Thousands of Australians are affected by ulcerative colitis and may not know what to do about it.
What is Ulcerative Colitis?
Ulcerative Colitis is a chronic, immune-mediated, inflammatory condition of the large colon and rectum. Ulcerative Colitis is also commonly referred to as Colitis. Still, this term refers only to the inflammation or irritation of the colon, usually caused by an infection by virus or bacteria. Ulcerative Colitis refers to a chronic condition, not primarily caused by an infectious agent1-2.
Inflammation in Ulcerative Colitis can occur in the rectum (called proctitis), left semicolon (called left-sided Colitis) or throughout the entire colon (called extensive Colitis or pancolitis)1.
Ulcerative Colitis is a common type of inflammatory bowel disease (IBD), specifically causing inflammation and sores (also known as ulcers) in the innermost lining of the large intestine (colon) and rectum1. Another common form of IBD is Chron’s Disease, which also causes similar symptoms, but can affect other parts of the gastrointestinal tract.
Ulcerative Colitis can lead to serious conditions and long-lasting health problems. There is no cure for ulcerative Colitis, but a person can lead an everyday life properly.
Typical symptoms of Ulcerative Colitis
The most common characteristic of ulcerative colitis is an inflamed rectum, resulting in bloody stools, abdominal or rectal cramping (known as tenesmus), and mucous on the stools. Ulcerative colitis can also cause diarrhea, fatigue, loss of appetite and weight, and anaemia. The severity of symptoms depends upon how much of the colon is affected or inflamed2.
Ulcerative colitis is a widespread condition affecting adults and children in Australia, Europe, the USA and many other countries worldwide. Ulcerative colitis usually affects people between 15 and 35 years of age and can have lifelong health effects3.
A critical aspect of ulcerative colitis is that this condition does not make the patient immunocompromised. However, some of the medications prescribed for this condition can affect the way your immune system functions. Patients should talk to their doctors about the side effects of their medications.
Main types of Ulcerative colitis
According to the specific location of the inflammation, ulcerative colitis can be classified into various types1-2, including:
This form of Ulcerative Colitis occurs in the region closest to the anus (rectum). A common symptom is rectal bleeding.
This Ulcerative Colitis involves the rectum and sigmoid colon (the lower end of the colon). Typical symptoms include bloody diarrhea, abdominal cramps and pain, and tenesmus.
In this form of Ulcerative Colitis, inflammation occurs from the rectum up through the sigmoid and descending colon. Typical symptoms include bloody diarrhea, abdominal cramping and pain on the left side.
This form of Ulcerative Colitis affects the entire colon. Typical symptoms include bouts of severe bloody diarrhea, abdominal cramps and pain, fatigue, and weight loss.
How common is Ulcerative Colitis?
Across the United States and Europe, Ulcerative Colitis is estimated to affect over 1 million people2. According to official figures, more than 33,000 Australians have been diagnosed with ulcerative colitis.
A recent study, published this year in The Medical Journal of Australia, found a high prevalence of Ulcerative Colitis among older Australians4. The study found a steady increase in the prevalence of Ulcerative Colitis relative to age. For example, prevalence among participants 25 years of age showed less than 50 cases per 100,000 population. This figure rapidly climbed to a prevalence of about 200 per 100,000 population in those aged 25 – 34 years and raised to a value above 300 for people over 35 years of age.
The highest prevalence was reported for the group above 85 years of age, with nearly 600 cases per 100,000 population. According to the study: “The age‐standardised IBD prevalence rate of 348 cases per 100 000 population we found is the highest ever reported in Australia.”4
What causes Ulcerative colitis?
The primary cause or causes driving ulcerative colitis are still under investigation. A leading hypothesis proposed a complex interaction between genetic susceptibility, gut microbiota, environmental factors, and altered immune function5-9.
An important line of support for this hypothesis comes from genetics. Recently, ulcerative colitis and Chron’s disease have been associated with more than 200 single nucleotide polymorphisms, some exclusive to each condition and other shared among them5-6.
How to diagnose Ulcerative colitis
The only way to reach a conclusive diagnosis of ulcerative colitis is through a tissue biopsy. For this, you need to go through endoscopic procedures, which may be invasive as they need to reach the areas potentially affected. Other tests may help rule out other conditions2. Some typical tests performed to get a diagnosis of ulcerative colitis include:
Blood tests to check for anaemia.
Stool testing may reveal specific protein markers indicative of ulcerative colitis. A stool sample can also help rule out other disorders, such as infections;
Colonoscopy this procedure allows for the visual examination of the entire colon.
X-ray may be used to reveal serious complications, such as a perforated colon.
CT scan this test is also used when complications are suspected.
Are you likely to develop Ulcerative Colitis?
Ulcerative colitis is considered to have a strong genetic component, so a significant risk factor, which can increase your chances of developing Ulcerative Colitis, are your genes. If you have a family history of ulcerative colitis, you may harbour genes associated with this disease1. Other risk factors associated with ulcerative colitis include:
Studies have found support for higher incidence of ulcerative colitis in women living in northern latitudes, possibly due to less exposure to sunlight or ultraviolet B (UVB)10;
Animal studies suggest that a lack of vitamin D may be a cause of IBD, since mice lacking the vitamin D receptor develop severe inflammation11;
Studies suggest that alteration to the normal composition of the gut microbiota can trigger abnormal inflammatory responses, leading to IBD12-13.
Following a diet rich in fats and sugars may cause detrimental changes in the diversity and function of the human gut microbiota, potentially contributing to IBD14.
Sleep Deprivation and Stress have also been linked to inflammation and have been found to be common characteristics of IBD patients15-16.
Who can diagnose Ulcerative colitis?
While you can visit your GP in the first instance when you or your child suffers from IBD symptoms, ultimately, a specialist is better equipped to deal with a potential case of ulcerative colitis.
A health care provider with experience managing patients with gastrointestinal problems, such as ulcerative colitis and related conditions, can help you identify your specific situation and tailor optimal treatments.
Treatment and management of Ulcerative colitis
Currently, there is no cure for ulcerative colitis. The best approach for someone with diagnosed ulcerative colitis is a comprehensive management strategy to reduce inflammation and control symptoms.
Typical approaches used in some patients for the treatment of ulcerative colitis under the standard of care model of health care involve certain medications, such as aminosalicylates, corticosteroids, immunomodulators, biologics and Janus kinase inhibitors, thiopurines, calcineurin inhibitors, anti-integrins, and anti-TNF agents, such as infliximab, adalimumab, and golimumab17.
In addition to any of these medications, a health care practitioner treating children may prescribe vitamins. In children with ulcerative colitis, vitamins may help supply micronutrients needed for their growth and development, such as iron, zinc, and vitamin D, which may be missing or depleted from their bodies due to their condition18.
Another potential option for extreme cases of ulcerative colitis is surgery.
When is surgery an option to treat ulcerative colitis?
Surgery is not the first option of treatment for ulcerative colitis. However, for some instances and patients, surgery may be the best choice to help patients who have not benefited from any other approach. From a standard of care perspective, there are three main reasons to do surgery on a patient suffering from ulcerative colitis19:
This is a potentially life-threatening condition. Patients presenting to a hospital with possible acute severe colitis are assessed against the Truelove-Witts criteria to determine if they will be admitted. This criteria establish a baseline of >6 bloody stools per day plus at least one of the following: (1) temperature greater than 37.8 C; (2) pulse greater than 90 beats per minute; (3) haemoglobin less than 10, 5 g/ dL; (4) erythrocyte sedimentation rate greater than 30 mm/h. Patients meeting the Truelove-Witts criteria are admitted to the hospital and treated with intravenous corticosteroids. For those that this treatment does not work, surgery may be the next step, in the form of a colectomy.
Based on guidelines from the ECCO (European Crohn’s and Colitis Organisation), refractory ulcerative colitis includes cases with both steroid dependency and immunomodulators or biologic-refractory ulcerative colitis. Basically, these are patients for whom the optimally available drug therapy does not work.
while rare, about 1% of all colorectal cancers are related to ulcerative colitis.
The most common type of surgery for ulcerative colitis is called proctocolectomy and ileoanal pouch or J-pouch surgery.
Prevention: how to stop ulcerative colitis flareups
If you have been diagnosed with ulcerative colitis and are undergoing treatment, your main priority should be avoiding flareups. The most common factors that can cause a flareup include:
People suffering from ulcerative colitis should keep a food journal to identify which foods to avoid because of their involvement with flareups. They should also limit their intake of fibre, as too much fibre can trigger ulcerative colitis flareups. Other foods to avoid include:
- Industrial seed oils
- Refined carbohydrates and refined sugars
- High fibre foods
- Alcohol and coffee
- Cooking technique is also very important
- Dairy
This is a major factor driving flareups. Reducing levels of stress can lower the body’s inflammatory response, which may help you avoid a flareup.
Forgetting or skipping medication
Taking certain over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen
Role of Diet and Nutrition in Ulcerative colitis
No diet will directly give you ulcerative colitis, just as no specific diet can prevent the disease or flareups. However, food can have a significant impact on the severity and duration of symptoms. Which foods you should eat and which you avoid depends on each person and need to be investigated individually. Some typical food causing problems for people with ulcerative colitis include:
- Greasy foods
- High sugar foods and drinks
- Carbonated beverages
- High-fiber foods
- Alcohol
In children and adolescents, salt and dairy products are also familiar sources of IBD-related problems. Children with ulcerative colitis may develop a low appetite and may need help obtaining the micronutrients they need.
What to expect following an ulcerative colitis diagnosis
First, patients should be aware that ulcerative colitis is lifelong with no cure. Patients should be mindful that they may experience a wide range of symptoms, from mild to severe, and they should strive to manage their symptoms as best as possible.
In most cases, symptoms of ulcerative colitis are not constant but appear randomly and then disappear. In a smaller proportion of patients with ulcerative colitis, the disease can spread to the colon and cause more common symptoms.
Patients should expect to need one or more medications, which they should use as prescribed. Skipping medication can lead to flareups. Surgery is an option if nothing else works.
When to visit your doctor
If you have been diagnosed with ulcerative colitis, visit your doctor if you experience persistent diarrhea, blood leaking from the anus or finding blood in the stool or if you experience constant fever and pain. These may be signs of a severe progression of your condition or an infection, which needs to be treated.
Optimal diet for Ulcerative colitis
While some diets may help patients reduce symptoms, no single “magic” diet can be prescribed to any patient with ulcerative colitis. However, it is essential to keep close track of what foods cause you harm and which are safe to eat. At AUSCFM, apply advanced testing technologies against gluten, lactose and cross-reacting foods. We also run a complete blood panel for nutrient deficiencies or overloads.
Overall, our approach ensures we can design a personalised and optimal diet for each patient with ulcerative colitis. A potential diet that can help reduce the risk of symptoms from IBD is the so-called autoimmune protocol (AIP). This protocol starts with a 6-week elimination phase (staged elimination of grains, legumes, nightshades, dairy, eggs, coffee, alcohol, nuts and seeds, refined/processed sugars, oils, and food additives). Next, patients go through a 5-week maintenance phase (no food group reintroduction allowed).
In a recent study, AIP was shown to have a high efficacy in patients with IBD. In just six weeks, 11 out of the 15 patients experienced clinical remission, meaning they did not exhibit symptoms.
Do you really need a colonoscopy for ulcerative colitis?
Your health care provider needs to ensure that the treatment prescribed is working. For this reason, a colonoscopy might be required, as this technique allows for direct inspection of the condition of the rectum and colon. This direct observation will help ensure that:
- The linings are healing
- Evidence of inflammation
- There is no evidence of cancer growth
Ulcerative colitis in children: effect on mental health
For children, it can be challenging to manage regular bouts of pain or discomfort, any of the other symptoms associated with ulcerative colitis or with the side effects of medications. As a consequence of their condition, children have a wide range of physical, emotional, social or family issues. Children with ulcerative colitis may experience:
- Mood Swings
- Anger, embarrassment and frustration
- Concern about their appearance
- Poor Concentration
Children with ulcerative colitis need all the support they can get from their families. Family members should inform themselves about the symptoms of ulcerative colitis to better understand what the child is going through. Support from a psychiatrist or therapist may be helpful.
Ulcerative Colitis in Australia
According to Australia’s recent report “INFLAMMATORY BOWEL DISEASE NATIONAL ACTION PLAN 2019”, health care costs related to IBD, which includes ulcerative colitis, led to nearly $100 million. The report also found productivity losses of more than $361 million and over $2.7 billion spent in carer costs, out-of-pocket expenses, welfare costs and loss of wellbeing, among other related expenses3.
A recent analysis of the quality of care in the treatment of ulcerative colitis and IBD shows that all hospitals audited did not meet the levels of care specified by Australian standards, highlighting the need to improve care among all stakeholders, including government, planners, healthcare providers and people living with IBD3.
Hence, there is a latent need to create a new and more efficient model of care for IBD, including ulcerative colitis. However, the standard model of care is yet to move a step forward and develop such a model. In contrast, the Australian Centre for Functional Medicine (AUSCFM) is leading the way in the treatment of IBD and ulcerative colitis.
Modern Functional Medicine and Ulcerative Colitis
At AUSCFM, we use an evidence-based, comprehensive approach to the treatment of ulcerative colitis. Our approach is based on extensive testing, including blood, stool, genetic, and microbiota testing. We also rely on extensive patient consultation and investigation aimed at identifying the specific drivers of your ulcerative colitis.
References
- Yeshi K, Ruscher R, Hunter L, Daly NL, Loukas A, Wangchuk P. Revisiting inflammatory bowel disease: pathology, treatments, challenges and emerging therapeutics including drug leads from natural products. Journal of clinical medicine. 2020 May;9(5):1273. Read it!
- Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG clinical guideline: ulcerative colitis in adults. American Journal of Gastroenterology. 2019 Mar 1;114(3):384-413. Read it!
- Inflammatory Bowel Disease National Action Plan 2019. Available online: https://www.crohnsandcolitis.com.au/site/wp-content/uploads/National-Action-Plan-FINAL-08-03-2019.pdf.Read it!
- Pudipeddi A, Liu J, Kariyawasam V, Borody TJ, Cowlishaw JL, McDonald C, Katelaris P, Chapman G, Corte C, Lemberg DA, Lee CH. High prevalence of Crohn disease and ulcerative colitis among older people in Sydney. Medical Journal of Australia. 2021 Jan 27. Read it!
- Liu JZ, Van Sommeren S, Huang H, Ng SC, Alberts R, Takahashi A, Ripke S, Lee JC, Jostins L, Shah T, Abedian S. Association analyses identify 38 susceptibility loci for inflammatory bowel disease and highlight shared genetic risk across populations. Nature genetics. 2015 Sep;47(9):979-86. Read it!
- Luo Y, de Lange KM, Jostins L, Moutsianas L, Randall J, Kennedy NA, Lamb CA, McCarthy S, Ahmad T, Edwards C, Serra EG. Exploring the genetic architecture of inflammatory bowel disease by whole-genome sequencing identifies association at ADCY7. Nature genetics. 2017 Feb;49(2):186-92. Read it!
- Roberts‐Thomson IC, Bryant RV, Costello SP. Uncovering the cause of ulcerative colitis. Read it!
- Sartor RB. Mechanisms of disease: pathogenesis of Crohn’s disease and ulcerative colitis. Nature clinical practice Gastroenterology & hepatology. 2006 Jul;3(7):390-407. Read it!
- Peloquin JM, Goel G, Villablanca EJ, Xavier RJ. Mechanisms of pediatric inflammatory bowel disease. Annual review of immunology. 2016 May 20;34:31-64. Read it!
- Khalili H, Huang ES, Ananthakrishnan AN, Higuchi L, Richter JM, Fuchs CS, Chan AT. Geographical variation and incidence of inflammatory bowel disease among US women. Gut. 2012 Dec 1;61(12):1686-92. Read it!
- Froicu M, Weaver V, Wynn TA, McDowell MA, Welsh JE, Cantorna MT. A crucial role for the vitamin D receptor in experimental inflammatory bowel diseases. Molecular endocrinology. 2003 Dec 1;17(12):2386-92. Read it!
- Martín R, Chain F, Miquel S, Lu J, Gratadoux JJ, Sokol H, Verdu EF, Bercik P, Bermúdez-Humarán LG, Langella P. The commensal bacterium Faecalibacterium prausnitzii is protective in DNBS-induced chronic moderate and severe colitis models. Inflammatory bowel diseases. 2014 Mar 1;20(3):417-30. Read it!
- Sokol H, Seksik P, Furet JP, Firmesse O, Nion-Larmurier I, Beaugerie L, Cosnes J, Corthier G, Marteau P, Doré J. Low counts of Faecalibacterium prausnitzii in colitis microbiota. Inflammatory bowel diseases. 2009 Aug 1;15(8):1183-9. Read it!
- Devkota S, Wang Y, Musch MW, Leone V, Fehlner-Peach H, Nadimpalli A, Antonopoulos DA, Jabri B, Chang EB. Dietary-fat-induced taurocholic acid promotes pathobiont expansion and colitis in Il10−/− mice. Nature. 2012 Jul;487(7405):104-8. Read it!
- Ananthakrishnan AN, Khalili H, Konijeti GG, Higuchi LM, de Silva P, Fuchs CS, Richter JM, Schernhammer ES, Chan AT. Sleep duration affects risk for ulcerative colitis: a prospective cohort study. Clinical Gastroenterology and Hepatology. 2014 Nov 1;12(11):1879-86. Read it!
- Ananthakrishnan AN, Khalili H, Konijeti GG, Higuchi LM, de Silva P, Fuchs CS, Richter JM, Schernhammer ES, Chan AT. Sleep duration affects risk for ulcerative colitis: a prospective cohort study. Clinical Gastroenterology and Hepatology. 2014 Nov 1;12(11):1879-86. Read it!
- Tripathi K, Feuerstein JD. New developments in ulcerative colitis: latest evidence on management, treatment, and maintenance. Drugs in context. 2019;8. Read it!
- Ehrlich S, Mark AG, Rinawi F, Shamir R, Assa A. Micronutrient deficiencies in children with inflammatory bowel diseases. Nutrition in Clinical Practice. 2020 Apr;35(2):315-22. Read it!
- Gallo G, Kotze PG, Spinelli A. Surgery in ulcerative colitis: When? How?. Best Practice & Research Clinical Gastroenterology. 2018 Feb 1;32:71-8. Read it!
