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  Ulcerative Colitis  
 
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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | It can lead to... | Recommendations

 

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. 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.

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.

A common subcategory of ulcerative colitis is ulcerative proctitis. For approximately 30% of all patients with ulcerative colitis, the illness begins as ulcerative proctitis. In this form of the disease, bowel inflammation is limited to the rectum. Because of its limited extent (usually less than the six inches of the rectum), ulcerative proctitis tends to be a milder form of ulcerative colitis. It is associated with fewer complications and offers a better outlook than more widespread disease.


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.

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.
 

 
 

Signs, symptoms & indicators of Ulcerative Colitis:
 
 
Lab Values - Cells  Elevated ESR or High ESR

Symptoms - Bowel Movements

  Frequent/occasional/regular painful urge to defecate
  Significant/frequent blood in stools
 Ulcerative colitis can cause bloody, watery or mucousy bowel movements which may consist only of blood and pus.

  Mucous 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.

  (Very) frequent stools or normal stool frequency
 Ulcerative colitis may result in an increased urgency to defecate, up to 10 or 20 times per day.

  Having very watery/having loose stools

Counter-indicators:
  (Tendency to/very) infrequent stools
  Occasional painful urge to defecate
  Having hard stools or having normal stool texture

Symptoms - Food - General

  Weak appetite

Symptoms - Gas-Int - General

  (Right/left) lower abdominal ache
  Severe/severe left/severe right lower abdominal pain

Symptoms - General

  Constant fatigue

Symptoms - Metabolic

  Occasional/frequent unexplained fevers
 In severe acute attacks there may be fever.

  Having a slight/having a moderate/having a high fever

Symptoms - Skeletal

  Joint pain/swelling/stiffness
 
 

Conditions that suggest Ulcerative Colitis:
 
 
Autoimmune  Ankylosing Spondylitis
 See the link between Crohn's Disease and Ankylosing Spondylitis.


Counter-indicators:
  Gluten Sensitivity / Celiac Disease
  Crohn's Disease

Circulation

  Anemia (Iron deficiency)

Diet

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

Digestion

  Increased Intestinal Permeability / Leaky Gut

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.

Infections

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

Inflammation

  Episcleritis

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 - having 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]

  Monocytes Elevated
  Hypoalbuminemia (A low albumin level)

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 / Risk
 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 Requirement
 All inflammatory bowel disease patients are prone to low serum folate levels. The drug sulfasalazine depletes the body of folic acid, so anyone taking sulfasalazine should be supplementing their diet with folic acid.

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 - Conditions

  Colitis
 
 

Risk factors for Ulcerative Colitis:
 
 
Autoimmune  Gluten Sensitivity / Celiac Disease
  Autoimmune Tendency

Childhood

  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.

Digestion

  Constipation
 Dr. Batmanghelidj, MD in his book Your Body's Many Cries For Water says that the left lower quadrant pain of colitis is sometimes a signal of localized thirst and associated with constipation.

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

  Low Adrenal Function / Adrenal Insufficiency

Infections

  Dysbiosis, Bacterial
 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.

  Parasite, Dientamoeba Fragilis
 DF has also been implicated as a cause of colitis in adults.

Lab Values - Chemistries

  Trace/significant amounts of occult blood or history of occult blood

Counter-indicators:
  Absence of occult blood

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

  Anorexia / Starvation Tendency

Symptoms - Gas-Int - Conditions

  Colitis in remission or colitis

Counter-indicators:
  Absence of ulcerative colitis

Symptoms - Nails

  Possible/some clubbing of digits or clubbing of toes and fingers

Counter-indicators:
  Absence of clubbing
 
 

Ulcerative Colitis suggests the following may be present:
 
 
Autoimmune  Gluten Sensitivity / Celiac Disease
  Autoimmune Tendency

Emergency Care

  A Potentially Urgent Medical Need
 Due to blood and electrolyte loss, as well as the need to prevent further tissue damage, early diagnosis of inflammatory bowel disease is important.

Immunity

  Immune System Imbalance (TH2 Dominance)
 
 

Ulcerative Colitis can lead to:
 
 
Circulation  Anemia (Iron deficiency)

Diet

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

Digestion

  Increased Intestinal Permeability / Leaky Gut

Inflammation

  Episcleritis

Nutrients

  Folic Acid Requirement
 All inflammatory bowel disease patients are prone to low serum folate levels. The drug sulfasalazine depletes the body of folic acid, so anyone taking sulfasalazine should be supplementing their diet with folic acid.

Risks

  Increased Risk of Colon Cancer
 Inflammatory bowel disease increases the risk of colon cancer.
 
 

Recommendations for Ulcerative Colitis:
 
 
Action  See a Doctor at Earliest Opportunity

Animal-based

  Probiotics / Fermented Foods
 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.

In another clinical trial, 77% of those treated with a probiotic bacteria mixture experienced relief of their mild to moderate ulcerative colitis. Of the 34 patients treated, 26 demonstrated improvement in their condition, with most of those experiencing a complete remission. Only three patients found their condition worsened after the treatment. [American Journal of Gastroenterology July 2005; 100(7):1539-46]

The mixture of eight lactic acid bacterial species is believed to work by:
  • Reducing the number of "bad" bacteria
  • Reducing the amount of inflammation
  • Increasing the mucus layer in the gut
  • Increasing the amount of anti-inflammatory molecules in the intestine
Another product, available over the counter (OTC) is VSL#3. This is a high-concentration probiotic preparation of eight live freeze-dried bacterial species that are normal components of the human gastrointestinal microflora, including four strains of lactobacilli (Lactobacillus casei, L. plantarum, L. acidophilus, and L. delbrueckii subsp. Bulgaricus), three strains of bifidobacteria (Bifidobacterium longum, B. breve, and B. infantis), and Streptococcus salivarius subsp. Thermophilus. Data from noncomparative trials suggest that VSL#3 has clinical potential in the treatment of active mild to moderate ulcerative colitis and as maintenance therapy for patients with ulcerative colitis in remission. In addition, a randomized, open-label, multicenter trial showed that VSL#3 in combination with low-dose balsalazide (a prodrug of mesalazine [mesalamine; 5-aminosalicylic acid]) was more effective than standard doses of basalazide or mesalazine monotherapy in the treatment of acute mild to moderate ulcerative colitis.

In a series of mouse experiments (2007), researchers at the Harvard School of Public Health (HSPH) have pinpointed a specific immune deficiency as the likely fundamental cause of ulcerative colitis, a chronic, sometimes severe inflammatory disease of the colon or large intestine that afflicts half a million Americans. Remarkably, the researchers also found that once the disease was established in mice, it could be passed from mother to offspring and even between adult animals, with potential implications for public health and prevention.

The researchers have linked ulcerative colitis in mice to a deficiency of a molecular "peacekeeper" in the immune system, allowing harmful bacteria in the large intestine to breach the bowel's protective lining and trigger damaging inflammation.

In a paper posted online by the journal Cell, a team led by Laurie Glimcher, Irene Heinz Given Professor of Immunology at HSPH, details a series of immunological events by which a shortage of a regulatory protein called T-bet opens the way to a bacterial attack on the intestinal wall. The resulting inflammation, in turn, causes the characteristic colitis marked by open sores, or ulcerations, throughout the colon. The first co-authors of the paper are Wendy Garrett, a research fellow in the laboratory of Glimcher and a clinical fellow at Dana-Farber Cancer Institute, and Graham Lord, formerly at HSPH and now a Professor of Medicine at King's College, London.

The key abnormality is a deficiency of the T-bet protein in "dendritic" cells -- white blood cells that capture identifying antigens of foreign microbes and activate the immune defenses. T-bet, discovered in 2000 in Glimcher's laboratory, is a "master regulator gene," a transcription factor that orchestrates a pro-inflammatory response of the immune system. T-bet had been found to play a role in the body's handling of infectious microbes and cancer cells and has been implicated in rheumatoid arthritis and asthma, but the discovery of its pivotal part in the innate immune system in inflammatory bowel disease came as a total surprise.

"We have identified a new molecular player, T-bet, and when it's missing, there is spontaneous onset of the disease in the mice," said Glimcher. "The importance of this study is that we now have a novel model for ulcerative colitis: The disease appears in 100 percent of the animals and looks just like the human disease."

If some people develop ulcerative colitis because of T-bet DNA variation or polymorphisms, it may be because of an inherited variation in the DNA affecting the T-bet gene. The researchers are following up this lead.

With its close mimicry of human ulcerative colitis, the animal model will have unprecedented value for testing new therapies and preventive measures, said Glimcher, who is also a professor of medicine at Harvard Medical School.

Ulcerative colitis and a related disorder, Crohn's disease, are known collectively as inflammatory bowel disease: they affect an estimated one million people in the United States. Crohn's disease tends to involve the small intestine as well as the colon. Ulcerative colitis usually appears between ages 15 and 30 but also can begin in the 50s and 60s, especially in men. The disease is somewhat more common among men than women, whites than non-whites, and Ashkenazi Jewish individuals than non-Jewish individuals.

Since about 20 percent of patients with ulcerative colitis have a close relative with the disease or with Crohn's disease, scientists have hunted specific genes that may be involved. Studies of the pathology of the inflamed intestine have suggested that an abnormal immune reaction and injury by bacterial residents of the colon are to blame. The T-bet shortage described in the Glimcher paper links these two mechanisms.

Beneficial bacteria in the colon aid in digestion and extraction of nutrients from food. However, harmful microbes also reside in the intestine, so animals that harbor bacteria have evolved a boundary, or barrier, in the form of the intestinal lining to keep the dangerous bacteria from injuring the colon wall.

The key to maintaining this mucosal barrier, the scientists discovered, is the "peacekeeper" activity of T-bet in the dendritic cells of the intestine's immune system. When T-bet is at normal levels, the boundary - a kind of demilitarized zone - remains intact and prevents trouble from pathogenic bacteria. But if T-bet is insufficient, the dendritic cells overproduce a powerful chemical called TNF-alpha (tumor necrosis factor-alpha) that triggers inflammation and causes normal cells to die. In ulcerative colitis, the T-bet-related excess of TNF-alpha leads to the death of cells making up the epithelial barrier of the colon, enabling harmful bacteria to chronically inflame the intestinal wall.

The scientists bred strains of mice that lacked T-bet and showed that the resulting disease was virtually identical to human ulcerative colitis.

Moreover, the investigators demonstrated that female mice with the disease could transmit it to baby mice that had adequate levels of T-bet. (The scientists placed genetically normal infant mice with the sick foster mother on their day of birth.) Presumably, the flourishing colonies of colitis-causing bacteria were passed down from the sick mother to the fostered mice. The disease was even "horizontally" transmissible from T-bet-deficient adult mice with ulcerative colitis to other adults with normal T-bet, through fecal-oral and skin-to-skin contact.

Inflammatory bowel disease can be treated with antibody drugs that block TNF-alpha activity, though their toxicity limits their use. The researchers showed that such antibody drugs cured and also prevented ulcerative colitis in T-bet-deficient mice. However, they are pursuing other potential therapies, such as increasing T-bet levels in the immune cells, administering natural immunity-dampening cells called T-regulatory cells, or giving "probiotics" - healthful bacteria that can keep the harmful microbes under control.

  Urine Therapy

Botanical

  Robert's Formula
 See the link between Ulcerative colitis and Slippery Elm.

  Aloe Vera
 Aloe vera has known anti-inflammatory properties. However, it has not been studied specifically for use in treating inflammation in UC.

  Slippery Elm (Ulmus rubra)
 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.

  Chlorella / Algae Products
 Fifty-five subjects with fibromyalgia, 33 with hypertension, and 9 with ulcerative colitis consumed 10gm of pure chlorella in tablet form and 100mL of a liquid containing an extract of chlorella each day for 2 or 3 months. Daily dietary supplementation with chlorella was seen to reduce high blood pressure, lower serum cholesterol levels, accelerate wound healing and enhance immune functions. Researchers concluded that the potential of chlorella to relieve symptoms, improve quality of life, and normalize body functions in patients with fibromyalgia, hypertension, or ulcerative colitis suggests that larger, more comprehensive clinical trials of chlorella are warranted. [Altern Ther Health Med. 2001 May-Jun; 7(3): pp.79-91. Review]

At the end of the second month, full examinations and interviews were completed to determine any improvements in the ulcerative colitis patientsí condition. These examinations were performed to determine the disease activity index (DAI) ó the most commonly used objective assessment for determining the state of inflammation of the colon. The DAI has four subscales: stool frequency, rectal bleeding, mucosal appearance, and physicianís overall assessment. Each subclass is scored from 0 to 3, thus the maximum score for the DAI is 12. Every participantís symptoms improved after adding chlorella to their diets. The examinations revealed significantly less inflammation. General assessment indicated that the patientsí overall ulcerative colitis had significantly improved. The average DAI decreased from an average of 7.2 to 2.8. Thatís nearly a sixty percent reduction in symptoms.

  Boswellia (Boswellia serrata)
 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 (Symphytum officionale)
 Comfrey has a reputation for promoting healing in stomach ulcers, hiatal hernia and ulcerative colitis.


Not recommended:
  Coffee Enema

Diet

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

In [Triumph Over Disease by Fasting And Natural Diet] 1977 by Dr. Jack Goldstein (D.P.M.), Dr. Goldstein gives a detailed account of a six-week fast he undertook in a controlled environment and under the supervision of a doctor - which literally saved his life. He also describes his new way of life based on the principles of a natural vegetarian diet.

  Juices / Juicing
 Dave Wilkerson, President, World Challenge, author of 'The Cross and the Switchblade' and 'The Vision'

"For the past 15 years I suffered from acute colitis, with constant pain and much bleeding. It drained me physically--I was always tired. A year ago I got desperate before the Lord, praying 'Lord, I can't minister to this huge congregation and keep all these ministries to the needy going unless You heal my bowels. I am at my wits end; I'm too weary to go on'. The Holy Spirit directed me to nutrition for healing. I always made fun of health nuts and all the claims being made for alternative health plans. The Holy Spirit taught me what to do: I got off sugar, I drink the juice of carrots and apples daily. I drink Aim's Green Barley.....I have been completely healed! I have more energy than I had at thirty years of age, and I have never felt better in my life...."

  Sugars Avoidance / Reduction
 Please see the comment under Ulcerative Colitis and Juicing.

  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.

  Gluten-free Diet
 Lymphocytic colitis is a form of microscopic colitis usually characterized by watery diarrhea and often associated with biopsy-defined celiac disease. Two patients with lymphocytic colitis and normal small intestinal biopsies who were administered 40gm of added dietary gluten for four consecutive weeks are presented. Small intestinal biopsies from multiple sites in the proximal small bowel were done after three and four weeks to determine whether pathological changes in latent celiac disease could be induced in these patients with a high gluten-containing diet. In addition, colorectal biopsies were done to determine whether the colitis was sensitive to oral gluten. No alterations in the small intestinal biopsies were detected in either patient and no changes occurred in colitis severity. Although microscopic forms of colitis have been linked to celiac disease, this study indicates that lymphocytic colitis is a heterogeneous clinicopathological disorder that, in some patients, is independent of any gluten-induced intestinal pathological changes. [Can J Gastroenterol. 1996 Nov-Dec;10(7):436-9]

Digestion

  Good Digestive Habits
 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.

Drug

  LDN - Low Dose Naltrexone
 The Promise Of Low Dose Naltrexone Therapy: Potential Benefits in Cancer, Autoimmune, Neurological and Infectious Disorders. By Elaine Moore, co-author SammyJo Wilkinson Foreword by Dr. Yash Agrawal, MD, PhD.

This is perhaps the first, and so far only book on LDN, and as such represents a milestone in the effort to bring LDN into mainstream use. Written by Elaine Moore, a high level science writer with a portfolio of previous accomplishments, her LDN book is perhaps somewhat technical and may be difficult for the untrained non-professional to follow. It delves into the sophisticated jargon of the medical research world. For example, in Chapter 5 on LDN and Cancer, there is a discussion of Zagon's work on Cyclin dependent kinases, P53 and protein 21 and how this relates to inhibition of cancer by LDN.

However, in addition to the esoteric technical sections of the book, there are also chapters devoted to the lay reader interested in learning how LDN can help them on a practical level. A listing of dispensing practitioners was included which I found contained my own office address and phone number.

The book is highly recommended for other health care practitioners who wish to get quickly up to speed in this new area of medicine which is destined to become the medical paradigm of the 21st century, casting a giant shadow over the rest of mainstream medicine.[ Comments on the LDN book by Jeffrey Dach MD]

  Conventional Drugs / Information
 Mild symptoms of UC may respond to antidiarrheal medications and dietary changes. Prescription medications may be used to treat mild symptoms and keep the disease in remission. Usually, corticosteroids (such as hydrocortisone or prednisone) are given for a few weeks to control active disease. Once inflammation is under control, aminosalicylates (such as sulfasalazine or mesalamine) can be used to maintain remission.

Moderate to severe symptoms of UC usually require corticosteroids to control inflammation. The required dose of steroids may be higher than that necessary to treat mild colitis.

Canasa Rectal Suppositories contains 500mg of mesalamine. Sulfasalazine has been used in the treatment of ulcerative colitis for over 55 years. It is split by bacterial action in the colon into sulfapyridine (SP) and mesalamine (5-ASA). It is thought that the mesalamine component only is therapeutically active in ulcerative colitis.

Immunomodulator medications, such as azathioprine (AZA) or 6-mercaptopurine (6-MP), also may be needed for severe cases that cannot be controlled with aminosalicylates alone. These medications suppress the body's immune system to prevent inflammation, and may be needed to avoid the long-term use of steroids.

Using an epidermal growth factor (EGF) enema with oral medication is effective in treating the ulcers and inflammation that ulcerative colitis causes, a study shows. EGF is known to stimulate the healing process. The research shows that the stimulating properties in an EGF enema can help speed up the healing process of the ulcers, improve symptoms, and lead to more remissions.

To determine EGF's effectiveness, researchers split 24 volunteers into two groups and evaluated them at two-, four-, and 12-week intervals. Half of the patients were men. Each participant gave himself or herself an enema and retained the solution for more than 45 minutes per day for 14 days. One group had enemas containing EGF, but the comparison group did not. All of the volunteers also combined their treatment with the ulcerative colitis drug mesalamine, which was taken orally. At the start, all of them had common symptoms of ulcerative colitis, including: fatigue, weight loss, loss of appetite, rectal bleeding, and loss of body fluids and nutrients

At two weeks, the group taking the EGF enemas showed significant decreases in symptoms, and 10 out of 12 went into remission, compared with 1 out of 12 in the comparison group. Eight of the 12 in the EGF group remained in remission after 12 weeks.

Two patients in the comparison group left the study by the second week because their symptoms got worse. [NEJM, July 24, 2003]

Crohn's disease (CD) and ulcerative colitis (UC) are chronic-relapsing diseases, the clinical courses of which are characterized by periods of remission and periods of acute flare up, determining clinical symptoms which have a strong impact on the quality of life for patients. For many years, corticosteroids have represented the cornerstone of therapy for induction of remission in Inflammatory Bowel Disease (IBD); however, the side-effects emerging with long-term use exceeded the clinical benefits. Recently, Infliximab (IFX) has become an alternative choice in the treatment strategies for CD and UC. Some safety issues are associated with IFX use, mostly related to the development of adverse events (e.g. opportunistic infections, autoimmune disorders and infusion reactions). Major concerns are related to the reactivation of latent tuberculosis and development of malignancy, even if there is no clear evidence the use of IFX increases the incidence of solid cancers. The research published in issue 39 of World Journal of Gastroenterology and led by Renato Caviglia at University Campus Biomedico in Italy aimed to retrospectively evaluate the safety and efficacy of long-term therapy with IFX, reviewing the medical charts of 41 IBD patients who received, after a loading dose of 3 IFX infusions, scheduled retreatment every 8 weeks as maintenance protocol.

Centocor, Inc., Schering-Plough Corporation, and Mitsubishi Tanabe Pharma Corporation have announced (2007) that an estimated one million patients have now been treated with REMICADE (infliximab), the leading anti-tumor necrosis factor (TNF)-alpha therapy worldwide. In fact, REMICADE has been used to treat more patients worldwide than all other anti-TNF-alpha agents combined. REMICADE was the first anti-TNF-alpha treatment approved by the U.S. Food and Drug Administration (FDA), when it was indicated for the treatment of acute moderate to severe Crohn's disease in 1998. The indication for Crohn's disease was quickly followed by additional indications, such as rheumatoid arthritis.

REMICADE has been studied in more than 37 clinical trials, evaluating its use in a wide variety of diseases of the immune system and is approved for use in 88 countries.

Extract

  Sprouted Grain / Wheat Grass Juice
 A study of patients with ulcerative colitis found that the use of germinated barley for a month produced improvement in symptoms and colon tissue health. The dose was between 20 and 30gm per day, and these patients had been unresponsive to standard medical therapy. [J Gastroenterol Hepatol 2002;17(8): pp.818-824]

Others have reported the usefulness of germinated barley foodstuff (GBF - a nutraceutical made from brewer's spent grain which contains a glutamine-rich protein and hemicellulose-rich fiber) in treating ulcerative colitis.

  Plant Sterols / Sterolins (Phytosterols)
 Although clinical studies have not been conducted using sterols and sterolins, based on existing research for other conditions, it is foreseeable that taking sterols and sterolins in cases of IBD will result in controlling the immune onslaught taking place on the mucosal surface. Sterols and sterolins will decrease the release of the inflammatory factors, get the good T cells to secrete the good factors, and induce a state of balance in the immune response. By so doing, it will allow repair mechanisms to kick in and recovery from such chronic conditions to take place.

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 / Trial
 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

  Hydrochloric Acid (Trial)
 It has been suggested that as many as 80% of those with UC have low stomach acid (hypochlorhydria).

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

  Test CBC (Complete Blood Count)
  Test for Occult Blood
  Test for DHEA
 DHEA can be a factor in autoimmune problems, which some consider ulcerative colitis to be.

  Digestive Enzymes / (Trial)
 Stool analysis or a pancreatic trial will reveal if pancreatic enzymes are necessary.

Mineral

  Calcium-2AEP
  Sulfur
 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.

Miscellaneous

  Reading List
 Breaking the Vicious Cycle by Elaine Gottschall is a practical book that addresses the problems of intestinal conditions, including indigestion, a "nervous stomach", chronic diarrhea or spastic colon, to the more serious and debilitating problems such as Ulcerative Colitis, Crohn's disease, Diverticulitis, Celiac Disease and Cystic Fibrosis. Breaking the Vicious Cycle provides an alternative way to help combat digestive disorders using dietary changes.

Nutrient

  Butyrate
 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 Folic Acid
 Please see the link between UC and Folic Acid Requirement.

  Vitamin D
 See the link between Autoimmune Tendency and Vitamin D.

  Vitamin A
  Vitamin E
  Vitamin C (Ascorbic Acid)
 Vitamin C (unless it causes colon irritation) may be supportive.
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Weakly counter-indicative
Strongly counter-indicative
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended
Reasonably likely to cause problems







GLOSSARY

Acute:  An illness or symptom of sudden onset, which generally has a short duration.

Anemia:  A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.

Antimicrobial:  Tending to destroy microbes, hinder their multiplication or growth.

Arthritis:  Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.

Cancer:  Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

Candidiasis:  Infection of the skin or mucous membrane with any species of candida, usually Candida albicans. The infection is usually localized to the skin, nails, mouth, vagina, bronchi, or lungs, but may invade the bloodstream. It is a common inhabitant of the GI tract, only becoming a problem when it multiplies excessively and invades local tissues. Growth is encouraged by a weakened immune system, as in AIDS, or with the prolonged administration of antibiotics. Vaginal symptoms include itching in the genital area, pain when urinating, and a thick odorless vaginal discharge.

Cholangitis:  Bile duct inflammation.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Cirrhosis:  A long-term disease in which the liver becomes covered with fiber-like tissue. This causes the liver tissue to break down and become filled with fat. All functions of the liver then decrease, including the production of glucose, processing drugs and alcohol, and vitamin absorption. Stomach and bowel function, and the making of hormones are also affected.

Cobalamin:  Vitamin B-12. Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).

Colitis:  Inflammation of the colon.

Colon:  The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.

Constipation:  Difficult, incomplete, or infrequent evacuation of dry, hardened feces from the bowels.

Copper:  An essential mineral that is a component of several important enzymes in the body and is essential to good health. Copper is found in all body tissues. Copper deficiency leads to a variety of abnormalities, including anemia, skeletal defects, degeneration of the nervous system, reproductive failure, pronounced cardiovascular lesions, elevated blood cholesterol, impaired immunity and defects in the pigmentation and structure of hair. Copper is involved in iron incorporation into hemoglobin. It is also involved with vitamin C in the formation of collagen and the proper functioning in central nervous system. More than a dozen enzymes have been found to contain copper. The best studied are superoxide dismutase (SOD), cytochrome C oxidase, catalase, dopamine hydroxylase, uricase, tryptophan dioxygenase, lecithinase and other monoamine and diamine oxidases.

Crohn's Disease:  Chronic inflammatory disease of the gastrointestinal tract. The most common symptoms are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia.

Diarrhea:  Excessive discharge of contents of bowel.

Electrolyte:  An element or compound that, when melted or dissolved in water or other solvent, breaks up into ions and is able to carry an electric current.

Fatty Liver:  Accumulation of triglycerides in the liver.

Folic Acid:  A B-complex vitamin that functions along with vitamin B-12 and vitamin C in the utilization of proteins. It has an essential role in the formation of heme (the iron containing protein in hemoglobin necessary for the formation of red blood cells) and DNA. Folic acid is essential during pregnancy to prevent neural tubular defects in the developing fetus.

Gastrointestinal:  Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.

Hepatitis:  Inflammation of the liver usually resulting in jaundice (yellowing of the skin), loss of appetite, stomach discomfort, abnormal liver function, clay-colored stools, and dark urine. May be caused by a bacterial or viral infection, parasitic infestation, alcohol, drugs, toxins or transfusion of incompatible blood. Can be life-threatening. Severe hepatitis may lead to cirrhosis and chronic liver dysfunction.

Immune System:  A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.

Kidney Stone:  A stone (concretion) in the kidney. If the stone is large enough to block the tube (ureter) and stop the flow of urine from the kidney, it must be removed by surgery or other methods. Also called Renal Calculus. Symptoms usually begin with intense waves of pain as a stone moves in the urinary tract. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin. The pain may continue if the stone is too large to pass; blood may appear in the urine and there may be the need to urinate more often or a burning sensation during urination. If fever and chills accompany any of these symptoms, an infection may be present and a doctor should be seen immediately.

Mucosa:  Mucous tissue layer lining tubular structures (nasal passages, ear canal, etc.).

Osteoporosis:  A disease in which bone tissue becomes porous and brittle. The disease primarily affects postmenopausal women.

Proctitis:  Inflammation of the mucous membranes of the rectum.

Serum:  The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.

Spondylitis:  Inflammation of one or more vertebrae.

Steroid:  Any of a large number of hormonal substances with a similar basic chemical structure containing a 17-carbon 14-ring system and including the sterols and various hormones and glycosides.

Ulcerative Colitis:  (Colitis ulcerosa): Ulceration of the colon and rectum, usually long-term and characterized by rectal bleeding or blood in the stool, frequent urgent diarrhea/bowel movements each day, abdominal pain.

White Blood Cell:  (WBC): A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. Also known as a leukocyte.