Characteristics Of Included Studies
All of the selected studies reported a control group. The design of these control groups varied among the studies. Four of the selected studies had waitlist control groups and two of them had attention control groups. Control group participants were taught about IBD and its management and the influence of stress on sleep, psychological and physical health was the subject for teaching by Jedel et al. . Three of the studies used standard care as the control group. Lastly, one study used a combination of attention control and waitlist control groups.
Twelve articles were excluded. Five were not RCTs . Two were study protocols . Three were reviews , along with one qualitative study and one study which included participants < 18 years of age .
All of the selected studies reported exclusion or inclusion criteria and included both men and women only one study was double-blinded . Three of the articles demonstrated adequate sample size by reporting the power analyses. Only one study informed the details of blinding procedures. Objectives, outcomes, details of the intervention, and statistical outcomes were clearly addressed in all studies. Sample sizes ranged from 11 to 51 in experimental groups and 1266 in control groups. The selected studies were from Spain, Australia, Netherlands, United Kingdom , New Zealand, Israel, United States , and Germany.
This Factsheet Is About Ulcerative Colitis
Ulcerative colitis is a disease of the rectum and the large bowel, . Ulcerative colitis is thought to affect around 1 in 420. The peak age of incidence between 15-25 years old with a smaller peak occurring between the age of 55 and 65 years old. But it can occur at any age.
INFLAMMATORY BOWEL DISEASE
Ulcerative colitis is one of a group of conditions that are known as Inflammatory bowel diseases, which also includes Crohns disease. Inflammatory bowel disease is different to Irritable Bowel Syndrome , which can cause similar symptoms but does not involve inflammation. The term colitis means the large bowel has become inflamed and if this becomes severe enough ulcers may form in the lining of the large bowel.
When To Get Treatment
An increase in inflammation causes a flare, and the nature of inflammation means that you should treat it as quickly as you can. Inflammation grows exponentially, because inflammation itself causes an increase in inflammation. The longer you leave it untreated, the worse it will get. In addition, untreated inflammation not only leads to the symptoms associated with ulcerative colitis, it can also increase your risk of developing complications such as colorectal cancer down the line. Pay attention to your symptoms, and visit your physician if you notice that they change or increase even a small amount.
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Definition Of The Rst Of Uc
Patients were classified as having the RST or a non-RST . The RST was noted when the rectum was obviously spared of active or chronic inflammation, and relatively little or no inflammation was observed at the rectum compared to proximal colitis in colectomy specimens. Alternatively, the RST was noted when rectal inflammation was limited to a Mayo endoscopic score of 0 or 1 and was also milder than that of the proximal colon based on pre-operative endoscopy. All endoscopic findings were assessed by expert physicians at our institution who were familiar with inflammatory bowel disease. The RST was exclusively characterized by unmagnified visual findings regardless of histological findings.
Safety Of Topical Mesalazine Suppository
Topically applied 5-ASA does not have relevant systemic side effects. Idiosyncratic side effects such as interstitial nephritis, myocarditis, or pancreatitis are very rare even when oral and systemic forms of 5-ASA are used . The effects of 5-ASA are dependent on the concentration in the colonic mucosa . In Switzerland, a previous report revealed that the consumption rate of topical 5-ASAs was 31.6% compared with the 42.5% for oral 5-ASA . However, in this study, the frequency of side effects in patients with topically or orally given 5-ASA products was quite low compared with those treated with immunomodulators or anti-TNF alpha antibodies . The safety of mesalazine suppository in 16 pregnant women was also reported with no relapses during pregnancy and 19 successful full-term pregnancies with no fetal abnormalities . Mesalazine is an FDA class B drug in pregnancy and only very low levels of 5-ASA occur in breast milk .
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Diet And Nutrition Modifications
Although food specifically doesnt cause ulcerative colitis, your diet can play a role in triggering or easing your symptoms. You may find that adopting a diet low in certain sugars or fiber particularly insoluble fiber, which passes through the GI tract undigested or free of lactose or gluten helps you manage your inflammatory bowel disease . Caffeine and carbonated beverages might also worsen your symptoms, as could spicy dishes.
Finally, if ulcerative colitis interferes with your bodys ability to absorb nutrients, ask your doctor whether you should take a vitamin supplement.
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Will Ulcerative Colitis Affect Me Over Time
The effects of ulcerative colitis vary considerably from person to person, based on the nature and severity of their disease. In many cases, the condition does not have much impact on daily life, the ability to work or to enjoy an active social life but does take some getting used to. When it is at an active stage, symptoms such as diarrhoea and abdominal pain often require time away from work, college etc. and can make it difficult to cope going out or even being at home. However, treatment usually makes the symptoms better within days or weeks so normal quality of life can be restored quite quickly. Some severe cases of ulcerative colitis, however, can have a significant impact on peoples lives. This can be due to a weak response to treatment which makes symptom-free remission difficult to achieve and can involve frequent flare ups.
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Types Of Ulcerative Colitis
The type of ulcerative colitis you have depends on where it is in your body:
- Ulcerative proctitis is usually the mildest form. ItÃ¢s only in the rectum, the part of your colon closest to your . Rectal bleeding may be the only sign of the disease.
- Proctosigmoiditis happens in your rectum and the lower end of your colon . YouÃ¢ll have bloody diarrhea, belly cramps, and pain. YouÃ¢ll have the urge to poop, but you wonÃ¢t be able to.
- Left-sided colitis causes cramps on that side of your belly. YouÃ¢ll also have bloody diarrhea, and you might lose weight without trying. YouÃ¢ll have inflammation from your rectum up through the left side of your colon.
- Pancolitis often affects your entire colon. It can cause severe bouts of bloody diarrhea, belly cramps, pain, fatigue, and major weight loss.
- Acute severe ulcerative colitis is rare. It affects your entire colon and causes severe pain, heavy diarrhea, bleeding, and fever.
How Is Ulcerative Proctitis Treated
Ulcerative proctitis is usually very responsive to treatment, says Dr. Yoon. Your doctor will likely start by prescribing topical therapy, which means youll either use a suppository or an enema with an anti-inflammatory medication called mesalamine.
Dr. Yoon explains that the recommendation is to either use it every single night or at least two or three times a week just to keep the inflammation from coming back. If it works, you should ideally continue using it every night moving forward.
But in a practical sense, most people dont want to do that. People with ulcerative proctitis are usually young, in their 20s, so getting them to use a suppository for the rest of their life is wishful thinking, Dr. Yoon says. I have patients do it for four weeks and if theyre feeling fine and symptoms are mild, they can go ahead and stop. In the future, if they start bleeding again, they can do it for another four weeks.
Treatment for ulcerative proctitis can also include corticosteroids, such as prednisone or budesonide, which help reduce inflammation. Treating ulcerative colitis in general can involve immune system suppressors, like the pill azathioprine, and biologics, which are antibodies given via IV infusion or an injection that stop certain proteins from causing inflammation, according to the Crohns & Colitis Foundation.
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Future Aspects In The Management Of Ibd
CD and UC are complex disorders which need complex therapeutic strategies and a continuous development of treatment managements, new drugs and alternative measures. Despite the high prevalence of mental health co-morbidities in IBD, psychological illness remains largely under treated, with studies showing that 60% of IBD patients experiencing mental health problems do not receive adequate help. Therapeutic approaches must always be chosen in agreement with the patients to increase the patients compliance.
Due to the complexity of the disease a collaboration of medical specialists is necessary to cover all complications and to improve treatment success.
A new scoring system for CD, the Lémann score, is developed to allow a better identification of patients with severe epithelial damage and those with rapid progression of damage. This system monitors the cumulative damage. It measures cumulative structural bowel progression at a specific time point, based on medical and disease history, by endoscopy and other imaging methods. This instrument can also be used to assess the effect of various medical therapies on the progression of bowel damage.
Another point in therapeutic care in IBD is a harmonization between different countries and centers. Two retrospective cross sectional studies from 2009 describe country and care-setting specific therapeutic variations. The impact on outcome is not yet clear.
Can I Get Surgery For My Ulcerative Colitis
Surgery is an option if medications arent working or you have complications, such as bleeding or abnormal growths. You might develop precancerous lesions, or growths that can turn into colorectal cancer. A doctor can remove these lesions with surgery or during a colonoscopy.
Research shows that about 30% of people with ulcerative colitis need surgery sometime during their life. About 20% of children with ulcerative colitis will need surgery during their childhood years.
There are two kinds of surgery for ulcerative colitis:
Proctocolectomy and ileoanal pouch
The proctocolectomy and ileoanal pouch is the most common procedure for ulcerative colitis. This procedure typically requires more than one surgery, and there are several ways to do it. First, your surgeon does a proctocolectomy a procedure that removes your colon and rectum. Then the surgeon forms an ileoanal pouch to create a new rectum. While your body and newly made pouch is healing, your surgeon may perform a temporary ileostomy at the same time. This creates an opening in your lower belly. Your small intestines attach to the stoma, which looks like a small piece of pink skin on your belly.
After you heal, waste from your small intestines comes out through the stoma and into an attached bag called an ostomy bag. The small bag lies flat on the outside of your body, below your beltline. Youll need to wear the bag at all times to collect waste. Youll have to change the bag frequently throughout the day.
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Alternative And Future Treatments
Several alternative therapies have emerged for the treatment of UC. Ova of the non-pathogenic helminth trichiuris suis taken orally has shown initial success in a double-blind placebo-controlled trial, inducing remission in 43% of patients taking ova compared with 16.7% in the placebo group. Transdermal administration of nicotine was proposed as being effective in active UC. A systematic review and analysis of 5 relevant studies demonstrated its effectiveness in achieving remission compared with placebo. However, direct comparative trials with 5-ASA are still missing. Omega-3 fatty acids, which are largely present in fish oil, have shown anti-inflammatory properties by reducing the production of leukotriene B4. However, in a meta-analysis of the 3 available studies on 138 UC patients in remission, no evidence was found to support the use of omega-3 fatty acids for maintenance of remission as similar relapse rates were found in the study group and the placebo group . Taken together, due to a lack of data on efficacy, safety and adverse events, no recommendation is given for the therapies mentioned above.
Learning About Colorectal Cancer
According to cancer.org, aside from skin cancer, colorectal cancer ranks as the third most commonly diagnosed cancer among men and women in the United States. Further, the American Cancer Society reports that there were over 100,000 new cases of colon cancer in 2019, which is in addition to over 44,000 new cases involving rectal cancer.
Although no one is impervious to either of these cancers, the survival rate is reasonably good as long as they are detected early. For example, the 5-year survival rate for colon cancer is 14 percent, 67 percent for rectal cancer. It is also important to note that the survival rate cancer diagnosed at a localized stage is even higher, typically in the neighborhood of 89 percent or better.
In this article, we will take a closer at the symptoms of colon cancer and treatments that are available.
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Types Of Treatment Available
Colorectal cancer treatments can vary as there are several factors that go into outlining a treatment plan including how far the disease has progressed. Additional factors may include medications that you may already be taking, which could cause an adverse reaction when combined with those used to treat colorectal cancer. That said, some of the more common colorectal cancer treatments include:
- Targeted therapy
If you have been diagnosed with colorectal cancer, it is a good idea to go over all of your treatment options with your physician so that you know what to expect as you work towards becoming cancer-free. For more information on cancer treatments and to learn more about the disease, consider visiting cancer.org.
Adherence To Topical Therapy
Ulcerative proctitis is an idiopathic and chronic disease. Continuous good adherence is important for controlling chronic diseases however, keeping good adherence of medication is difficult. Adherence to topical therapy in ulcerative colitis is low. In terms of 5-ASA formula consumption, mesalazine suppositories and oral 5-ASAs were used most often, followed by combination therapy , mesalazine enema , and rectal steroids in patients with new-onset ulcerative proctitis . However, in a Swiss IBD cohort study on 800 patients, only 26% patients with ulcerative proctitis were treated with topical therapy of 5-ASA or corticosteroids . From these evidences, low adherence to rectal therapy is considered a reason for low consumption of rectal formula. Recently, a prospective cohort study estimated the adherence of 70 patients treated with rectal mesalazine . In this report, adherence was assessed by tracking pharmacy refills and patients interview. Moreover, 55% patients self-reported occasional nonadherence at enrollment. Surprisingly, 71% of all the subjects were nonadherent to their prescribed regimen based on the medication possession ratio criteria. The reasons for nonadherence were transanal mode of administration and busy lifestyle.
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Get Regular Exercise To Reduce Uc Inflammation
Snider says exercise is useful in managing many of the complications associated with ulcerative colitis, including decreased bone density, a weakened immune system, emotional health problems, stress, and weight gain.
Try to engage in a moderate-intensity exercise like swimming or biking, three or four days per week, he says. A review published in August 2016 in Pharmacological Reports noted that moderate exercise releases protective myokines such as irisin from working skeletal muscles, which promotes healing and helps with inflammatory bowel disease inflammation.
Snider also strongly recommends yoga as a natural treatment for ulcerative colitis, as it promotes relaxation and targets the digestive system, flooding the area with oxygen and nutrition for healing. Find what type and frequency of exercise works for you and take it slow: Too much exercise can cause mild systemic inflammation.
Research indicates that stress plays a role in inflammatory bowel diseases such as ulcerative colitis. Researchers analyzed data on 2,007 adults in a Swiss IBD study and found a relationship between depression and anxiety and disease symptoms. The results were published in June 2016 in Clinical Gastroenterology and Hepatology.
Counteract stress with relaxation techniques such as meditation, deep breathing, and progressive muscle relaxation to help your body relax.
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Medication Options For Ulcerative Colitis
Medication is the first line of treatment for ulcerative colitis. Your doctors recommendation for which medication will work best for you is based on the severity of your disease, your overall health, and other individual factors.
There are six major classes of medication used to treat ulcerative colitis.
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Side Effects Of Ulcerative Colitis
Side effects are based on the biologic medication that youre receiving. While some are minor, others may be life-threatening. You should talk to your doctor before receiving infusion therapy to ensure that you are getting the best option for your UC. The most common side effects include:
- Serious allergic reactions
- Lymphoma and other cancers including skin and cervical cancer
- Heart problems including failure
Side Effects Of Medical Treatment
Treatment with 5-ASA and budesonide was significantly less frequently associated with side effects compared to immunomodulator or anti-TNF-alpha antibody treatment . Oral 5-ASA was the most common therapy , and patients experienced side effects in 13.1% of the cases. Most common side effects of oral 5-ASA treatment were asthma, skin rash, interstitial nephritis, diarrhea and pancreatitis. Most common side effects of topical 5-ASA treatment were painful application of treatment, diarrhea due to intolerance, and skin rash. Side effects occurred in 25 cases out of 334 patients treated with topical therapies. The treatment with immunomodulators was frequently associated with side effects . Side effects for anti-TNF alpha antibody treatment were described in 24% of the cases .
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