis:

Lab Values - Cells

Lab Values - Chemistries

Counter-indicators

Symptoms - Abdomen

Symptoms - Bowel Movements

Occasional/frequent mucus in stools

If the disease is limited to the rectosigmoidal area then stools may be normal or dry although there can also be constipation.  Rectal mucous, which can be high in red and white blood cells, accompanies stools or occurs between bowel movements.

Frequent/significant red blood in stools

Ulcerative colitis can cause bloody, watery or mucusy bowel movements which may consist only of blood and pus.

(Very) frequent stools

Ulcerative colitis may result in an increased urgency to defecate, up to 10 or 20 times per day.

Counter-indicators
Counter-indicators

Symptoms - Food - General

Symptoms - Gas-Int - General

Symptoms - Metabolic

Occasional/frequent unexplained fevers

In severe acute attacks there may be fever.

Symptoms - Skeletal

Conditions that suggest Ulcerative Colitis:

Autoimmune

Ankylosing Spondylitis

See the link between Crohn's Disease and Ankylosing Spondylitis.

Counter-indicators
Gluten Sensitivity / Celiac Disease

Having been diagnosed with celiac disease implies a much lower chance of ulcerative colitis being the explanation for one's symptoms.

Circulation

Diet

Dehydration

Dehydration occurs in patients with severe diarrhea as seen in ulcerative colitis.

Digestion

Counter-indicators

Environment / Toxicity

Copper Toxicity

Patients with ulcerative colitis may absorb excess copper in their intestinal tissues which can lead to intestinal disorders, impaired healing and reduced resistance to infections.

General

Infections

Conjunctivitis

Ulcerative colitis occasionally causes eye inflammation which resolves when the colitis is treated.

Lab Values

Elevated Homocysteine Levels

Because people with inflammatory bowel disease (IBD), like ulcerative colitis and Crohn's disease, have a much higher risk of both thromboses and osteoporosis, a team of researchers from McGill University in Montreal explored the idea that homocysteine excess may play an important role in this chronic gastrointestinal disease.

To test this hypothesis, they measured homocysteine levels in the plasma of 65 patients with IBD and in 127 healthy controls.  Their results revealed a striking difference: The patients with IBD had nearly a six-fold increased incidence of hyperhomocysteinemia (homocysteine levels above the normal range) compared to controls.

About one in every seven patients in the IBD group had hyperhomocysteinemia.  As expected, those with vitamin B12 deficiency tended to have higher homocysteine levels.  Yet researchers were also surprised to find that 80% of the IBD patients with hyperhomocysteinemia had normal blood levels of vitamins.

This suggests that homocysteine imbalances could be an early warning sign of B-vitamin deficiency inside cells – one that occurs well before vitamin levels actually decline in serum.  It is still too early to tell if treating high homocysteine could actually reduce IBD symptoms in patients.

Importantly, as homocysteine levels rose in the patients with IBD, so did the clinical ratings of IBD disease severity, including its length of duration and the use of steroid medications to treat it.  [Am J Gastroenterol.  2001 96(7): pp.2143-9]

Musculo-Skeletal

Rheumatoid Arthritis

Joint inflammation can occur from the overactive immune system seen in ulcerative colitis.  This problem may go away when the colitis is treated.

Osteoporosis - Osteopenia

Scientists believe osteoporosis may occur when the immune system triggers inflammation in other parts of the body.  These problems are usually mild and go away when the colitis is treated.

Nutrients

Folic Acid Deficiency

All inflammatory bowel disease patients are prone to low serum folate levels.

Organ Health

Cirrhosis of the Liver

Cirrhosis of the liver can occur when the immune system triggers inflammation there as a result of ulcerative colitis.

Kidney Stones (Urolithiasis)

When the immune system triggers inflammation in other parts of the body because of ulcerative colitis, kidney stones may result.  This influence is usually mild and stones may not be a problem once the colitis is treated.

Fatty Liver

Scientists believe a fatty liver can occur when the immune system triggers inflammation in other parts of the body.  These problems are usually mild and go away when the colitis is treated.

Hepatitis

The immune system may trigger mild inflammation in the liver as a result of ulcerative colitis.  This problem is usually mild and goes away when the colitis is treated.

Skin-Hair-Nails

Rashes

Skin rashes may occur as a result of the presence of ulcerative colitis and disappear when the colitis is treated.

Symptoms - Gas-Int - General

Risk factors for Ulcerative Colitis:

Autoimmune

Childhood

Past and future vaccination or past vaccinations

Based on a study of 3,545 people who received live measles vaccine as children, their rate of developing ulcerative colitis was 2.5 times higher (3 times higher for Crohn's) compared to an unvaccinated group.

Family History

Colitis in family members

Crohn's disease affects men and women equally and seems to run in some families.  About 20% of people with Crohn's disease have a blood relative with some form of IBD, most often a brother or sister and sometimes a parent or child.  A person with one parent who had colitis is five times more likely to have the condition themselves.

Hormones

Infections

Bacterial Dysbiosis

A variety of bacterial pathogens can cause severe gastrointestinal symptoms such as bloody diarrhea, fever or abdominal pain.  In addition, many of these intestinal microbes can exacerbate or cause flare-ups of symptoms in patients who already have ulcerative colitis.

Medical Procedures

Counter-indicators

Mental

Stress

Long term stress increases the risk of Ulcerative Colitis flare-ups, according to a study by Susan Levenstein, MD, at the Nuovo Regina Margherita Hospital in Rome.  [American Journal of Gastroenterology, May 2000]

Metabolic

Symptoms - Gas-Int - General

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Ulcerative Colitis suggests the following may be present:

Autoimmune

Ulcerative Colitis can lead to:

Diet

Dehydration

Dehydration occurs in patients with severe diarrhea as seen in ulcerative colitis.

Digestion

Nutrients

Folic Acid Deficiency

All inflammatory bowel disease patients are prone to low serum folate levels.

Tumors, Malignant

Colon Cancer

Inflammatory bowel disease increases the risk of colon cancer.

Recommendations for Ulcerative Colitis:

Botanical

Robert's Formula

See the link between Ulcerative colitis and Slippery Elm.

Slippery Elm

Slippery elm's soothing mucilage effect has been used for disorders of the gastrointestinal tract.  It is part of the herbal combination called "Robert's Formula", which is widely prized by naturopathic physicians for such intestinal inflammations as gastritis, Crohn's disease and ulcerative colitis.  For digestive disorders, taking 500-1,000mg of powder tid is often recommended.  It may be used in lozenge form as well.

Boswellia

One small, controlled, double-blind trial has shown that boswellia extract may be helpful for ulcerative colitis.  [Eur J Med Res 1997;2: pp.37-43]

Comfrey

Comfrey has a reputation for promoting healing in stomach ulcers, hiatal hernia and ulcerative colitis.

Diet

Therapeutic Fasting

Short fasts can be beneficial, giving the entire organism an opportunity to restore its cellular and immunogenic integrity.

High/Increased Fiber Diet

Approach a high fiber diet cautiously during periods of inflammation, as it may aggravate the condition.  As you stabilize, fiber and unrefined foods are important to continue the health of the colon.

A study found Plantago ovata seed (the whole psyllium seed, not just the husk) at 10gm bid to be as effective as the drug mesalamine for maintaining remission in patients with ulcerative colitis.  In addition, the Plantago ovata seed may help prevent colon cancer, a common complication of ulcerative colitis, because it increases colonic butyrate levels.

Food Additive Avoidance

It may be wise to avoid the food additive carrageenan, found in various foods such as apple cider, hot dogs, most ice creams and prepared sauces and jellies, as it can produce inflammation and immunodeficiency and has been found to cause colitis and anaphylaxis in humans.

Digestion

Hydrochloric Acid (Trial)

It has been suggested that as many as 80% of sufferers have low stomach acid (hypochlorhydria).

Digestive Habit Changes

Foods should be eaten slowly and be well chewed.  Eat in a calm atmosphere; do not read or watch television while eating.  Any influence that may disrupt good digestion should be avoided.

Probiotics

Dr. McCann, originally with Kaiser Permanente in Ohio, has pioneered a dramatic, experimental treatment for inflammatory bowel disease which has induced a rapid remission in 16 out of 20 patients with ulcerative colitis.  A two-day course of multiple broad-spectrum antibiotics to "decontaminate" the gut is followed by administration of defined strains of E. coli, and Lactobacillus acidophilus to produce a "reflorastation" of the colon.  Others have not achieved this same degree of success.  It may need to be combined with the specific carbohydrate diet described in the book Breaking the Vicious Cycle.

Digestive Enzyme (Trial)

Stool analysis or a pancreatic trial will reveal if pancreatic enzymes are necessary.

Drug

Habits

Tobacco Avoidance

Smokers have lower than average rates of ulcerative colitis, but higher than average rates of Crohn's disease.  Some patients with ulcerative colitis, in fact, have reported that their disorder began after they quit smoking, and many studies have reinforced the association between smoking and protection against ulcerative colitis.  Studies are showing that the nicotine patch helps to induce remission and reduce symptoms in almost 40% of patients who use it for four weeks.  Another study found, however, that patches are not useful for maintaining remission.  Side-effects, particularly in nonsmokers, include nausea, lightheadedness, and headache.  Investigators are studying methods of applying nicotine directly into the colon.  (No one should smoke for relief of ulcerative colitis symptoms; the risks from cigarettes far outweigh the potential benefits of their nicotine.)

Hormone

Hydrocortisone

Ulcerative colitis is both an autoimmune disorder and sensitive to stress.  Using hydrocortisol to reduce inflammation followed by physiologic replacement doses when indicated is a reasonable supportive therapeutic strategy.

Lab Tests/Rule-Outs

Test for Food Allergies

As many as 50% of sufferers will improve by avoiding food allergens such as dairy, wheat, corn and eggs.

Test for DHEA

DHEA can be a factor in autoimmune problems, which some consider ulcerative colitis to be.

Mineral

MSM (Methyl Sulfonyl Methane)

Some doctors have reported reduced pain with the use of MSM.

Zinc

Zinc supports tissue regeneration and can be especially useful if levels are deficient.

Nutrient

Butyrate

Whether by supplement or by enema, pilot studies suggest butyrate is useful in reducing symptoms and restoring indicators of colon health in ulcerative colitis, although one study showed no benefit over placebo.  Several doctors claim that many people are helped by butyrate enemas.

Butyrate by enema has substantially reduced the number of bowel movements and amount of bleeding in patients who have not responded to other therapies.  This is especially true when the distal colon is involved – an area where the enema can easily reach.

Oxygen / Oxidative Therapies

Ozone / Oxidative Therapy

Rectal insufflation of ozone can hasten tissue repair and kill bacteria that may be slowing the healing process.

Psychological

Counseling

Unresolved grief is sometimes a hidden contributing factor.  Resolving the issue as completely as possible may hasten healing and reduce relapses.

Vitamins

Vitamin C (Ascorbic Acid)

Vitamin C (unless it causes colon irritation) may be supportive.

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