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Ulcerative Colitis (UC)

  • About UC

    How does your digestive system work?

    The digestive system is a collective of organs- from the mouth to the anus-that works together to convert food into absorbable nutrients, which provide energy for the body. 1,2

    What happens in your digestive system affected by UC?

    Ulcerative Colitis is a condition that causes inflammation and ulceration of the inner lining of the colon and rectum(the large bowel). 1
    The inflammation usually begins in the rectum and lower colon, but it may affect the entire colon. 1,3
    Inflamed segments are extended in a continuous, uninterrupted pattern. 1, 5

    Anatomic distribution of ulcerative colitis 3, 5

    How are UC and other bowel disorders different?

    Many people are confused when it comes to the differences between inflammatory bowel disease(IBD), Crohn’s disease and ulcerative colitis. 1,5-9

    Ulcerative Colitis

    Affected area
    Affects large intestine only
    Extent
    Uniform or continuous
    Cause
    Exact cause is unknown, but attributed to overactive immune system triggering inflammatory response
    Gender frequen
    Male = Female
    Classified as
    Structural disease

    Also, IBD shouldn’t be confused with irritable bowel syndrome(IBS).

    • Crohn's Disease

      Affects any part of digestive system
      Occur in patches
      Exact cause is unknown, but attributed to overactive immune system triggering inflammatory response
      Male = Female
      Structural disease
    • Irritable Bowel Syndrome(IBS)

      Come in large intestine
      No inflammation cause
      Exact cause is unknown, but associated with the disruption on intestinal muscle contractions
      Male < Female frequent
      Functional Disorder

    What causes UC?

    While multiple contributing factors have been found, the exact cause of ulcerative colitis is unknown. 4,10

    UC is associated with some risk factors including 4,10

    • 1 Gender

      Men and women are equally likely to be affected, but older man are more likely to be diagnosed than older women.

    • 2 Age

      It can occur at any age, though most people are diagnosed in their mid-30s.

    • 3 Family history

      People who have a family history of UC are more susceptible to the disease.

    • 4 Immune system disturbance

      Abnormal immune responses may attack the healthy cells of the body, causing the symptoms of UC.

    • 5 Other factors

      Environmental triggers such as smoking, stress, and unbalanced diet are associated with a higher risk of developing UC.

  • Symptoms

    What are the symptoms of UC?

    Your symptoms may vary according to how much of the colon is inflamed and how severe the inflammation is, but the most common symptoms during a flare-up are 1,11

    Most common symptoms include:

    • Urgent need to move bowels and sensation of incomplete evacuation are other symptoms related to inflammation of the Gl tract. 12,13

    • Weight loss, night sweats and loss of normal menstrual cycle are general symptoms that may be associated with UC 12,13

  • Diagnosis

    How is UC diagnosed?

    An ulcerative colitis diagnosis is based on several factors, including your medical history, a physical exam, and a series of medical tests 1,14,15

    Diagnosis of UC 1,14,15,16

    • Blood Tests

      To check for levels of red blood cells(or white blood cells) and whether you show signs of inflammation, infections, or anaemia.

    • Stool Samples

      Tested for signs for bleeding or inflammation, and to check whether your diarrhea is caused by an infection. Fecal calprotectin has been proposed as a noninvasive surrogate marker of intestinal inflammation in IBD.

    • Upper GI Endoscopy

      Endoscope is inserted through your mouth or nose to examine your oesophagus, stomach and duodenum(the first part of the small intestine or bowel).

    • Sigmoidoscopy or Colonoscopy

      A short endoscope called a sigmoidoscope, or a longer and more flexible colonoscope, is inserted through the anus to examine the rectum and colon.

    • MRI and CT Scans

      Perform to obtain a more detailed image of organs and tissues.

  • Treatment

    How is UC treated?

    Ulcerative Colitis is chronic ongoing and life long conditions. Therefore, the main goals of medical treatment are to achieve remission(the absence of symptoms), maintain remission(prevent flare-ups of symptoms) and improve quality of life. 1,6
    UC may range from mild to severe, and will vary from person to person. 6
    Medications for UC aim to suppress the inflammation of the colon. 1

  • Tips & FAQs

    Living with UC

    UC is ongoing and lifelong, although you may have long periods of good health know as remission, as well relapses or flare-ups when your symptoms are more active. 1
    Flare-ups can come on suddenly, without an obvious trigger. 1,12,17
    With proper treatment over time, periods of remission can be extended and periods of symptom flare ups can be reduced. 17

    A flare is the reappearance of disease symptoms. The most common symptoms of UC are: 17,18

    • Frequent and/or urgent bowel movements
    • Diarrhea
    • Blood in stool or rectal bleeding
    • Abdominal pain

    You cannot completely prevent flare-ups of UC. But, there are several self managements that you can do to optimize your health: 1,18

    Take all IBD medications regularly

    The best way to control UC and reduce the risk of flares is by taking medications as recommended by your doctor.

    See your doctor regularly

    Well informed about the details of your symptoms and stay in close communication with your doctors.

    Quit smoking

    Smoking can make the symptoms of UC worse and can make it more difficult to treat.

    Eat a well-balanced diet

    Well-balanced nutrition is an essential part of staying healthy and minimizing the effects of the disease.

    Physical activity

    A regular exercise routine can improve overall health, and may be particularly beneficial for people with UC.

    A flare-up will probably not resolve by itself, and treatment will be needed. Maintenance drugs will be continued during a flare-up, and other drugs, diet modifications, or more treatment may be prescribed by your doctor to bring the disease back under control. 18

    Frequently asked Questions

    1. Can Ulcerative Colitis lead to cancer?1

    Ulcerative Colitis is not a form of cancer. However, if you have had UC for many years, you have a greater risk than normal of developing cancer in the colon or rectum.

    2. Does Ulcerative Colitis run in families? 1,18

    Ulcerative Colitis tends to run in families, and parents with IBD are slightly more likely to have a child with IBD. However, studies show for most people the actual risk is relatively small. If one parent has Colitis, the risk of their child developing IBD is about 2%.

    3. Will UC patients need surgery? 1,18

    Up to one in four people with ulcerative colitis may eventually need surgery, depending on how severe the disease is and which part(s) of the colon are affected. People with extensive or total colitis are more likely to require surgery than those with proctitis.

    Tips

    Tracking your diet with daily food journal can help you identify what foods and beverages work well for you and which ones don’t.

    Diet and Nutrition Tips 18

    Low-salt diet

    Used during corticosteroid therapy to reduce water retention

    Low-fiber diet

    Used to avoid blockages in UC patients with strictures and to avoid stimulating bowel movements

    Low-fat diet

    Typically recommended during a flare in UC when fat absorption may become an issue

    Lactose-free diet

    For those who have an intolerance to dairy products

    High-calorie diet

    For those who experience weight loss or growth delay

    Reduce the amount of greasy or fried foods

    It may cause diarrhea and gas

    Restrict carbonated beverages

    It may cause excessive gas

    Restrict caffeine

    It may cause a severe diarrhea

    Eat smaller meals at more frequent intervals

References

1. Crohn’s and Colitis UK. Ulcerative Colitis Your Guide Edition 9d. Available at http://s3-eu-west-1.amazonaws.com/files.crohnsandcolitis.org.uk/Publications/ulcerative-colitis.pdf Accessed June 2020

2. IBD clinic. Digestive system and its function. Available at http://www.ibdclinic.ca/what-is-ibd/digestive -system-and-its-function/ Accessed June 2020

3. Armando Hasudungan. Inflammatory Bowel Disease. Available at https://armandoh.org/disease/inflammatory-bowel-disease/ Accessed June 2020

4. Crohn’s and Colitis Foundation. Overview of Ulcerative Colitis. Available at https://www.crohnscolitisfoundation.org/what-is-ulcerative-colitis/overview Accessed June 2020

5. Ulcerative Colitis. Available at https://www.hopkinsmedicine.org/gastroenterology_hepatology/_pdfs/small_large_intestine/ulcerative_colitis.pdf Accessed June 2020

6. IBD clinic. Ulcerative colitis. Available at http://www.ibdclinic.ca/what-is-ibd/ulcerative-colitis/ Accessed June 2020

7. IBDrelief. Medication options for inflammatory bowel disease. Available at https://www.ibdrelief.com/ learn/treatment/medication-for-ibd Accessed June 2020

8. IBD clinic. Frequently asked questions. Available at http://www.ibdclinic.ca/what-is-ibd/who-getsibd-fact-and-fiction/ Accessed June 2020

9. Mayo Clinic. Irritable bowel syndrome. Available at https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/symptoms-causes/syc-20360016 Accessed June 2020

10. Patient Information. Ulcerative Colitis. Available at https://patient.info/digestive-health/inflammatory-bowel-disease/ulcerative-colitis Accessed June 2020

11. NYU Langone Health. Diagnosing Inflammatory Bowel Disease in Adults. Available at https://nyulangone.org/conditions/inflammatory-bowel-disease-in-adults/diagnosis Accessed February 2020

12. Crohn’s and Colitis Foundation. Signs and Symptoms of Ulcerative Colitis. Available at https://www.crohnscolitisfoundation.org/what-is-ulcerative-colitis/symptoms Accessed June 2020

13. Crohn’s and Colitis Foundation of America. The facts about inflammatory bowel disease. Available at https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/updatedibdfactbook.pdf Accessed August 2020

14. Crohn’s and Colitis Foundation. Ulcerative Colitis Diagnosis and Testing. Available at https://www.crohnscolitisfoundation.org/what-is-ulcerative-colitis/diagnosis-testing Accessed June 2020

15. Crohn’s and Colitis Foundation of America. Diagnosing and Managing IBD. Available at https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/diagnosing-and-managing-ibd-1.pdf Accessed June 2020

16. https://www.medscape.com/answers/179037-54913/what-is-the-role-of-fecal-calprotectin-levels-in-the-diagnosis-of-inflammatory-bowel-disease-ibd Accessed August 2020

17. Crohn’s and Colitis. Ulcerative Colitis Treatment Options. Available at https://www.crohnscolitisfoundation.org/what-is-ulcerative-colitis/treatment-options Accessed June 2020

18. Crohn’s and Colitis Foundation. Living with Ulcerative Colitis. Available at https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/living-with-ulcerative.pdf Accessed June 2020

Abbreviations

CT, computed tomography; GI, gastrointestinal; IBD, inflammatory bowel disease; IBS, irritable bowel syndrome; MRI, magnetic resonance imaging; UC, ulcerative colitis;