Ulcerative Colitis 101

Ulcerative Colitis 101

Answers to your ulcerative colitis questions.

Living with ulcerative colitis isn’t always easy -- it can mean dealing with symptoms such as rectal bleeding, and finding a life-long treatment that reduces inflammation and ulcerations in the lining of the colon.

While the causes of ulcerative colitis (UC) are generally unknown, understanding the disease can help minimize its impact on your quality of life.

Here are the facts about ulcerative colitis that can help you better manage this chronic condition, unraveled by gastroenterologist Eric Esrailian, MD, MPH, chief of development and section head of general gastroenterology at the David Geffen School of Medicine at UCLA.

Diagnosing Colitis

Ulcerative colitis is a type of inflammatory bowel disease (IBD), a category of conditions that causes inflammation in the small intestine and/or colon. Ulcerative colitis strikes only in the colon -- its distinguishing characteristic from its cousin, Crohn’s disease. With UC, inflammation takes place in the lining of the colon, causing ulcers to form, and resulting in bleeding and diarrhea. 

“There are multiple components to diagnosing UC,” says Esrailian. “Colonoscopy is one of the primary ways, allowing a gastroenterologist to view the tissue and obtain biopsy samples from inside the colon, looking for evidence of inflammation and disruption of the tissue -- both can be signs of UC.”

Colitis Flares

Once you know you have UC, reducing the frequency of flare-ups and finding a medication that works best for your symptoms are key next steps.

A true UC flare is often categorized by bloody diarrhea with or without whitish mucus, symptoms that signal that the lining of the colon is inflamed and irritated. Other symptoms imitate ulcerative colitis but may not be the real deal, including bloating, diarrhea, and gas.

“Knowing the difference between a UC flare and less-worrisome GI symptoms can help you understand when you should be talking to your doctor,” says Esrailian.

It’s also important to know what triggers a flare, and nonsteroidal, anti-inflammatory pain medications, such as aspirin, ibuprofen, and naproxen, top the list. So if you need pain relief and you’re living with UC, talk to your doctor before you try over-the-counter remedies.

What Causes Colitis?

Although the cause is unknown, finding the culprit remains an important area of research, starting with genetics -- about 15% of patients with the disease have a close family member who also lived with an IBD.

Another suspect is the body’s immune system, with some evidence indicating UC could be an autoimmune disease. “The body’s own immune system can overreact to a trigger that prompts it to kick into high gear,” says Esrailian. “As a result, a person develops the symptoms and signs of UC, which does lead us to believe an autoimmune component may be at play.”

Stress doesn’t cause ulcerative colitis, but research shows it can increase the risk of flare-ups. “If someone isn’t sleeping because of stress and becomes ill from a viral illness, for example, that can lead to a flare because it can stimulate the immune system, which triggers inflammation, and leads to symptoms,” says Esrailian.

But again, the typical effects of stress on the GI tract are different than the true symptoms of UC, explains Esrailian. While a rough day at the office might cause bloating and a stomachache, for instance, that doesn’t mean it’s a flare -- it just means you’re not treating your body as well as you could. 

Treating Colitis

Treating UC means finding a drug therapy that works for you. “Whatever therapy you’re on, it’s considered maintenance, meaning you have to take it to control symptoms, and as soon as you stop, your symptoms can return,” Esrailian says.

Treatments for UC are primarily oral or topical. “Generally, a mainstay treatment is a class of drugs called 5-aminosalicylates, which have an anti-inflammatory effect on the bowel to help minimize flare-ups,” Esrailian explains.

Another class is the immunomodulators, which suppress the immune system to calm any unnecessary activity in the bowel. Biologic agents are another option for more severe disease, as are corticosteroids in the short-term.

While the Internet touts treatments such as probiotics, omega-3 fatty acids, and herbal remedies like boswellia -- a gum resin from the boswellia tree -- the scientific research hasn’t quite caught up. “There’s not a lot of clear evidence because alternative therapies are not rigorously studied,” says Esrailian. “While limited evidence does show probiotics might be beneficial, for instance, more research is necessary before they can be recommended widely.”

Diet and Colitis

A common misconception with UC and other IBDs, is that spicy or fried food can trigger a flare, but it’s not true. “Often people severely limit their diet out of fear of a flare, which isn’t necessary as long as they’re eating healthy in general,” says Esrailian. Still, it doesn’t hurt to avoid foods that you know cause you trouble.

“It is important to live a healthy life in general to put your body in the best situation to fight off illness and UC symptoms in case you experience a flare,” says Esrailian. “Simply, this means getting adequate sleep and exercise and paying attention to good nutrition.”

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