Information

Ulcerative Colitis

            Ulcerative colitis is a gastrointestinal disease that affects a variety of people today. This disease can prevent many people from pursuing a normal every day life. Ulcerative colitis is a disease localized in the colon, which causes inflammation and sores. When the colon becomes inflamed it is unable to absorb moisture; furthermore, causing the colon to also empty frequently, leading to diarrhea. While the colon is inflamed, there could also be bleeding from ulcers in the lining of the colon, which increases the amount of abdominal pain that a patient may be experiencing. This makes living up to the demands of everyday life very difficult. There are a lot of inconveniences that follow this disease aside from the constant abdominal pain. Some people could experience high levels of anxiety with this condition. Being aware of location of restrooms at places that you visit routinely could help. Some people with this condition might be consuming different medicines and keeping track of all medicine currently and previously taken can be overwhelming. Planning outdoor type events carefully with restrooms accessible can also be beneficial, because flare-ups can appear anytime for any unknown reason. These inconveniences may vary on the involvement of the colon and your ability to accommodate with your condition.

Colitis is an umbrella term for many different types GI (gastrointestinal) track diseases. The sores in the lining of the colon are called ulcers. The ulcers begin to form in inflamed portions of the colon where cells of the lining have died; the ulcers bleed and produce mucus (National Digestive Disease Information Clearinghouse (NDDIC), 2003, p.1, para.2).

The inflammation and ulcers in most cases are concentrated in the lower portion of the colon and the rectum; however, it can affect the entire colon. This condition is known as Fulminant colitis. Fulminant colitis is rare and could be life threatening. This form of colitis causes severe pain, profuse diarrhea, dehydration, and shock. People with fulminant colitis are at risk of serious complications including colon rupture and toxic mega colon, which occurs when the colon becomes severely distended (Mayo Foundation for Medical Education and Research, 2005, p. 2, para. 5). In rare cases ulcerative colitis can also affect the small intestine. In these rare situations, the ileum can become inflamed due to back wash, and it is called terminal ileum (T. Oei, MD, personal communicaton, August 15, 2005.).

            There is also an underlining concern for ulcerative colitis because you are more likely to develop colon cancer if you have a chronic inflammatory bowel disease, (IBD) then if you have a healthy lower GI track. About five percent of the people who develop ulcerative colitis could develop colon cancer. Despite this increased risk, however, more than 90 percent of people with inflammatory bowel disease never develop cancer. The risk of cancer increases with the duration and the extent of involvement of the colon. The more the colon is inflamed or infected, the higher the risk of cancer (Mayo Foundation for Medical Education and Research, 2005, p. 7, para. 2). Cases of ulcerative colitis, where the entire colon is involved, are at risk at a rate of 32 times higher than the normal rate. Precancerous changes occur in the cells lining the colon. These changes are called “dysplasia.” GI specialists look for signs for dysplasia when performing a colonoscopy or sigmoidoscopy, and when examining the histology from the biopsies after the test (National Digestive Disease Information Clearinghouse (NDDIC), 2003, p.6, para.9).

The guidelines for colon cancer screening updated for 2002 says, “ 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.” This reduces the risk of cancer because the doctors are able to identify the possible cancerous tissue early and have a better chance to prevent it from developing. These guidelines were produced by an independent expert panel and numerous organizations, including the American Cancer Society, the American College of Gastroenterology, the American Society of Colon and Rectal Surgeons, and the Crohn’s and Colitis Foundation of America Inc.

There are many theories about what causes ulcerative colitis, but there are no clear proven causes, yet. The Crohn’s and Colitis Foundation of America (CCFA) is the leading foundation in research on inflammatory bowel disease (IBD). CCFA has been a means for progress in IBD research. Established at a time when no other organization was devoting funds specifically to IBD, the foundation has dedicated more than $80 million to research that seeks the cause and cure. (Crohn’s & Colitis Foundation of America Inc., 2005, p.1, para. 1) Despite all research, leading scientist and physicians in the GI field conclude that an overactive immune response in the intestines may be the underlying cause. However, this is believed to not be the only cause. Other research has concluded that environmental factors, such as bacterium, triggers the disease; but only in people who have a genetic predisposition to IBD.

There is new research that suggests there might be still another factor leading to this disease. There is a case in the courts at the present time that is trying to prove that Accutane could trigger the over production of TNF-alpha, which leads to ulcerative colitis. “Accutane, intended for treatment of severe acne, recalcitrant, nodular acne, has been linked with numerous grave side effects.”(Accutane Side Effects, 2005, para. 12) Accutane has been known since it was developed to cause serious after effects: Inflammatory bowel disease and rectal bleeding, Crohn’s Disease, Ulcerative Colitis, Proctitis, Entercolitis, lleocolitis, lletis bleeding, sigmoiditis, colitis, Premature epiphyseal closure, Desiccation of the spine and desiccated discs, Optic neuritis, Cirrhoses, Hepatotoxicity ( Accutane Side Effects, 2005, para. 2). I personally have interest in this case because I took Accutane in high school for two sessions of twelve week periods and also later developed fulminant ulcerative colitis.

There are other theories and possible contributions to the unknown cause, such as age and ethnicity. Ulcerative colitis does not appear at any certain age; however it does appear more often with people of younger ages. Although people may still develop this disease later years of their life, the most common ages are between the teenage years and people in their thirties. The other factor is ethnicity. The white population is at the highest risk of developing this disease. “If you are Jewish and of European descent, you’re four to five times as likely to have ulcerative colitis.”(Mayo Foundation for Medical Education and Research, 2005, p. 4, para. 5) However, it is important to remember that these are just theories. No body truly knows what causes ulcerative colitis, yet.

            The diagnosis process can be long and requires many different physical exams and tests. One of the difficult parts of diagnosing ulcerative colitis is that it is very similar to another IBD called Crohn’s disease. Blood tests may be taken to determine white blood cell count, which indicates infection, and red blood count to determine loss of blood. Other blood tests are done to check kidney function, which is important because the medicine that doctors often prescribe can damage the kidney. Stool samples are taken to determine infection and blood in the colon and rectum. A sigmoidoscopy and colonoscopy are tests that are much more thorough. They are vital in indicating whether the patient has developed ulcerative colitis or Crohn’s disease. Sigmoidoscopy tests are done with an endoscope connected to a TV monitor which shows the inside of the lower portion of the colon, usually to the end of the sigmoid. An endoscope is a long, narrow, flexible tube with a strong light and a video camera used for viewing the gastrointestinal track on a TV monitor (R. Sundberg, MD, 2001.). The doctor may not completely make it to the end of the sigmoid because of the pain from the pressure of the air and liquid that the endoscope pushes into the colon to allow the tube to pass sharp corners in the colon. Biopsies are usually done to sample the lining of the colon by ripping off a small portion of the inflamed tissue (“Lower GI Endoscopy,” 2001.).

Colonoscopy tests are done less often because they require sedation medicine to prevent the patient from tensing up and adding more pressure to the colon during the test. This test is very painful and the sedation is helpful for the patient to deal with the pain of the test. The medication is administered through an IV (intravenous) line, which is very potent, and can be very dangerous. Colonoscopy is done much the same way as a sigmoidoscopy but the doctor moves the endoscope all the way through the colon and sometimes also through and into the ileum of the small intestine. It is much more dangerous and done less often because it can only be done when symptoms are in remission due to the possibilities that the endoscopes could rip the lining of the colon. There are a lot more sharp turns when traveling the whole colon (T. Oei, MD, personal communication, September 5, 2005).

Barium enema x-ray of the colon may also be required. This procedure involves filing the colon with barium, a chalky white solution. The barium shows up white on x-ray film, allowing the doctor a clear view of the colon, including any ulcers, polyps, or other abnormalities. This shows more of the upper gastrointestinal track then other tests like the colonoscopy; however it’s not as thorough (National Digestive Disease Information Clearinghouse (NDDIC), 2003, p.3, para.4).

            Medication for ulcerative colitis does not cure the disease, but symptomatically are attempting to keep inflammation as low as possible, as best as possible. The only cure for the disease to remove the infected portion of the colon, and in some cases, removing the entire colon is necessary, and in rare cases the distal portion of the ileum is removed. With advances in the medicine having to resort to surgery is becoming more and more rare.

Doctors use several categories of drugs to control the symptoms in many different ways. Some dugs that work well for some people may not work for others. So for many doctors controlling the symptoms is through a trail and error basis. The drugs that are used to obtain remission are very poisonous and have many severe side effects, so you’ll need to weigh the benefits and the risks of the drugs.

            There are different drug types that can work well. One drug type that is available is an anti-inflammatory. This includes: Sulfasalazine (Azulfidine), Mesalamine (Asacol, Rowasa) and olsalazine (Dipentum), Balsalazide (Colazal), and Corticosteroids (Prednisone); which, are usually tried first (Mayo Foundation for Medical Education and Research, 2005, p. 7, para. 8-13). Most of them usually perform well for long term usage, however, Corticosteroids such as prednisone can have extremely harmful long term effects and so doctors try to limit the duration of this drug (T. Oei, MD, personal communication, September 5, 2005). Another type of drug used is immune system suppressors. These drugs also reduce the inflammation, but they target your immune system rather than treating inflammation itself. The drugs used as immune suppressors are Azathioprine (Imuran) and Mercaptopurine (Purinethol), Cyclosporine (Neoral, Sandimmune), Infliximab (Remicade) (Mayo Foundation for Medical Education and Research, 2005, p. 7, para. 14-17).

I have tried most of the medications and so far for me Prednisone is the only medicine that has helped me. There are a large number of side effects that follow this type of drug therapy such as: difficulty sleeping, mood changes, nervousness, increased appetite, or indigestion, swelling of feet or legs, unusual weight gain; black, tarry stools, vomiting material periods, headache, muscle weakness, or prolonged sore throat, cold or fever. In my situation the most noticeable side effects from this drug are: the swelling of the legs, weight gain, breakout on my chest and back, tarry stools, and difficulty sleeping.

Drug therapy treatments like, aminosalicylates (sulfasalazine) are mostly used to maintain remission, however they are usually not effective enough to put a patient into remission. I have tried sulfasaslazine but I did not reap any of the benefits, because I saw no changes for the better while on the drug. Immunomodulators (asathioprine) and 6-mercaptopurine (6-MP), are very poisons and also have a large amount of side effect, furthermore, they take a long time to start working usually about six months or more. Side effects for both immunomodulators include: vomiting, diarrhea, rash, fever, muscle aches, sore throat, mouth sores, unusual bleeding or bruising, pale stools, or dark urine, skin rash, yellow discoloration of the skin or eyes, abdominal pain or swelling (Mayo Foundation for Medical Education and Research, 2005, p. 7, para. 8-17). In addition to all of these side effects there is also a risk of sever damage to the pancreas. I went through a very rough time when trying these drugs.   I could not handle the poisonous reaction from these drugs and so I could not stay on them even long enough for them to be able to do anything.

Mesalamine (Asacol, Rowasa) and olsalazine (Dipentum) are medications that tend to have fewer side effects than Sulfasalazine. I have used both of these drugs and Asacol has worked before in times of remission in order to keep symptoms under control. However, Mesalamine (Asacol) is also not strong enough to put me in remission and steroids like prednisone are required. Mesalamine (Rowasa) is a medication that is also given in the form of enemas and can relieve sings of symptoms in more than 80 percent of people (Mayo Foundation for Medical Education and Research, 2005, p. 7, para. 8-17). However, the enemas are a localized medication it can only affect the inflamed portion that fluid injected can reach, otherwise it won’t work. Patients with fulminant colitis this form of medication does not work because too much of the colon is inflamed. With most of these drugs there is always a risk of kidney damage, so routine blood work is usually done.

The FDA just recently approved a medication to treat ulcerative colitis, which I personally just started, called Remicade (Infliximab). This medicine has been used to treat adults with severely active rheumatoid arthritis, Crohn’s disease and now ulcerative colitis. Remicade has been used as an immune suppressor for other disease prior to its approval for treating ulcerative colitis. Remicade is used for Crohn’s disease and ulcerative colitis patients who have not responded well enough to other medicines. “Remicade is a biologic therapy that recognizes, attaches to, and blocks the action of a protein in your body called tumor necrosis factor alpha (TNF-alpha). TNF-alpha is made by certain blood cells in your body.” (“Remicade INFLIXIMAB,” September 2005, p. 1)   Remicade works in a variety of inflammatory disorders by attaching to your body’s immune system that overproduces TNF-alpha. Too much TNF-alpha can cause your immune system to attack healthy tissues in your body and cause inflammation. If this condition is left untreated, the ongoing inflammation can cause permanent damage to the body’s bones, cartilage, and tissue. Remicade will not cure inflammatory disorders, such as Ulcerative colitis, but blocking TNF-alpha may reduce the inflammation caused by the presence of too much TNF-alpha in your body (Centocor, Inc., “How Remicade (infliximab) Works,” September 22, 2005, para. 2-5).

            “There is no perfect drug.” While taking Remicade it can block the TNF-alpha that causes inflammation; nonetheless, it can also lower your body’s ability to fight infections. So taking Remicade can make your more prone to getting infections and it can make an infection that you already have worse. Some people have had serous infections while receiving Remicade. Some of the patients have died from the infections. Some of the infections include tuberculosis, infections caused by viruses, fungi or bacteria that have spread throughout the body. In some people the body may fail to produce enough blood to fight infection and reduced coagulation rate. Some patients have had severe allergic reactions to Remicade. These reactions can happen while you are getting your Remicade infusion or shortly afterwards. The allergic reaction includes red, raised, itchy patches of skin, fever, muscle and joint pain, difficulty breathing and chest pain. Reports of a type of blood cancer called lymphoma in patients on Remicade or other similar TNF blockers are rare but occur in more people then expected. So taking this drug is a big risk, but hopefully it works out okay. (“Remicade INFLIXIMAB,” September 2005, p. 2)

            Eating nutritional meals and building good eating habits are ways you can lead a healthy lifestyle. That’s why its important to make smart food choices and knowing how your body reacts to certain food is extremely important. Everybody’s body behaves differently and only you can truly know what works and what doesn’t.   There is no evidence that any particular food causes ulcerative colitis. But for some people some foods have been known to make symptoms worse. And this is why being conscientious to the way your own body reacts is so important; moreover, keeping a symptom diary to see which foods aggravate your symptoms can be useful. I have found the symptomatic nutrition diary to be very effective. Dietary changes can be made to help, but usually your diet alone is not enough to prevent a flare-up, but it could be enough to cause an episode lapse. Omega – 3 fatty acids have been proven to help GI regulation. In general some people have found that spicy and or high-fiber foods make symptoms worse. Professionals recommend eating soft bland foods during a flare-up instead of raw vegetables or spicy meals (Life with UC, “Eating Smart,” September 30, 2005, para. 1).

            Diarrhea and bleeding during an episode or flare-up can cause nutritional deficiencies and strip your body of fluids and electrolytes. Proper nutrition is important to ensure that your body stays healthy. Diarrhea can also cause dehydration, so it is equally important that you drink plenty of water, especially during warmer weather. (Life with UC, “Eating Smart,” September 30, 2005, para. 3)

            Some nutritional type things that I have done and they have been helpful are keeping track of your diet and eating much smaller meals throughout the day instead of three larger meals. The most important thing for me is moderation and self control, remembering that this is a life long commitment and it will take time to set new habits.

Aside form your diet, another main factor in maintaining your health especially during a flare-up, is stress. I personally know that having to put your life on hold can really screw things up bad and can be very stressful. Living with ulcerative colitis is not easy. You will have good days and bad days. However, it is important to try to control your stress whenever possible and maintain a positive outlook. For me it is just trying to be patient and wait out the episodes. It helps to remind yourself that you did not do anything to cause your illness. Ulcerative colitis is not caused by anything you have eaten or you personally, so don’t internalize your problems because it will just make things worse. Not only is it important to maintain stress levels during a flare-up, but also during remission, because it has been reported that stress can also lead to a flare-up.

There are many ways to deal with your stress such as: meditate, being physically active, and a lot of people say that simply talking about these issues to somebody you trust. I usually try to be physically active during any time of remission to help prevent a episode lapse. During a flare-up it is hard to be active so I usually resort to talking to my friends, which does help. You can also seek help or support through a therapist who is knowledgeable about (IBD) or other chronic illnesses. One other thing I have read and have found to be very effective is finding some way to let out your frustration. Knowing it is ok to be mad or angry; you don’t have to be happy all the time. Allow some time in your life for a bad day so you can relax and recover. (Life with UC, “Managing Stress,” September 30, 2005, para. 2)

The most important thing to do is educate yourself as much as possible on the disease you are fighting. Being ignorant can make an illness become overwhelming and make you feel like your loosing control of your life. When in fact the more you learn about the disease the better you and your doctor can control it. Keep up on new advancements in medicine and research, which can allow you to take part in discussions with your doctor, and be more involved in your treatment. The more knowledge you have the more control you’ll have and the better you feel.

While discussing all the negatives of the disease it has been beneficial to remember that every thing happens for a reason, although, we may not realize it now there is a reason for the trials. “Pain gives joy; Heart-ache builds character; Failure allows opportunity for success; Reflect-Learn-Grow.