Ulcerative colitis (UC) is a digestive disorder that takes place in the colon and rectum. This disorder is classified as an Inflammatory Bowel Disease (IBD) like Crohn’s Disease (CD). Unlike CD, which can take place anywhere in the digestive tract, ulcerative colitis only occurs in the colon and has its own unique symptomatology. It is usual to have bloody diarrhea as the main symptom, but other symptoms can include; crampy abdominal pain, bloating, an urgency to defecate, fever, weight loss, and even constipation in some people. UC can also have extra digestive symptoms secondary to the inflammation inside the bowel, such as osteoporosis, uveitis, bone pain, and skin infections (1).
Who Can Have Ulcerative Colitis
Anyone can be diagnosed with UC, but it is far more likely in the Caucasian and Jewish populations. UC is most likely to occur between the ages of 15-35 and after the age of 70, but UC can occur at any age. Other risk factors include family history, and still having an appendix. While smoking appears to weaken ulcerative colitis, doctors do not recommend it due to the much more lethal side effects.
What Ulcerative Colitis Does
Ulcerative colitis ultimately reduces the body’s ability to break down, process, and absorb foodstuffs, as well as hinder the body’s ability to remove waste. The cause of UC is unknown, but there is research showing evidence that genetics, environmental conditions, lifestyle choices, and our gut microbiome all play a substantial role. Scientists have classified UC as a more aggressive autoimmune disease when compared to CD. UC is more common on the left side of the colon but can spread all the way to the IC valve/ascending colon.
Symptoms of Ulcerative Colitis
Common symptoms of ulcerative colitis include bloody loose stools, an urgency to have a bowel movement, abdominal pain, weight loss, fever, a raised heart rate (over 120bpm), anemia, dehydration, hypotension, and abnormal levels of electrolytes (2).
Diagnosis
Doctors will usually make a diagnosis with a sigmoidoscopy. A colonoscopy is contraindicated in most cases, and doctors may utilize abdominal X-rays instead to see the progression of the disease. Doctors may perform a biopsy to confirm a diagnosis of UC. Doctors can order a Lactoferrin and/or Calprotectin stool tests to access the likelihood of flare-ups or to gauge the level of inflammation in the colon. A doctor may also perform an occult blood test to assess blood in stools. A blood test that analysis certain antibodies such as pANCA might be assessed, or general inflammatory markers such as CRP.
DDX
First, parasites and colorectal cancer must be ruled out. Classic infections such as Campylobacter spp, Chlamydia trachomatis, Clostridium difficile, CMV, Amoebas, HSV, Salmonella, Shigella, Yersinia, and Mycobacterium tuberculosis all need to be ruled out. Hemorrhoids, diverticulosis, diverticulitis, and Behcet’s disease all need to be ruled out as well.
Allopathic Treatment
Allopathic treatment includes using an IV to replenish low levels of electrolytes, using antibiotics to flush bacteria out of the digestive tract, and using steroids to reduce inflammation in the colon. The final step for allopathic treatment is surgery, to remove the inflamed portion of the colon and to stitch up any perforations in the digestive tract lining. Surgery is typically saved as the last resort if patients do not respond to other treatment methods. The antibiotics and steroids also have potential side-effects that could alter the patient’s ability to recover. Drugs such as Balsalazide, Mesalazine, olsalazine, corticosteroids, amoxicillin, tetracycline, metronidazole. Doctors can also utilize a classic surgery called an Ileal Pouch-Anal anastomosis. This is where the colon is removed and the small intestines are attached to the anus. Another surgical procedure includes the placement of a colostomy bag.
Naturopathic Treatment
There are many different naturopathic medical treatments that can help people suffering from UC but these should always be discussed with your naturopathic physician. Doctors recommend going to the hospital if you notice there is severe dehydration, hemorrhaging, malnutrition, bloody diarrhea, and excessive weight loss. Patients can use naturopathic medications in conjunction with allopathic medications to prevent and reduce flares. Researchers have found many different herbs can be helpful such as Boswellia serrata, Aloe vera gel, Curcuma longa, and Allium sativa.
Numerous studies have shown nutritional supplements such as fish oil and butyrate – a short-chain fatty acid – can help reduce inflammation in the colon and help heal the inflamed colonocytes. Different probiotic strains, zinc, glutathione have also shown to be beneficial. Fecal Microbiota Transplantation (FMT) can help reinoculate the large bowel with beneficial bacteria but needs to be performed under medical supervision. Acupuncture has also shown promise for symptomatic management in UC patients.
Potential Complications
Patients who are diagnosed with ulcerative colitis have a higher risk of contracting colorectal cancer. They also run the risk of developing “toxic megacolon” where the colon expands and dilates. When this happens, the colon is unable to expel gas or feces. With no place to go, these substances build up until they rupture either the colon or the large intestine, both of which are life-threatening. Arthritis is also common in UC patients as there is some link to an overactive immune system. Different skin lesions such as erythema nodosum and pyoderma gangrenosum can be common.
Related Bacteria
Kluyvera spp. has been shown to be elevated in people who have severely inflamed guts. This is an opportunistic bacteria line that we are still learning about. Dr. D’Adamo’s Utopia program found an excellent government research study on Kluyvera spp. which can be read here.
Government researchers found in a study that patients with CD tend to have a lower number of Roseburia and Faecalibacterium prausnitzii, and a higher number of the Enterobacteriaceae family and Ruminococcus gnavus.
Patients with severe cases of UC commonly have low quantities of Faecalibacterium prausnitzii. This is most likely due to this bacteria’s ability to help reduce inflammation in the bowels. This bacteria, along with Roseburia hominis, also produce butyrate as a byproduct. Having low levels of both of these bacteria can induce dysbiosis in patients with UC.
Patients with UC have a higher concentration of the Desulfovibrio spp. of bacteria. These bacteria create a sulfide gas, or H2S gas, as a byproduct. This smelly chemical is incredibly toxic to the human body. This sulfide-reducing bacteria converts amino acids into hydrogen sulfide, which damages the integrity of the mucosal lining of the digestive tract. An overgrowth of H2S producing bacteria is known as Intestinal Sulfide Overproduction, or ISO.
Researchers have found data that suggests that the Eggerthella spp. could be a cause of UC. Patients with ulcerative colitis commonly have lower levels of the Clostridium coccoides and Eubacterium rectale species as well. Agathobacter rectalis has been shown to decrease colonization of fecal Clostridium coccoides and Eubacterium rectale in UC patients
Related Genes
Government research has spanned decades looking for the links between our genetics and our susceptibility to disease. For instance, research has found that the presence of the gene IL23R reduces our risk of not just UC, but CD as well. The ABCB1 gene can increase the risk of developing IBD by mutating. The IRF5 gene helps to balance out cytokines and other inflammatory molecules. The IL23R gene is responsible for making the Interleukin 23 receptor. This receptor helps control inflammation and balances the immune system.
Researchers have studied other genes as well, including PTPN2, IL10RA, IL10RB, and the SNP Arg381Gln. While their exact effects are unknown, scientists believe that these genes have an influence on our gut and IBD.
References
- Yarnell, E. (2011). Natural Approach to Gastroenterology (2nd ed., Vol. 1). Seattle, WA: Healing Mountain Pub.
- Grover, S. (2007). Gastroenterology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.