What Are Common Ulcerative Colitis Causes
The exact cause of ulcerative colitis is not known. A major potential cause of this condition is an abnormal immune system response. In this case, the immune system attacks the healthy cells in the gastrointestinal tract. This causes inflammation, damage, and the elimination of a healthy gut biome. Whether ulcerative colitis destroys the gut biome, or a depleted biome leads to ulcerative colitis, is the subject of recent research.
Genetics may also play a role in the disease. Ulcerative colitis is more common in individuals who have family members with the condition.
Other risk factors increase your chances of developing ulcerative colitis. These ulcerative colitis risk factors include:
- Age: People over 30 are more likely to develop UC
- Race: While ulcerative colitis can occur in any race, white people have the highest risk of developing the disease
- Isotretinoin use: Use of this medication has been found to be a risk factor for developing IBD in general
What Uc Abdominal Pain Feels Like
Youre certainly not alone if you are experiencing gut . More than half of people with UC report abdominal discomfort, according to a recent report in the Journal of Crohns and Colitis. UC pain is no joke, confirms Jonathan Cruz, a Spanish teacher and actor in Leander, TX, who lives with ulcerative colitis. Cruz describes the pain as something fresh from a horror film. For the most part, average stomachaches are manageable because most over-the-counter medications can control the symptoms, he says. Meanwhile, ulcerative colitis pain is like in the movies when a person is being tortured until the pain makes the victim surrender.
Cruz says one of the hardest aspects of UC pain is the mental anguish that often goes hand in hand. UC pain can go beyond physical pain because it can also impact your mental wellbeing, preventing you from thinking clearly, he says. Whats more, ulcerative colitis pain usually lasts longer than your average stomachache. Oftentimes a non-UC stomachache will last a couple of hours, Cruz says. But abdominal pain associated with UC can become worse throughout the day and continue into the next day and night.
What Are The Causes And Risk Factors Of Ulcerative Colitis
Ulcerative colitis is believed to be caused by an abnormal response by your bodys immune system.
Your immune system is supposed to defend you against harmful invasive bacteria and viruses. But in some people, the immune system mistakenly attacks the bodys own tissue.
While we dont know exactly what causes ulcerative colitis, there are two leading theories:
Experts believe that ulcerative colitis develops because of a combination of environmental factors and genetic predisposition.
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Inflammatory Pathways In Axial And Peripheral Spa
Genetic studies have provided a significant step in the discovery of potential triggers of SpA pathogenesis. The most studied gene for SpA susceptibility is the class I histocompatibility molecule HLA-B27 , which, previously was considered as a potential link with arthritogenic peptides presented to self-reactive lymphocytes nevertheless, this has not been proven, and current theories postulate other roles like the induction of endoplasmic- reticulum stress and homodimer formation .
Studies in animal models of transgenic HLA-B27 rats and mice revealed that this molecule tends to misfold during its synthesis in the endoplasmic reticulum , causing ER stress, activation of the unfolded protein response and the induction of the inflammatory cytokine IL-23 . However, UPR activation has not been proven in humans, as UPR markers are not increased in samples of patients of SpA , and instead, some reports suggest that IL-23 production could be related to an increase of autophagy markers in the gut . Furthermore, killer immunoglobulin receptors expressed on NK and Th17 cells can recognize aberrant B27 homodimers , and therefore, induce IL-17 production. Remarkably, heavy chain homodimers have been found in patients’ gut and vertebral joints .
Joint Pain: The Most Common Non
About 30 percent of people with ulcerative colitis experience joint pain, according to the Crohns and Colitis Foundation, making it the most common non-GI symptom of the disease. Joint pain often occurs in the knees, ankles, elbows, and wrists. Its usually joint pain thats symmetrical, meaning both knees or both ankles, says Dr. Rubin. This type of joint pain tends to parallel bowel activityso if you fix the intestine, the joint pain goes away.
However, ulcerative colitis is also related to inflammatory joint conditions that affect your spine, like ankylosing spondylitis. This type of joint pain can be independent of your bowelso your bowel can be completely in remission, and your back or your pelvis is inflamed, and you can have joint damage, says Rubin.
The good news: Some medications used to treat ulcerative colitis are also used to treat inflammatory joint conditions like ankylosing spondylitis. Its not that fixing the bowel makes these joints betterits that the medication that works on the bowel also works on these joint conditions, says Rubin. So if youre experiencing joint pain, its important to work with your doctor to understand what type of joint pain you have and get proper treatment. In some cases it may be necessary to see a doctor who specializes in the joints, a rheumatologist, to work with your IBD doctor.
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Healthy Habits For Arthritis Prevention
Adhere to your ulcerative colitis treatment plan. Treating your ulcerative colitis can lower your chances of developing arthritis or ease arthritis symptoms if you already have joint problems. If you can get your colitis under very good control and quiet it down, your arthritis will quiet down, Dr. Fischer says. Generally, while treating underlying IBD is helpful for people with axial arthritis, it is not as effective as it is for those with peripheral arthritis, according to the Crohns and Colitis Foundation.
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Talk to your gastroenterologist about joint pain. You might think your gastroenterologist doesnt need to hear about your achy joints, but they should be the first person you speak to about your symptoms, says Amar Naik, MD, an associate professor of medicine and the director of the inflammatory bowel disease program at Loyola University Health System in Maywood, Illinois.
Tell your doctor which joints are affected, whether the pain is moving from one joint to another, and if theres swelling. You should also clarify whether your ulcerative colitis is in remission or if youre in a flare, Dr. Naik says. Your gastroenterologist can help advise you on how to treat the symptoms. If those things arent working, going to a rheumatologist can be very helpful, he adds.
Do treat arthritis pain. If youre bothered by symptoms, talk to your doctor about the best treatment for your arthritis pain.
Radiation Colitis And Enteritis
Inflammation of both the colon and the small intestine can be caused by radiation exposure, most commonly from cancer radiation therapy. However, medical procedures such as X-rays or CT scans can also irritate the colon tissues. Radiation colitis is usually temporary and is marked by diarrhea, cramping, nausea, and vomiting. Symptoms are temporary and usually fade in a few weeks. However, chronic radiation colitis can occur months to years following radiation therapy due to radiation damage. It is a progressive and serious complication of radiation therapy.
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If You Have Moderate To Severe Ulcerative Colitis
In 2020, the American Gastroenterological Association released updated treatment guidelines for adults with moderate to severe UC.
The AGA suggested that people whove never received biologics before should only receive tofacitinib if theyre a part of a clinical study or registry study.
The organization also recommended that people whove never received biologics before choose infliximab or vedolizumab instead of adalimumab .
Adalimumab isnt as effective as the other two biologics. However, people with UC can administer adalimumab to themselves, while healthcare professionals have to administer infliximab and vedolizumab. If youre looking for convenience over efficacy, its fine to choose adalimumab instead.
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Surgery A Last Resort
For patients with certain complications and those whose disease is not controlled with medication, surgery is an option.
If surgery is required for ulcerative colitis, the standard surgical procedure is removal of the colon and rectum, called proctocolectomy. In the past, patients who underwent this procedure had to wear a bag over a small hole in the abdomen to collect stool. Today, many patients undergo variations to the procedure that do not require wearing a permanent external bag.
Many patients with Crohns have surgery on their small bowel. urgery for Crohns removes the area that is most involved, leaving behind as much bowel as possible. In many cases, the surgeon removes the end of the small bowel and beginning of the colon and reconnects those areas.
Interview with Dr. Darrell S. Pardi, July 2017.
References
Medication For Inflammatory Bowel Disease In Adults
Gastroenterologists at NYU Langones Inflammatory Bowel Disease Center may prescribe one or more medications to reduce inflammation in the digestive tract caused by inflammatory bowel disease, or IBD. The goals of treatment are to improve symptoms and heal any damage to the intestines.
Our gastroenterologists develop a personalized treatment plan for you based on the type of IBD, the severity of the condition, and the results of diagnostic tests. These tests may have confirmed that you have Crohns disease, which can affect any part of the gastrointestinal tract, or ulcerative colitis, which only affects only the colon, or large intestine.
Medications work differently in different people, so your gastroenterologist closely monitors how well you respond to treatment. He or she adjusts the type or dose of medication as often as needed.
Medications for IBD can often reduce inflammation and promote healing in the intestines, resulting in remissionmeaning long-term symptom relief. However, for many people with IBD, the condition is chronic and treatment is lifelong. It is very important to follow up regularly with your gastroenterologist.
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What Are The Symptoms Of Ulcerative Colitis
Ulcerative colitis symptoms often get worse over time. In the beginning, you may notice:
- Diarrhea or urgent bowel movements.
- Abdominal cramping.
- Loss of fluids and nutrients.
Symptoms are similar in pediatric ulcerative colitis and may also include delayed or poor growth. Some ulcerative colitis symptoms in children can mimic other conditions, so it is important to report all symptoms to your pediatrician.
Do I Have Ulcerative Colitis
Diagnosing ulcerative colitis is often a diagnosis of exclusion. This means that your doctor may start by looking for what you dont have, as opposed to focusing on an ulcerative colitis diagnosis.
Symptoms of ulcerative colitis vary dramatically among the people who have it. Which symptoms are present depends on the severity of inflammation and which areas are affected. Some patients also have long periods where the disease goes into remission.
Some common symptoms include:
Children with ulcerative colitis may not experience normal growth and development.
To begin the process of diagnosis, your doctor takes a detailed medical history and performs a thorough physical examination.
A colonoscopy may be recommended. This helps your doctor see visual evidence of potential ulcerative colitis in the colon. During the colonoscopy, your doctors takes a tissue biopsy. If the bowel is too inflamed, flexible sigmoidoscopy may be utilized instead of colonoscopy. This procedure uses a small, flexible tube to visualize the last part of the colon.
There are a variety of other lab tests that will help your doctor rule out other causes. Blood tests may be ordered to check for infection or anemia. A stool sample looks for white blood cells in the stool . This sample also rules out other conditions, including infections caused by bacteria, parasites, and viruses.
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Complications Of Ulcerative Colitis
If you have an inflammatory bowel disease like ulcerative colitis , a gastroenterologist can prescribe medication and create a treatment plan for the inflammation and sores, called ulcers, that occur in the lining of the large intestine and rectum. But this autoimmune disorder is often associated with complications in other parts of the body that should be addressed as well.
Extraintestinal complications those that exist outside the intestines can even overshadow symptoms in your bowels, making UC tricky to diagnose. They are also highly prevalent, occurring in nearly half of UC patients and appearing more often in women, according to a review published in May 2019 in Current Gastroenterology Reports. While it remains unclear why UC complications can arise beyond the intestines, the review noted that genetic predisposition, irregular immune response, and changes to the gut microbiome are some common contributing factors.
“It’s easy to forget that ulcerative colitis is not just a disease of the intestines but a systemic or body-wide disorder of the immune system,” says Jessica Philpott, MD, PhD, a gastroenterologist at Cleveland Clinic in Ohio.
Below are five conditions commonly linked to ulcerative colitis, along with some treatment options.
Ulcerative Colitis In Children
According to one study of IBD in the United States, 1 in 1,299 children between ages 2 and 17 years old were affected by the condition in 2016. Crohns disease was twice as common as UC, and boys were more likely to have IBD than girls.
For children with IBD, a diagnosis is more likely after 10 years old.
UC symptoms in children are similar to symptoms in older individuals. Children may experience bloody diarrhea, abdominal pain and cramping, and fatigue.
In addition, they may experience issues compounded by the condition, such as:
- anemia due to blood loss
- malnutrition from poor eating
- unexplained weight loss
UC can have a significant effect on a childs life, especially if the condition isnt treated and managed properly. Treatments for children are more limited because of possible complications. For example, medicated enemas are rarely used as a treatment method in children.
However, children with UC may be prescribed medications that reduce inflammation and prevent immune system attacks on the colon. For some children, surgery may be necessary to manage symptoms.
If your child has been diagnosed with UC, its important that you work closely with their doctor to find treatments and lifestyle changes that can help. Check out these tips for parents and children dealing with UC.
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Outlook For People With Ulcerative Colitis
If you have UC, a doctor will need to monitor your condition, and youll need to carefully follow your treatment plan throughout your life.
The only true cure for UC is removal of the entire colon and rectum. Your doctor will usually begin with medical therapy unless you have a severe complication that requires surgery. Some people will eventually require surgery, but most do well with nonsurgical therapy and care.
Contribution Of Animal Models
Remarkably, in different animal models of SpA, midfoot arthritis and ossification are the main clinical features that can happen either before or simultaneously that axial arthritis. Animal models of transgenic animals like the HLA-B27-transgenic rats develop spontaneous arthritis in the hind paws accompanied by spondylitis, uveitis, and gut inflammation, resembling human disease . Interestingly, a transgenic model of TNF overexpression in mice is characterized by Crohn’s-like ileitis, midfoot ossification and inflammation, sacroilitis, and spinal ossification that worsens with increased mechanical stress and can develop in the absence of mature T or B cells . A more recently described model involves the transmembrane expression of TNF in this model, animals develop a disease characterized by axial and peripheral enthesitis with abundant leukocyte infiltration . These experimental approaches resemble human disease and point to the importance of peripheral arthritis and enthesitis in the onset of the disease with an interesting involvement of immune pathways and mechanical forces.
Table 1. Foot and axial involvement in animal models of SpA.
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Complementary And Alternative Remedies
Alternative treatments such as acupuncture may help reduce and regulate bowel inflammation, reducing UC pain.
Another form of alternative treatment called moxibustion may also have a positive effect on UC symptoms. Moxibustion is a type of heat therapy. It uses dried plant materials burned in a tube to warm the skin, often in the same areas targeted by acupuncture.