- Finding the Right Ulcerative Colitis Doctor
- Ulcerative Colitis Specialist
- What is ulcerative colitis?
- What symptoms does ulcerative colitis cause?
- What causes ulcerative colitis?
- How is ulcerative colitis diagnosed?
- What treatments are available for ulcerative colitis?
- New guidelines for treating patients with ulcerative colitis
- Ulcerative colitis
- Ulcerative Colitis
Finding the Right Ulcerative Colitis Doctor
Ask for recommendations. You can also ask your current doctor for recommendations, assuming you feel comfortable doing so, says Melmed. Other people who are living with ulcerative colitis can be another valuable resource. Asking them for doctor references can help guide you to the right place. Joining an ulcerative colitis support group is a great way to network and exchange information with others who have the condition.
Make some phone calls. If you have a list of doctors to try and you’re not sure which one will be best for you, it may be worth calling their offices and asking how many ulcerative colitis patients the doctor sees to get a sense of how much experience the physician has with the condition, Melmed advises.
Aim for a long-term relationship. A good physician won’t just treat the disease but will treat you as a person and help you understand the impact of the condition on your quality of life, Dr. Sagi says. You’ll be seeing your physician for a long time, so it’s important to have a good working relationship.
Consider a hospital system. As many as 45 percent of people with ulcerative colitis may need surgery, according to the CCFA. It’s not necessary to get routine care at a hospital that specializes in ulcerative colitis surgery, Melmed says, but finding one within your insurance network is something to think about.
As you conduct your search for the right doctor, be sure your medical records join you. “It can be tricky for a doctor to see new patients when the records aren’t available,” Melmed says. Either make sure your records precede you to the new office, or bring them with you yourself to ensure you get the best care from the start.
Ulcerative Colitis Specialist
What is ulcerative colitis?
Ulcerative colitis is one of two major forms of inflammatory bowel disease, or IBD (the second major form is Crohn’s disease). Ulcerative colitis causes ulcers, or sores, in the lining of the colon and the rectum, and without proper management, it can cause serious medical problems like internal bleeding which can become life-threatening.
What symptoms does ulcerative colitis cause?
Ulcerative colitis can cause a wide array of symptoms, including:
bleeding from the rectum
pain in the rectum
increased need to move the bowels
unintentional weight loss
The type of symptoms can vary based on which portion of the colon is affected and the severity of the disease. Ulcerative colitis can increase the risk of developing colon cancer, and it can also increase the risk of developing a perforation, or hole, in your colon, which can cause life-threatening complications.
What causes ulcerative colitis?
The underlying cause of ulcerative colitis is not completely understood, but research indicates the condition may develop when the immune system reacts abnormally, sending out agents that attack healthy colon tissue. Ulcerative colitis occurs more commonly among people with a family history of the disease, and some research has indicated a possible link between ulcerative colitis and the acne drug isotretinoin, although to date, results are inconclusive.
How is ulcerative colitis diagnosed?
Ulcerative colitis is typically diagnosed with a colonoscopy to extract tiny samples of tissue (biopsies) for evaluation under a microscope. Your symptoms and risk factors may also help lead to a diagnosis.
What treatments are available for ulcerative colitis?
In most cases, ulcerative colitis can be successfully managed with medications, including drugs to control inflammation or mediate the immune system responses. Antibiotics, pain medications and anti-diarrhea medications may also be prescribed. In severe cases, surgery may be required.
New guidelines for treating patients with ulcerative colitis
New guidelines on diagnosing and managing ulcerative colitis are aimed at helping patients experience sustained periods of remission from the debilitating inflammatory disease while relying less on traditionally used steroids.
“These novel recommendations will help doctors better prevent and care for patients with ulcerative colitis by shifting us from managing flare-ups to better monitoring and preventing them in the first place,” said gastroenterologist David Rubin, MD, chief of gastroenterology, hepatology, and nutrition and co-director of the Digestive Diseases Center at the University of Chicago Medicine.
Rubin led the team of experts that established the guidelines, published in the March issue of The American Journal of Gastroenterology.
Ulcerative colitis (UC), a chronic disease affecting roughly 1 million Americans, is characterized by periods of inflammation and ulcers in the lining of the large intestine. Symptoms include bloody stool, diarrhea, abdominal pain and urgency to go to the bathroom, as well as joint pain.
Rubin says the new management guidelines are geared towards relieving symptoms, preventing harmful secondary effects that may be brought on by treatment, and helping patients into remission. The guidelines place added importance on reducing inflammation and ulcers in the innermost lining of the colon and rectum, which physicians refer to as mucosal healing.
“If we can help heal that critical lining of the bowel, we can decrease the chance a patient has of having another flare-up and keep them in remission,” Rubin said.
The authors also provide new classifications for disease activity — remission, mild, moderate-severe and severe. The guidelines likewise note a specific distinction from previous recommendations on how physicians should decide on a treatment: doctors should now consider both the patient’s inflammatory activity and the prognosis.
“For instance, a patient with mildly active ulcerative colitis who has required steroids and has been previously hospitalized but now in remission, should be evaluated for treatments usually used for patients with moderately to severely active ulcerative colitis,” Rubin explained.
Physicians should always stool test to ensure a patient’s symptoms aren’t caused by Clostridioides difficile (C.diff). Serologic antibody testing is no longer recommended in the guidelines to diagnose ulcerative colitis.
For patients hospitalized with severe ulcerative colitis, the guidelines recommend a flexible sigmoidoscopy (preferably within one day) and treatment with methylprednisolone or hydrocortisone, followed by infliximab or cyclosporine and surgical consultation for those who do not respond to the initial treatment.
New treatments have been developed since the previous guidelines were established in 2010, including several biologic therapies. Rubin says the emerging treatment strategy for UC is using organ-selective treatments, whenever possible, before more systemic therapies. The guidelines also state that additional study of fecal transplantation and probiotics treatment are needed.
The researchers propose stool tests for calprotectin – a type of protein secreted when the colon or rectum is inflamed – as a tool to monitor the effectiveness of treatments and relapse. Rubin says this recommendation will help ensure the test is covered by insurance companies.
Once a patient is in remission, physicians should avoid steroids. Because patients with long-term ulcerative colitis have a higher risk of colorectal cancer, the guidelines recommend patients have colonoscopies beginning eight years after their initial diagnosis, followed by colonoscopies every one to three years, depending on their risk factors. Biopsies from these colonoscopies should be interpreted by an experienced gastrointestinal pathologist.
The goals of treatment are to:
- Control the acute attacks
- Prevent repeated attacks
- Help the colon heal
During a severe episode, you may need to be treated in the hospital for severe attacks. Your doctor may prescribe corticosteroids. You may be given nutrients through a vein (IV line).
DIET AND NUTRITION
Certain types of foods may worsen diarrhea and gas symptoms. This problem may be more severe during times of active disease. Diet suggestions include:
- Eat small amounts of food throughout the day.
- Drink plenty of water (drink small amounts throughout the day).
- Avoid high-fiber foods (bran, beans, nuts, seeds, and popcorn).
- Avoid fatty, greasy or fried foods and sauces (butter, margarine, and heavy cream).
- Limit milk products if you are lactose intolerant. Dairy products are a good source of protein and calcium.
You may feel worried, embarrassed, or even sad or depressed about having a bowel accident. Other stressful events in your life, such as moving, or losing a job or a loved one can cause worsening of digestive problems.
Ask your health care provider for tips about how to manage your stress.
Medicines that may be used to decrease the number of attacks include:
- 5-aminosalicylates such as mesalamine or sulfasalazine, which can help control moderate symptoms. Some forms of the drug are taken by mouth. Others must be inserted into the rectum.
- Medicines to quiet the immune system.
- Corticosteroids such as prednisone. They may be taken by mouth during a flare-up or inserted into the rectum.
- Immunomodulators, medicines taken by mouth that affect the immune system, such as azathioprine and 6-MP.
- Biologic therapy, if you do not respond to other drugs.
- Acetaminophen (Tylenol) may help relieve mild pain. Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). These can make your symptoms worse.
Surgery to remove the colon will cure ulcerative colitis and removes the threat of colon cancer. You may need surgery if you have:
- Colitis that does not respond to complete medical therapy
- Changes in the lining of the colon that can lead to cancer
- Severe problems, such as rupture of the colon, severe bleeding, or toxic megacolon
Most of the time, the entire colon, including the rectum, is removed. After surgery, you may have:
- An opening in your belly called the stoma (ileostomy). Stool will drain out through this opening.
- A procedure that connects the small intestine to the anus to gain more normal bowel function.
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Ulcerative colitis causes inflammation and ulcers in the digestive tract. It is an inflammatory bowel disease (IBD) that affects the inner lining of the large intestine (colon) and rectum. While ulcerative colitis can be managed if detected at the right time, it can also sometimes cause life-threatening complications.
Ulcerative colitis is not usually detected immediately and it takes some time for symptoms to surface, depending on what part of the colon is most inflamed.
Most noticeable symptoms include:
- Prolonged and unexplained fever
- Rectal pain and/or rectal bleeding
- Failure in growth, in children
- Abdominal pain
- Weight loss
- Inability to defecate despite urgency
If you have some/any/all of the above symptoms, immediate medical attention is highly advisable.
Like Crohn’s disease, ulcerative colitis is also dependent on the following factors:
- Ethnicity: While it is likely that a person of any ethnicity could develop this condition, people most prone to ulcerative colitis are those of Jewish descent
- Age: You are most likely to develop ulcerative colitis before the age of 30. People above 30 could also have it but it is unlikely for anyone to develop the condition post 60 years of age
- History of the disease being present in the family
- Usage of isotretinoin which is a drug used to acne or scarring cystic acne
Once your doctor has ruled out all other possibilities and concluded you have ulcerative colitis, he may run the following tests/procedures to confirm the same:
- Blood test
- Stool sample
- CT scan
- Flexible sigmoidoscopy and biopsy
Treatment would be as per your diagnosis and the effects that ulcerative colitis has had on your body, and depending on this, the doctor will prescribe what kind of treatment is required.
The treatment of ulcerative colitis is similar to that of Crohn’s disease – through medication or surgery.
Anti-inflammatory drugs such as aminosalicylates, corticosteroids may be given.
Immune system suppressors such as azathioprine, cyclosporine, vedolizumab and/or infliximab may be given.
In addition to these, iron supplements, pain relievers, anti-diarrhoeal drugs and antibiotics may also be given.
If medication proves futile, doctors may recommend a proctocolectomy which is the surgical removal of the colon.