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Ulcerative Colitis
 

Ulcerative Colitis Introduction

Ulcerative Colitis is a chronic inflammatory disorder of the large intestine (colon). It is characterized by the uniform, diffuse ulceration and destruction of the mucosal layer of the colon. Breakdown of the mucosal layer causes bloody diarrhea, which is the chief complaint of individuals with Ulcerative colitis. Ulcerative colitis is one of the two diseases included under Inflammatory Bowel Disease (IBD); the other being Crohn's disease. Ulcerative Colitis is different from Crohn’s in many ways. The most prominent feature being that Ulcerative Colitis involves only the colon, and only the mucosal layer of the intestine. [1]

There is no known cause for Ulcerative Colitis. It is mediated by an immune reaction against an unknown antigen (environmental, dietary, infectious) in the GI tract. There is thought to be a familial predisposition, though not strong. [2] However, studies have shown that oxidative stress and damage from free radicals has a role in the pathogenesis of the disease.

Ulcerative colitis affects men and women equally. It is more prominent in whites versus non-whites; with the Jewish population being affected the most. It is uncommon in individuals from Asia and South American. The mean age of incidence is from 15-30, though incidence peaks again between 50-70 years of age. [3]

Ulcerative Colitis Symptoms

The primary symptom of Ulcerative colitis is bloody diarrhea. The initial attack is usually very painful, and fever can be present. Individuals can have more than 10 bowel movements a day. The bowel movements are often filled with blood, mucous, and pus. It is not uncommon for leakage of fecal material to be an issue, even when sleeping.

Individuals with Ulcerative colitis will also suffer from fatigue, loss of appetite, weight loss, Ulcerative Colitis, and malabsorption. Complications of Ulcerative colitis may include toxic megacolon - an expansion of the diameter of the colon greater than 6 cm. This secondary condition can result in perforation, which is very dangerous. Another complication is toxic colitis, when the colon loses all tone, and does not function any more.

Ulcerative colitis increases ones risk for developing Colon cancer. It can also contribute to a myriad of conditions, such as osteoporosis, problems with the gallbladder, including hardening and cancer of the bile duct. Many patients may also develop arthritis, skin diseases, eye problems, and other autoimmune diseases. [4]

Ulcerative Colitis Statistics

  • In the US alone, 500,000 individuals have Ulcerative colitis. Incidence is estimated at 1-15 cases per 100,000 people. [5]
  • 20% of individuals with Ulcerative colitis will have a relative with the disease. [6] 1/3 of individuals will require some surgery.
  • 25-40% of individuals with Ulcerative colitis will have to have their colon removed due to severe bleeding.
  • 5% of individuals with Ulcerative colitis will develop colon cancer; the risk is increased by 32 times if the entire colon is involved. [7]

Ulcerative Colitis Treatment

The primary goal of treatment for Ulcerative Colitis is to induce remission and increase the quality of life. There are three main drug categories used to induce remission.

  • The first classification of drugs are aminosalicyltates, such as Sulfasalazine. They control inflammation in mild to moderate Ulcerative colitis.
  • The second drug type is corticosteroids like Prednisone. These are used if the first class of drugs did not work. They are effective for moderate to severe cases of Ulcerative colitis. It is important that corticosteroids not be used long term.
  • The last category is immunomodulating drugs, like Azathioprine. These are chemotherapeutic drugs that reduce inflammation via the immune system. They are usually reserved for use in cases that did not respond to the first two categories. The average time for therapeutic benefit is after 6 months of treatment.

All three drug types cause serious side effects. Other medications may be prescribed for Ulcerative Colitis to help with the symptoms. Analgesics are often given to help decrease pain, as well as anti-cholinergic drugs to decrease diarrhea.

Alternative treatment is focused on preventing the many complications of Ulcerative colitis. Additionally, supplementation corrects the many nutrient deficiencies that develop due to the chronic state of Ulcerative colitis.

Supplements helpful for Ulcerative Colitis

Omega 3 Fatty Acids

Omega 3 fatty acids are found in fish oils (EPA and DHA), flaxseed oil, evening primrose oil (DGLA), and borage oil. Omega 3 fatty acids are anti-inflammatory in nature. They decrease the production of pro-inflammatory cell signaling molecules. Fish oils have been studied extensively for their effects on remission in individuals with Ulcerative colitis. They have been shown to be equally effective in reducing the oxidative stress of patients with Ulcerative colitis. [8]

One study found that supplementation with EPA and DHA caused a clinical improvement in 56% of the participants, as compared to 4% in the placebo group for patients with mild to moderate Ulcerative colitis. [9] Another study compared remission rates in individuals who took fish oils and found that time to relapse was prolonged. [10] Yet another study highlighting the benefits of Omega 3 oils on Ulcerative Colitis patients showed that using evening primrose oil, participants reported an increase in stool consistency and improvement in clinical symptoms. [11]

Folic Acid

Folic acid is a vitamin co-enzyme involved in DNA metabolism. It also functions as an immune system modulator. Recently, folic acid has also been studied as a treatment for patients with Ulcerative colitis. It has been specifically aimed at reducing the risk of colon cancer. It is believed that colon cancer risks are directly correlated with the availability of folic acid in the body.

One study measured the proliferation of cells in the rectal mucosa of patients with Ulcerative colitis. Under normal disease circumstances proliferation is increased, therefore leading to increase risk for cancer. Supplementation with folic acid caused a decrease in this proliferation, and exhibited chemoprotective effects against the development of colon cancer. [12]

Aloe Vera gel

Aloe Vera gel is used in the treatment of Ulcerative colitis. It is important to note that the gel does not contain constituents that have a laxative effect. Aloe Vera gel is the mucilaginous component of the plant. It has anti-inflammatory and demulcent properties. Aloe Vera has been shown to promote the healing of tissues, especially those of the GI tract.

In a study of individuals with mild to moderate Ulcerative colitis, four weeks of treatment resulted in a clinical response in 100% of participants. 30% went into remission compared to 7% in the placebo group. Overall there was an improvement in 67% of the participants compared to 28% in the placebo group. There was also histological (cellular) response of decreased disease activity. [13]

DHEA

DHEA is a steroid hormone precursor made by the body. Recently, DHEA has been studied in the treatment of Ulcerative Colitis. Studies show it to be deficient in patients with inflammatory bowel disease. In clinical trials, the supplementation with DHEA for 8 weeks resulted in a decrease of disease activity. 85% of the participants responded favorably to treatment by entering into remission. [14]

Vitamin D and Calcium

Both Vitamin D and calcium should be supplemented in patients with Ulcerative colitis, due to the increased risk of developing osteoporosis. Vitamin D regulates calcium metabolism, and is often deficient in patients with Ulcerative colitis. Calcium, a necessity for strong bones, is often poorly absorbed and deficient in patients with Ulcerative colitis. Osteoporosis develops in Ulcerative colitis because of an increase in bone resorption (breakdown) and a decrease in bone formation. In fact, one study showed that supplementation with Vitamin D and calcium together resulted in increased bone density. [15]

High Potency Multi-Vitamin and Mineral Formula

A high potency vitamin and mineral formula is recommended, due to the decrease in the absorption nutrients; a typical manifestation in Ulcerative Colitis sufferers. High levels of antioxidants, including Vitamins A, C and E, will also be beneficial. Many vitamins and minerals are deficient in individuals with Ulcerative colitis abd supplementation is almost always necessary.

References

[1] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. Pages: 307-312.

[2] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. Pages: 307-312.

[3] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml National Digestive Disease Information Clearinghouse. November 2004.

[4] Beers M and Berkow R. The Merck Manual 17th Ed. 1999. Pages: 307-312.

[5] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml National Digestive Disease Information Clearinghouse. November 2004.

[6] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml Crohn’s and Colitis Foundation of America. November 2004.

[7] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml National Institute of Health. November 2004.

[8] Barbosa DS et al. Decreased oxidative stress in patients with ulcerative colitis supplemented with fish oil omega 3 fatty acids. Nutrition. 2003 Oct; 19(10): 837-842.

[9] Aslan A and Triadafilopoulos G. Fish oil fatty acids in active ulcerative colitis: a double blind placebo controlled crossover study. Am J Gastroenterol. 1992 Apr; 87(4): 432-437.

[10] Loeschke K et al. N-3 fatty acids only delay early relapse of ulcerative colitis in remission. Dig Dis Sci. 1996 Oct; 41(10): 2087-2094.

[11] Greenfield SM et al. A randomized controlled study of evening primrose oil and fish oils in ulcerative colitis. Aliment Pharmacol Ther. 1993 Apr; 7(2): 159-166.

[12] Biasco G et al. Folic acid supplementation and cell kinetics of rectal mucosa in patients with ulcerative colitis. Cancer Epidemiol Biomarkers Prev. 1997 Jun; 6(6): 469-471.

[13] Langmead L et al. Randomized double blind placebo controlled trial of aloe Vera gel for active ulcerative colitis. Aliment Pharmacol Ther. 2004 Apr; 19(7): 739-747.

[14] Andus T et al. Patients with refractory Crohn’s disease or ulcerative colitis respond to dehydroepiandrosterone: a pilot study. Ailment Pharmacol Ther. 2003 Feb; 17(3): 409-414.

[15] Abitbol V et al. Osteoporosis in inflammatory bowel disease: effect of calcium and vitamin D with or without fluorine. Aliment Pharmacol Ther. 2002 May; 16(5): 919-927.