Risk Of Bias Evaluation
As shown in Figure 2, we assessed the risk of bias for each study by the Cochrane risk of bias tool. For random sequence generation, seven studies mentioned random and described the specific random assignment method and were therefore judged as low risk. The remaining seven studies were classified as an unclear risk because they only mentioned randomization but did not specify the method used. For allocation concealment, all studies were assessed as unclear because of the absence of detailed information. For blinding of participants and personnel, 13 studies were regarded as unclear due to the lack of detailed description. However, one study referred to the treatment based on syndrome differentiation, which means that the selection of different herbal medicinals depending on the specific symptoms of patients, is considered to be of high risk. For blinding of outcome assessment, all studies were assessed as unclear risk due to the lack of details. For incomplete outcome data, one trial was judged to be unclear risk because the authors did not explain the specific reasons why patients were lost to follow-up. Finally, all studies regarding selective outcome reporting and other sources of bias were considered to be of unclear risk as no specific information as described.
FIGURE 2. Results of the risk of bias assessment of the original literature included in the meta-analysis. Overall risk of bias assessment results. Risk of bias results for each specific original study.
Avoid Foods That May Exacerbate Uc Symptoms
Because a healthy diet is a cornerstone for overall health, its no surprise that it tops Sniders list of natural remedies for ulcerative colitis. Diet is a foundational treatment for patients with ulcerative colitis, he says, adding that theres often a dietary component to the disease.
According to a review published in October 2014 in Clinical Gastroenterology and Hepatology, people who reported a diet high in fats were more likely to have a relapse of UC. Other studies highlighted in the paper suggested avoiding greasy foods, dairy products, caffeine, and raw fruits and vegetables if you have ulcerative colitis. But the review notes that theres no one-size-fits-all diet for UC, so youll have to figure out what works best for you through trial and error.
It helps to keep a food diary to discover which foods are best for you. Snider says it cant hurt to limit certain foods, and then if your symptoms improve according to your symptom diary, to continue doing so. He also notes that its worthwhile to avoid sugar because its effect on the pancreas hinders the output of anti-inflammatory enzymes.
Also Check: Do Ulcers Make You Lose Weight
Icipants And Data Collection
We surveyed IBD patients meeting at patient workshops organized by the German Crohns and Ulcerative Colitis Association . The DCCV is a national organization established by patients and for patients with Crohns disease and Ulcerative Colitis . The patient workshops of the DCCV take place regularly in different regions of Germany and are open to the public. Normally experts are invited to give lectures on recent developments in diagnostic and therapeutic possibilities in order to inform patients. Three of these workshops took place in different German federal states . A questionnaire was handed out to all participants of the workshops. The questionnaires were distributed on the tables in the convention hall and had to be completed during the workshop or were to be returned by mail.
You May Like: Diet When You Have An Ulcer
Acupuncture For Ulcerative Colitis: Benefits Side Effects And More
Ulcerative colitis is a type of inflammatory bowel disease that affects the large intestines. It causes inflammation and ulcers along the lining of the colon.
Theres no cure for UC, but working with your doctor and starting a treatment plan can reduce the severity of your symptoms. This can also bring about periods of remission, which is when your symptoms go away.
Traditional medication for this condition includes anti-inflammatory drugs and immunosuppressant drugs. These medications work to stop inflammatory responses.
Even if medication improves your symptoms and quality of life, UC is a lifelong condition. Episodes of diarrhea, bloody stools, and stomach pain can return.
When medication alone doesnt keep your body in remission, it might be time to look into alternative or complementary therapy programs like acupuncture.
Doshas And Ulcerative Colitis
In Ayurvedic thought, when theres an imbalanced dosha, the life force is interrupted and can lead to digestive problems and waste buildup. Ulcerative colitis is thought of as a disease caused by Pitta pradhana Vata doshas, an imbalance between pitta and vata, in which vata is increased by pungent and bitter tastes.
Practitioners suggest avoiding spicy foods. In one clinical study, 43 patients with ulcerative colitis were treated for one month with the medicinal plant Udumbara kvatha basti , along with other Ayurvedic medications derived from plants that have antibacterial and antidiarrheal effects.
Researchers found that symptoms as well as the use of steroids and other anti-inflammatory drugs were reduced by more than 80%. Red blood cells in the stoola primary sign of ulcerative colitiswas reduced by 93.02%. Hemoglobin in the blood increased by 16.76%. Steroid use was decreased by 87.32%.
You May Like: Sacral Dressings To Prevent Pressure Ulcers
Read Also: What Causes Stomach Ulcers In Horses
Can Probiotics Help Ibd
Most probiotics have not been shown to work for Crohns disease or ulcerative colitis. VSL 3# is the only probiotic that has been shown to be of benefit for some people in order to prevent pouchitis after colectomy. Probiotics have been shown to be harmful in rare cases for people who are very sick. Talk to your doctor before starting a probiotic.
Epidemiology Of Complementary And Alternative Medicine Use In Patients With Inflammatory Bowel Disease
The estimated prevalence of CAM use in patients with IBD is high, ranging between 21% and 60%.,,, Reasons for CAM use include a desire for holistic approaches to supplement conventional therapy, the perception that herbal remedies are more natural, less toxic, or harmless a lack of response to or undesirable side effects of conventional therapy, and the desire for more control of the disease and symptoms to improve quality of life ., Predictors of CAM use include psychiatric comorbidities dissatisfaction with the patient-doctor relationship side effects from conventional therapies use of CAM among friends or family vegetarianism longer disease duration high corticosteroid usage female sex and higher income, education, and socioeconomic status.,, There is also geographic variation with regard to CAM use., In the United States, CAM is more frequently used in the Mountain, Pacific, and Midwest regions compared to other parts of the country.
Most CAM therapies fall into one of the following main categories: herbal/botanical or dietary supplements and mind-body practices, including hypnosis, yoga/exercise, mindfulness, and stress reduction. The most commonly used CAM therapies include probiotics, herbs , vitamins, and fish oil., Other therapies include the use of traditional Chinese practices such as acupuncture and moxibustion.
You May Like: Elemental Diet For Ulcerative Colitis
Inclusion And Exclusion Criteria
This study included clinical studies of UC with CHM intervention published in English and Chinese up to November 25, 2020. We included studies on subjects given the diagnosis of UC defined by clear diagnostic criteria or references, regardless of age, gender, course of disease and severity. The CHM interventions are typically administered as either single herbs or formulas , which may have been administered alone or in combination with other interventions of conventional Western Medicine or CAM. No limitation on their formulation, preparation, dosage, dosage form or route of administration. The control intervention could be active, conventional medicine, placebo, no treatment, or other CAM treatments, etc. There were no limitations in the assessed outcomes. We considered randomized controlled trials , quasi-randomized controlled trials, non-randomized controlled trials, observational clinical studies including the control group, casecontrol studies for inclusion. We excluded the following studies: repeated and withdrawal publications, studies with non-CHM interventions, comprehensive interventions focused on pharmacological treatment rather than CHM, plant extracts , clinical studies without a comparison or control group, study protocols, reviews, case series, case reports, abstracts or full-text reports not found, non-human studies, and non-English or non-Chinese language reports.
Ulcerative Colitis Chinese Medicine Perspective
Chinese medicine considers ulcerative colitis as having certain characteristics of dysentery: diarrhea, blood in the stool, intestinal wind and toxin in the colon. The main pathological changes in this disease are located in the spleen, stomach and large intestine and are closely associated with the liver and kidney. Spleen and kidney deficiency and exuberant dampness are the main etiological factors. In Chinese medicine, the key to a successful treatment is to assess the degree of excess and deficiency to control the condition at the remission stage.
Also Check: Symptoms Of Peptic Ulcer In Stomach
Traditional Chinese Medicine Alleviates Ulcerative Colitis Via Modulating Gut Microbiota
1Department of Gastroenterology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
Ulcerative colitis is a chronic inflammatory bowel disorder characterized by relapsing and remitting inflammation of the bowel. In recent decades, traditional Chinese medicine has been widely used in the therapy of UC. However, its underlying mechanisms have not been sufficiently elucidated. Accumulating studies indicate that the gut microbial dysbiosis is closely related to UC. It has been demonstrated that TCM could alter the composition of intestinal microbiota by enriching beneficial and SCFA-producing bacteria and reducing pathogenic bacteria. In this review, we discussed recent evidence regarding the TCM and its role in modulating gut microbiota for the treatment of UC.
Ulcerative colitis is an idiopathic inflammatory disorder affecting the large intestine. It is generally characterized by relapsing and remitting inflammation of the bowel. The main clinical symptoms include abdominal pain, diarrhea, and bloody stool . An estimated 1 million individuals in the United States and 2.5 million people in Europe suffer from inflammatory bowel disease . The incidence of UC is increasing rapidly in Asia. Data from a systematic review of epidemiological studies indicated the incidence rates for IBD and UC were 1.80 and 1.33/1,000,000 in mainland China .
2. Traditional Chinese Medicine and UC
3. Gut Microbiota and UC
Randomized Controlled Trial On Cannabis Oil
Randomized controlled trials are the gold standard for clinical research, and they are essential for determining whether a new treatment is effective. In a recent trial, the effects of medical marijuana on patients with IBD symptoms were compared to those of a placebo group.
A clinical trial is essential for determining whether a new treatment is effective. In a recent trial, the effects of medical marijuana on patients with inflammatory bowel diseases were compared to those of a placebo group. The results showed that patients in the cannabis group compared had significantly lower levels of UC symptoms than those in the placebo group.
This is a promising finding, as it suggests that medical marijuana may be an effective treatment for IBD. However, more extensive and more definitive trials are needed to confirm these results.
Don’t Miss: Foods To Stay Away From With Ulcerative Colitis
The Mechanisms Of Action Of Probiotics And Tcm In The Treatment Of Uc
Mechanism of Action of Probiotics
Furthermore, anti-inflammatory cytokines such as IL-10, IL-27 and IL-35 can be expressed and produced by Lactobacillus and non-pathogenic Escherichia coli . Saccharomyces boulardii can ameliorate DSS-induced colitis in mice by inhibiting the activation of nuclear factor kappa-B signaling pathway and inhibiting the release of pro-inflammatory cytokines . Notably, increased short-chain fatty acids generation in response to probiotics can decrease TNF- and IL-12, increase IL-10, inhibit NF-B signaling pathway, and produce anti-inflammatory effects .
Mechanism of Action of TCM
The Interaction of Probiotics and TCM
In summary, the mutual synergistic effect between probiotics and TCM not only plays a therapeutic role through its unique biological activity but also is an important mechanism leading to the improvement of clinical efficacy .
FIGURE 9. The mechanism of action of probiotics combined with TCM for UC. Probiotics and TCM exert therapeutic effects through their respective actions, while the interaction between them reflects the synergistic effect and necessity of this combination.
How Do Doctors Treat Symptoms And Complications Of Ulcerative Colitis
Doctors may recommend or prescribe other treatments for symptoms or complications of ulcerative colitis. Talk with your doctor before taking any over-the-counter medicines.
To treat mild pain, doctors may recommend acetaminophen instead of nonsteroidal anti-inflammatory drugs . People with ulcerative colitis should avoid taking NSAIDs for pain because these medicines can make symptoms worse.
To prevent or slow loss of bone mass and osteoporosis, doctors may recommend calcium and vitamin D supplements or medicines, if needed. For safety reasons, talk with your doctor before using dietary supplements or any other complementary or alternative medicines or practices.
Doctors most often treat severe complications in a hospital. Doctors may give
- antibiotics, if severe ulcerative colitis or complications lead to infection
Recommended Reading: What Foods Should You Avoid When You Have An Ulcer
Also Check: Safety Considerations For Ulcerative Colitis
Risk Of Bias Assessment
Two review authors will independently assess the risk of bias of each included study in duplicate using the bias risk assessment tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0, which comprises 7 items: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other bias. The results for each domain will be divided into 3 levels: low risk of bias, high risk of bias, and unclear risk of bias, and studies will be assessed and given an overall rating. Any inconsistencies between the reviewers will be resolved through discussion or, if necessary, a third reviewer will be consulted.
Data Management And Statistical Analysis
Data recorded in printed case report forms are kept in locked cabinets. Data will be double-entered on electronic case report forms by two persons. Frequency, median, and mean±standard deviation of the steroid-free remission rate and the mean withdrawal time of steroids will be used for descriptive statistics. Students t test and analysis of variance will be employed using continuous variables with a normal distribution. The MannWhitney U test and KruskalWallis test will be used for continuous variables with abnormal distributions, such as health-related quality of life and inflammation markers. A chi-square test or Fishers exact test will be used for categorical variables, including the efficacy of endoscopic response and the degree of mucosal healing. Results will be analyzed as per intention-to-treat. All data will be analyzed by an independent statistician using SAS 9.4. For all analyses, P< 0.05 is considered statistically significant.
To summarize the present study protocol, please see Additional file 1 for an overview of enrollment, interventions and assessments, and Additional file 2 for an overview of the Standard Protocol Items: Recommendations for Interventional Trials checklist.
Also Check: Stage 3 Pressure Ulcer Treatment
Data Synthesis And Statistical Analysis
We will perform a conventional pairwise meta-analysis of the direct evidence using the random-effects model with R 3.4.4 software to estimate the effect size and 95% CI. Then, a network meta-analysis within a Bayesian framework will be undertaken using WinBUGS 1.4.3 software. We will adopt random-effects and consistency models, as they are considered to be the most conservative approach to dealing with between-study heterogeneity. A 2-stage approach to the data synthesis will be used. For dichotomous outcomes, data will be analyzed by calculating Mantel-Haenszel odds ratios together with 95% confidence intervals , where appropriate. For continuous outcomes, standardized mean difference and 95% CIs will be used to summarize the data for each group.
Furthermore, geometry of the network will be drawn to present the structure of interventions across studies to ensure the feasibility of the NMA. The probability of each intervention being the best for each outcome will be calculated and reported in the form of rankograms. The hierarchy of interventions will be ranked by importing the above model into R software and calculating the surface under the cumulative ranking curve .
Symptoms And Complications Of Ulcerative Colitis
Inflammation can result in the colon being more empty more often, causing diarrhoea. Tiny open ulcers formed on the surface of the lining of the colon may cause blood in stool. The inflamed lining also produces a larger than normal amount of intestinal mucus which sometimes contain pus.
The symptoms of ulcerative colitis can vary depending on how much of the colon is affected and the level of inflammation.
Common symptoms include:
In severe cases where inflammation has penetrated deeper into the walls of the colon, serious complications such as profuse bleeding from deep ulcers and perforation of the colon may arise. Other complications such as primary sclerosis cholangitis, cirrhosis, arthritis, inflammation of the eye, or osteoporosis may occur when the immune system triggers inflammation in other parts of the body.
Recommended Reading: How Does One Get Ulcerative Colitis
Cam Therapies Considered For Ibd
A range of CAM therapies have been considered in the context of IBD. Some of these may have particular relevance for individuals with IBD . Some CAM therapies have direct anti-inflammatory effects that could enhance disease control in conjunction with standard treatments. These include nutritional interventions, agents that may enhance host immune responses, and interventions that may modulate psychological or emotional responses to the disease. Herbal therapies appear to be one of the most commonly used CAM, but substantial variations occur between cultures and regions of the world.
Langmead and Rampton reviewed the data supporting the benefits of CAM therapies used commonly in the context of IBD. These authors concluded that there is little controlled data supporting agents that have been commonly suggested for IBD. Note was made, however, of promising data arising from studies examining acupuncture in IBD. Hilsden et al. made similar conclusions relating to the evidence supporting CAM in IBD and referred to specific resources, including internet databases of available CAM agents.