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Ulcerative Colitis Samples

Bay Biosciences provides high-quality biopsy tissue samples, formalin fixed paraffin embedded (FFPE) tissue blocks, with matched fresh frozen sera (serum), plasma, and peripheral blood mononuclear cells (PBMC) bio-fluids, from patients diagnosed with ulcerative colitis.

The sera (serum), plasma and peripheral blood mononuclear cells (PBMC) biofluid specimens are processed from patients peripheral whole-blood using customized collection and processing protocols from ulcerative colitis.

Overview

Ulcerative colitis (UC) is a long-term disease that is characterized by chronic inflammation of the gastrointestinal (GI) tract. Specifically, ulcerative colitis occurs in the large intestine (colon) and the rectum.

Consequently, it causes irritation, inflammation, and ulcers in the lining of the large intestine (also called the colon).

Moreover, the colon is the large intestine (bowel) and is the part of the digestive system where water is removed from undigested material, and the remaining waste material is stored.

Additionally, the rectum is located at the end of the colon adjacent to the anus. In patients with ulcerative colitis, ulcers and inflammation of the inner lining of the colon lead to symptoms of abdominal pain, diarrhea, and rectal bleeding.

Furthermore, ulcerative colitis is closely related to another condition of inflammation of the intestines known as Crohn’s disease. Together, they are frequently referred to as inflammatory bowel disease (IBD).

In fact, Crohn’s disease and ulcerative colitis are chronic conditions. Notably, Crohn’s disease can affect any portion of the gastrointestinal tract, including all layers of the bowel wall. It may not be limited to the GI tract; rather, it can also affect the liver, skin, eyes, and joints.

Effects the Lining of The Colon

UC only affects the lining of the colon (large bowel). Furthermore, men and women are affected equally. Although the most commonly begin during adolescence and early adulthood, they also can begin during childhood and later in life.

Moreover, there’s no cure for ulcerative colitis, and UC patients usually have symptoms off and on for the rest of their life. However, the right treatments can help manage the disease.

Additionally, UC is found worldwide; however, it is most common in the United States, England, and northern Europe. It is especially common in people of Jewish descent. Conversely, ulcerative colitis is rare in Eastern Europe, Asia, and South America, and is rare in the black population.

For unknown reasons, an increased frequency of ulcerative colitis has been observed recently in developing nations.

Types of Ulcerative Colitis

The type of ulcerative colitis depends on where the disease develops in the patients’ GI tract:

• Firstly, Acute Severe Ulcerative Colitis: This is a rare condition; consequently, it affects the entire colon and causes severe pain, heavy diarrhea, bleeding, and fever.
• Secondly, Left-sided Colitis: In this case, it causes cramps on the left side of the patients’ belly. Additionally, it causes bloody diarrhea, and you might lose weight without trying. Moreover, you’ll have inflammation from your rectum up through the left side of the colon.
• Moreover, Pancolitis: Similarly, this condition often affects the entire colon. As a result, it can cause severe bouts of bloody diarrhea, belly cramps, pain, fatigue, and major weight loss.
• Furthermore, Ulcerative Proctitis: In contrast, this type is usually the mildest form. Specifically, it only involves the rectum, the part of the colon closest to the anus. Notably, rectal bleeding may be the only sign of the disease.
• Finally,  Proctosigmoiditis: Lastly, this type occurs in the rectum and the lower end of your colon (you may hear the doctor call it the sigmoid colon). Consequently, you’ll have bloody diarrhea, belly cramps, and pain. Furthermore, you’ll have the urge to poop, but you won’t be able to. (This condition is known as tenesmus.)

Signs and Symptoms of Ulcerative Colitis

Usually, the main symptom of ulcerative colitis is diarrhea. Specifically, stools become progressively looser, and, in addition, some people may experience abdominal pain with cramps and a severe urge to go to the bathroom.

Moreover, diarrhea may begin slowly or suddenly. Consequently, symptoms depend on the extent and spread of inflammation.

Following are, in fact, the other common symptoms of ulcerative colitis:

• Anemia
• Bloody diarrhea with mucus
• A constant urge to pass stools
• Dehydration
• Eye pain when looking at a bright light
• Fatigue or tiredness
• Inability to defecate despite urgency
• Loss of appetite
• Not feeling hungry
• Rectal pain during bowel movements
• Skin sores
• Weight loss

Symptoms of a Flare-up

Interestingly, some ulcerative colitis patients may go for weeks or months with very mild symptoms, or none at all (remission). However, this is often followed by periods where the symptoms are particularly troublesome (flare-ups or relapses).

During a flare-up, in fact, some patients with ulcerative colitis also experience symptoms elsewhere in the body.

For example, some patients develop the following medical conditions:

• Areas of painful, red, and swollen skin
• Eye irritation
• Ulcers in the mouth
• Painful and swollen joints (arthritis)

Furthermore, in severe cases, defined as having to empty your bowels 6 or more times a day, additional symptoms may include:

• A high fever
• Blood in your stools
• Shortness of breath
• Skin sores

Additionally, in most patients, no specific trigger for flare-ups is identified, although a gut infection can occasionally be the cause.

Causes of Ulcerative Colitis

The exact cause of ulcerative colitis remains unknown. Previously, diet and stress were suspected; however, now doctors know that these factors may aggravate but don’t cause ulcerative colitis.

One possible cause, for instance, is an immune system malfunction. When the immune system tries to fight off an invading virus or bacterium, unfortunately, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too.

The immune system is supposed to defend the body against harmful bacteria, viruses, and other foreign invaders. Normally, in fact, the immune system is activated only when the body is exposed to harmful invaders.

In patients with ulcerative colitis, however, the immune system is abnormally and chronically activated in the absence of any known invader. Consequently, the continued abnormal activation of the immune system causes chronic inflammation and ulceration in portions of the large intestine.

This susceptibility to abnormal activation of the immune system is, notably, genetically inherited. As a result, first-degree relatives (brothers, sisters, children, and parents) of patients with inflammatory bowel disease (IBD) are therefore more likely to develop these diseases.

Studies have found there to be approximately 30 genes that might increase susceptibility to ulcerative colitis, including immunoglobulin receptor gene FCGR2A, 5p15, 2p16, ORMDL3, ECM1, as well as regions on chromosomes 1p36, 12q15, 7q22, 22q13, and IL23R.

Furthermore, heredity also seems to play a role in that ulcerative colitis is more common in people who have family members with the disease. However, most people with ulcerative colitis don’t have this family history.

In addition, the exact causes of ulcerative colitis are unclear. Nevertheless, they may involve the following:

Environment

Specifically, the following environmental factors might affect the onset of ulcerative colitis:

• Exposure to air pollution
• Diet
• Smoking

Genetic Factors

Moreover, research study suggest that patients with ulcerative colitis are more likely to have certain genetic features. Consequently, the specific genetic feature that a person has may affect the age at which the disease appears.

Immune System

Additionally, the body might respond to a viral or bacterial infection in a way that causes the inflammation associated with ulcerative colitis.

Once the infection resolves, the immune system continues to respond, which ultimately leads to ongoing inflammation.

Finally, another theory suggests that ulcerative colitis may be an autoimmune condition. In this case, a fault in the immune system may cause it to fight nonexistent infections leading to inflammation in the colon.

Diagnosis of Ulcerative Colitis

A doctor will ask about the patient’s symptoms and medical history. Additionally, they will also investigate whether any close relatives have had ulcerative colitis, IBD, or Crohn’s disease.

Furthermore, they will check for signs of anemia, or low iron levels in the blood, as well as tenderness around the abdomen.

Moreover, several tests can help rule out other possible conditions and diseases, including Crohn’s disease, infection, and irritable bowel syndrome (IBS).

In order to determine if you have UC instead of another gut disease, your doctor will use tests.

• For instance, blood tests can show if you have anemia or inflammation. Additionally, other blood tests may also be checked, including kidney function, liver function tests (LFT), iron studies, and C-reactive protein tests (another sign of inflammation).
• In contrast, colonoscopy is the same process as flexible sigmoidoscopy; however, your doctor will look at your whole colon, not just the lower part.
• On the other hand, flexible sigmoidoscopy allows your doctor to look at the lower part of your colon. In this procedure, they’ll put a bendable tube into your lower colon through your anus. Notably, the tube has a small light and camera on the end. Lastly, your doctor might also use a small tool to take a piece of the lining of your lower colon. This is called a biopsy. A doctor in a lab will look at the sample under a microscope.
• Moreover, stool samples can help your doctor rule out an infection or parasite in your colon. They can also show if there’s blood in your stool that you can’t see.
• Furthermore, X-rays are less common for diagnosing the disease, but your doctor may want you to have one in special cases.

Risk Factors of Ulcerative Colitis

Ulcerative colitis affects about the same number of women and men. The risk factors may include the following:

• Firstly, Age: Ulcerative colitis usually begins before the age of 30. However, it can occur at any age, and some patients may not develop the disease until after age 60.
• Additionally, Race or Ethnicity: Although whites have the highest risk of the disease, it can occur in any race. Specifically, if you’re of Ashkenazi Jewish descent, your risk is even higher.
• Moreover, Family history and genetics: You’re at higher risk if you have a close relative, such as a parent, sibling, or child, with the disease.

Complications of Ulcerative Colitis

Furthermore, the possible complications of ulcerative colitis can range from a lack of nutrients to potentially fatal bleeding from the rectum.

For instance, possible complications include:

Colorectal Cancer

One significant complication is Colorectal Cancer.

In particular, if the symptoms of ulcerative colitis are severe or extensive, it increases the risk of developing colorectal cancer.

According to the NIDDK, colon cancer risk is highest when ulcerative colitis affects the entire colon for longer than 8 years.

Toxic Megacolon

Another complication is Toxic megacolon.

In this case, this complication occurs in a few cases of severe ulcerative colitis.

Rarely, the colon can acutely dilate to a large size when the inflammation becomes very severe. Consequently, this condition is called toxic megacolon.

Other Complications of Ulcerative Colitis

Complications of ulcerative colitis can involve other parts of the body.

• Firstly, Ankylosing spondylitis (AS) is a type of arthritis that affects the vertebral joints of affected patients. There seems to be an increased incidence of ankylosing spondylitis among patients with inflammatory bowel disease (IBD).
• Secondly, some of the patients (around 10%) can develop inflammation of the joints (arthritis).
• Additionally, diseases of the liver and bile ducts also may be associated with ulcerative colitis. For example, in patients with a rare condition called sclerosing cholangitis, repeated infections and inflammation in the bile ducts can lead to recurrent fever, yellowing of skin (jaundice), cirrhosis and the need for a transplantation of the liver.
• Moreover, patients with ulcerative colitis also might have an increased tendency to form blood clots, especially in the setting of active disease.
• Furthermore, rarely, patients may develop painful, red, skin nodules (erythema nodosum) . Others can have painful, red eyes (uveitis, episcleritis). Because these particular complications can risk permanent vision impairment, eye pain or redness are symptoms that require a physician’s evaluation.
• Finally, some patients have lower back pain due to arthritis of the sacroiliac joints.

Treatment of Ulcerative Colitis

Ulcerative colitis symptoms can range from mild to severe; however, it needs treatment. Without treatment, the symptoms may go away; nevertheless, there is a higher chance of them coming back.

UC is a chronic condition. Consequently, the goal of treatment is to reduce the inflammation that causes your symptoms in order to prevent flare-ups and have longer periods of remission.

Both medications and surgery have been used to treat ulcerative colitis. However, surgery is reserved for those with severe inflammation and life-threatening complications.

Furthermore, there is no medication that can cure ulcerative colitis. Patients with ulcerative colitis will typically experience periods of relapse (worsening of inflammation) followed by periods of remission (resolution of inflammation) lasting months to years.

During relapses, symptoms of abdominal pain, diarrhea, and rectal bleeding worsen. Conversely, during remissions, these symptoms subside. Remissions usually occur because of treatment with medications or surgery; however, occasionally they occur spontaneously, that is, without any treatment.

Most patients will receive outpatient treatment. Nevertheless, around 15% of people with the disease have a severe form. Of these, 1 in 5 may need to spend time in the hospital.

Treatment will focus on:

• First, maintaining remission to prevent further symptoms
• In addition, managing a flare until symptoms go into remission

Moreover, several medications are available for treating ulcerative colitis, and the doctor will make a treatment plan that takes individual patients specific situation and severity of their symptoms. Furthermore, natural approaches can support medical treatment, but they cannot replace it.

Medications

Since ulcerative colitis cannot be cured by medication, the goals of treatment with medication are to:

• Induce remissions,
• Maintain remissions
• Minimize side effects of treatment
• Improve the quality of life
• Minimize risk of cancer

Treatment of ulcerative colitis with medications is similar, though not always identical, to treatment of Crohn’s disease.

Anti Inflammatory Drugs

Medications for treating ulcerative colitis include the following:

• Anti-inflammatory agents such as 5-ASA compounds, systemic corticosteroids, topical corticosteroids
•  Immunomodulators

Anti-inflammatory medications that decrease intestinal inflammation are analogous to arthritis medications that decrease joint inflammation (arthritis). The anti-inflammatory medications that are used in the treatment of ulcerative colitis are:

• Topical 5-ASA compounds such as sulfasalazine (Azulfidine), olsalazine (Dipentum), and mesalamine (Apriso, Asacol, Lialda, Pentasa, Rowasa enema) that need direct contact with the inflamed tissue in order to be effective.
• Systemic anti-inflammatory medications such as corticosteroids that decrease inflammation throughout the body without direct contact with the inflamed tissue. Systemic corticosteroids have predictable side effects with long term use.

Immunomodulators are medications that suppress the body’s immune system either by reducing the cells that are responsible for immunity, or by interfering with proteins that are important in promoting inflammation.

These medications increasingly are becoming important treatments for patients with severe ulcerative colitis who do not respond adequately to anti-inflammatory agents.

Some patients may need corticosteroids to help reduce inflammation, but these can have adverse effects, so doctors try to limit their use. If an infection is present, you may need antibiotics.

For patients who have moderate to severe symptoms, a doctor may prescribe a type of medication known as a biologic. These biologics are made from antibodies and help block inflammation. Taking these can help prevent a symptom flare-up.

Effective options for most ulcerative colitis patients include the following medications:

• Adalimumab (Humira)
• Golimumab (Simponi)
• Infliximab (Remicade)
• Tofacitinib (Xeljanz)
• Ustekinumab (Stelara)
• Vedolizumab (Entyvio)