GI Conditions
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      2. GI Conditions

      Ulcerative Colitis

      Brief Overview: Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes inflammation and ulcers in the inner lining of the colon and rectum. It typically develops gradually and causes symptoms such as diarrhea, abdominal pain, and rectal bleeding. UC can range from mild to severe and often has periods of flare-ups and remission.

      Prevalence: According to NIDDK, “Research suggests that about 600,000 to 900,000 people in the United States have ulcerative colitis.”

      Etiology: The exact cause of Ulcerative Colitis is not known, but it’s believed to be caused by a combination of genetic, environmental, and gut-immune factors.

      Risk Factors:

      • Age 15-30 years old, or > 60 years old
      • Family history of IBD
      • Jewish descent

      Commonly Associated Conditions:

      • Anemia
      • Arthritis
      • Uveitis, episcleritis
      • Primary sclerosing cholangitis
      • Osteoporosis

      Common Medications:

      • Topical mesalamine – suppository or enema
      • Topical Glucocorticoids – suppository, foam preparation, enema
      • Oral 5-ASA agents – mesalamine, sulfasalazine
      • Oral glucocorticoids – budesonide multimatrix, prednisone
      • For moderate to severe UC: Anti-TNF agents, vedolizumab, anti-interleukin antibody-based therapy, S1P receptor modulators, systemic oral/IV glucocorticoids, JAK inhibitors

      Common Labs, Imaging, and Tests:

      • CBC, ESR, CMP, CRP
      • Sigmoidoscopy, colonoscopy
      • Stool studies
      • Endoscopy and biopsy
      • Abdominal imaging – x-ray, CT, MRI, ultrasound

      Common Symptoms:

      • Diarrhea, may or may not be associated with blood
      • Small, frequent bowel movements
      • Colicky abdominal pain
      • Fecal urgency
      • Tenesmus – frequent urge to have a bowel movement without being able to, or when the bowels are empty
      • Fecal incontinence
      • Rectal bleeding
      • Systemic symptoms – fever, fatigue, weight loss, dyspnea, palpitations

      Common Treatments:

      • Medications (see above)
      • Nutrition and dietary management
      • Surgery may be indicated for some

      Physical Findings:

      • Typically, normal physical exam, especially between flares
      • Abdominal tenderness may be present
      • Extraintestinal signs – skin lesions, joint swelling, eye inflammation

      Potential Complications and Contraindications:

      • Increased risk for venous and arterial thromboembolism
      • Severe bleeding, toxic megacolon
      • Pulmonary complications: airway inflammation, parenchymal lung disease, serositis, thromboembolic disease
      • Vitamin and mineral deficiencies
      • Dehydration
      • Increased risk of infections
      • Increased risk of colorectal cancer
      • Increased risk for bone loss
      • Avoid NSAIDs
      • Avoid opioids

      General Health and Lifestyle Guidance:

      • Staying up to date with recommended, age-appropriate vaccinations is important – flu vaccine, pneumonia vaccine, RSV vaccine, shingles vaccine. Talk to your healthcare provider about what is recommended for you.
      • Stay up-to-date with age-appropriate cervical cancer screening
      • Stay adequately hydrated to avoid dehydration associated with diarrhea
      • Exercise regularly as tolerated. Speak with your healthcare provider about what exercise regimen is safe for you.
      • Annual skin examinations by a dermatologist is recommended for all IBD patients who are taking immunomodulators, anti-TNFs, or small molecules
      • Talk to your healthcare provider and/or dietician about any specific dietary modifications that are recommended for you. Keeping a food/symptom diary may be helpful.

      Suggested Questions to Ask Patients:

      • How often are you experiencing diarrhea or rectal bleeding?
      • Have you noticed any weight loss, fatigue, or joint pain?
      • Are you able to maintain your medications consistently?
      • Do you feel supported in managing stress or anxiety around flares?
      • Have you had a recent colonoscopy or lab work?

      Suggested Talking Points:

      • You will have ongoing periodic monitoring with lab work, stool studies, and imaging (colonoscopy, lower endoscopy). Make sure to complete all ordered tests and follow up with your healthcare provider as directed.
      • Make sure to report any new, worsening, or persistent symptoms to your healthcare provider.
      • Make sure to talk to your healthcare provider before taking any supplements

      Sources: