Bay Biosciences provides high-quality biopsy tissue samples, formalin fixed paraffin embedded (FFPE) tissue blocks, with matched 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 UC patients peripheral whole-blood using customized collection and processing protocols from ulcerative colitis.
Ulcerative Colitis (UC) Overview
Ulcerative colitis (UC) is a chronic disease of the large intestine, in which the lining of the colon becomes inflamed and develops tiny open sores, or ulcers. UC belongs to a group of conditions called inflammatory bowel disease (IBD). which results from the immune system’s overactive response.
Inflammation in ulcerative colitis starts in the rectum and may spread to the colon. This inflammation produces tiny sores called ulcers on the lining of the colon. Symptoms may be constant or come and go. They include diarrhea, weight loss, abdominal cramping, anemia, and blood or pus in bowel movements.
The inflammation causes the bowel to move its contents rapidly and empty frequently. As cells on the surface of the lining of your bowel die, ulcers form. The ulcers may cause bleeding and discharge of mucus and pus.
While this condition affects patients of all ages, most individuals develop UC between ages 15 and 30 years old, according to the American Gastroenterological Association. After 50 years old, there’s another small increase in diagnosis of IBD, usually in men.
Who gets Ulcerative Colitis (UC)?
Anyone at any age, including young children, can get ulcerative colitis. Your chance of getting it is slightly higher if you:
- Have a close relative with inflammatory bowel disease (IBD).
- Are between 15 and 30 years old, or older than 60.
- Are Jewish.
- Eat a high-fat diet.
- Use frequent nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil or Motrin).
Types of Ulcerative Colitis (UC)
Symptoms may vary depending on the area of inflammation.
Following are the various types of ulcerative colitis, many of which affect different parts of the colon:
Ulcerative proctitis
This type affects only the end of the colon, or the rectum. Symptoms tend to include:
- Rectal bleeding, which may be the only symptom
- An inability to pass stools despite frequent urges
- Rectal pain
Ulcerative proctitis is usually the mildest type of ulcerative colitis.
Proctosigmoiditis
This involves the rectum and the sigmoid colon, which is the lower end of the colon.
Symptoms include:
- Abdominal pain
- Bloody diarrhea
- Abdominal cramps
- A constant urge to pass stool
Left-sided Colitis
This affects the rectum and the left side of the sigmoid and descending colon.
Symptoms usually include:
- Abdominal cramping on the left side
- Bloody diarrhea
- Weight loss
Pancolitis
This affects the whole colon. Symptoms include:
- Abdominal pain and cramps
- Considerable weight loss
- Fatigue
- Occasionally severe, bloody diarrhea
Fulminant Colitis
This is a rare, potentially life threatening form of colitis that affects the whole colon.
Symptoms tend to include severe pain and diarrhea, which can lead to dehydration and shock.
Fulminant colitis can present a risk of colon rupture and toxic megacolon, which causes the colon to become severely distended.
Signs and Symptoms of Ulcerative Colitis (UC)
The symptoms of ulcerative colitis vary from person to person and about half of all ulcerative colitis patients experience mild symptoms. First symptom of ulcerative colitis is usually diarrhea. Stools become progressively looser, and some patients may experience abdominal pain with cramps and a severe urge to go to the bathroom.
Diarrhea may begin slowly or suddenly. Symptoms depend on the extent and spread of inflammation.
The most common symptoms of ulcerative colitis include the following:
- Abdominal pain
- Bloody diarrhea with mucus
Some patients may also experience:
- Anemia
- Constant urge to pass stools
- Dehydration
- Fatigue or tiredness
- Fever
- High temperature
- Increased abdominal sounds
- Loss of appetite
- Malnutrition
- Rectal pain
- Weight loss
Symptoms are usually worse early in the morning. These symptoms may be mild or absent for months or years at a time. However, they will usually return without treatment and vary depending on the affected part of the colon.
Ulcerative colitis may cause additional symptoms, such as:
- Eye inflammation
- Joint pain
- Nausea and decreased appetite
- Joint swelling
- Mouth sores
- Skin problems
Ulcerative colitis (UC) symptoms usually come and go, with longer periods in between flares when the patient may not experience any discomfort at all. Those periods are called remission, and they can span months or even years. Because there is not yet a cure for ulcerative colitis, the symptoms will eventually return.
UC is an unpredictable disease, and the length of periods of remission between flares can make it difficult for doctors to evaluate whether your course of treatment has been effective or not.
Causes of Ulcerative Colitis (UC)
The exact causes of ulcerative colitis are unclear. Earlier diet and stress were suspected. However, researchers now know that these factors may aggravate but don’t cause ulcerative colitis.
One possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacterium, an irregular immune response causes the immune system to attack the cells in the digestive tract, too.
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 patients with ulcerative colitis don’t have this family history.
Following are some of the factors which cause ulcerative colitis (UC):
Genetic Factors
Research suggests that people with ulcerative colitis are more likely to have certain genetic features. The specific genetic feature that a person has may affect the age at which the disease appears.
Environment
The following environmental factors might affect the onset of ulcerative colitis:
- Air pollution
- Cigarette smoke
- Diet
Immune system
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 leads to ongoing inflammation.
Another theory suggests that ulcerative colitis may be an autoimmune condition. A fault in the immune system may cause it to fight nonexistent infections, leading to inflammation in the colon.
Diagnosis of Ulcerative Colitis (UC)
Endoscopic procedures with tissue biopsy are the only way to definitively diagnose ulcerative colitis. Other types of tests can help rule out complications or other forms of inflammatory bowel disease, such as Chron’s disease.
A doctor will ask about a person’s symptoms and medical history. They will also ask whether any close relatives have had ulcerative colitis, IBD, or Crohn’s disease. They will also check for signs of anemia, or low iron levels in the blood, and tenderness around the abdomen.
To help confirm a diagnosis of ulcerative colitis, you may have one or more of the following tests and procedures:
Lab Tests
- Blood Tests: Your doctor may suggest blood tests to check for anemia, a condition in which there aren’t enough red blood cells to carry adequate oxygen to your tissues, or to check for signs of infection or inflammation.
- Stool Studies: White blood cells or certain proteins in your stool can indicate ulcerative colitis. A stool sample also can help rule out other disorders, such as infections caused by bacteria, viruses and parasites.
Endoscopic Procedures
- Colonoscopy: This exam allows your provider to view your entire colon using a thin, flexible, lighted tube with a camera on the end. During the procedure, tissue samples are taken for laboratory analysis. This is known as a tissue biopsy. A tissue sample is necessary to make the diagnosis.
- Flexible Sigmoidoscopy: Your healthcare provider uses a slender, flexible, lighted tube to examine the rectum and sigmoid colon, the lower end of your colon. If the colon is severely inflamed, this test may be preferred instead of a full colonoscopy.
Imaging procedures
- X-Ray: If you have severe symptoms, your provider may use a standard X-ray of your abdominal area to rule out serious complications, such as a megacolon or a perforated colon.
- CT Scan: A computerized tomography (CT) scan of your abdomen or pelvis may be performed if a complication from ulcerative colitis is suspected. A CT scan may also reveal how much of the colon is inflamed.
Ulcerative Colitis (UC) Colonoscopy
Healthcare providers use a colonoscopy to diagnose UC or determine the severity of the condition.
Before the procedure, a doctor will likely instruct the patient to reduce solid foods and switch to a liquid-only diet. The patient will also be instructed to fast for a period of time before the procedure.
Typical colonoscopy preparation involves taking a laxative the evening before the procedure. This helps eliminate any remaining waste in the colon and rectum. It is easier for a doctor to examine a clean colon.
During the procedure, the patient lies on the side. The doctor will give the patient a sedative to help them relax and prevent any discomfort.
Once the medication takes effect, the doctor will insert a colonoscope into your anus. This device is long and flexible so it can move easily through the gastrointestinal (GI) tract. The colonoscope also has a camera attached so the doctor can see inside the colon.
During the exam, the doctor will look for signs of inflammation and check for precancerous growth known as polyps. The doctor may also perform a biopsy. The tissue is sent to a laboratory for histopathology and further examination.
Risk Factors of Ulcerative Colitis (UC)
Ulcerative colitis affects about the same number of women and men.
Risk factors may include the following:
- Age: Ulcerative colitis usually begins before the age of 30, but it can occur at any age. Some people may not develop the disease until after age 60.
- Race or Ethnicity: Although white people have the highest risk of the disease, it can occur in any race. If you’re of Ashkenazi Jewish descent, your risk is even higher.
- Family History: 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 (UC)
Following are some of the possible complications of ulcerative colitis:
- A hole in the colon, also called a perforated colon
- An increased risk of colon cancer
- Bone loss, also called osteoporosis
- Extreme dehydration
- Increased risk of blood clots in veins and arteries
- Inflammation of the skin, joints and eyes
- Rapidly swelling colon, also called a toxic megacolon
- Severe bleeding
Treatment of Ulcerative Colitis (UC)
Ulcerative colitis symptoms can range from mild to severe, but it needs treatment. Without treatment, the symptoms may go away, but there is a higher chance of them coming back.
Most people will receive outpatient treatment. However, 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:
- Maintaining remission to prevent further symptoms
- Managing a flare until symptoms go into remission
Various medications are available, and a doctor will make a treatment plan that takes individual needs and wishes into account. Natural approaches can support medical treatment, but they cannot replace it.
Long-Term Treatment to Maintain Remission
The first aim of treatment is to reduce the risk of a flare and its severity if a flare does occur. Long-term therapy can help achieve this.
There are several types of medication, and a doctor will make a treatment plan to suit the individual.
Ulcerative colitis results from a problem with the immune system. Three types of drugs that can help are biologics, immunomodulators, and small molecules. These target the way the immune system works.
These include the following:
- Anti-integrin agents, such as vedolizumab (Entyvio)
- Immunomodulators, for instance, thiopurines (azathioprines) and methotrexate
- interleukin 12/23 antagonists, such as ustekinumab (Stelara)
- Janus kinase (JAK) inhibitors, such as tofacitinib (Xelijanz) or upadacitinib (Rinvog)
- TNF-α antagonists, such as infiximab (Remicade) or adalimumab (Humira)
These drugs can help patients with moderate to severe symptoms, but they may have adverse effects. Individuals should talk to their doctor about the options available and the benefits and risks of each drug.
However, for mild to moderate symptoms, guidelines suggest 5-aminosalicylic acid, or aminosalicylates (5-ASA), as a first-line treatment.
Examples include:
- Balsalazide
- Mesalamine
- Sulfasalazine
Anti-Inflammatory medications
Anti-inflammatory medications are often the first step in the treatment of ulcerative colitis and are appropriate for most patient’s with this condition.
These include the following:
- 5-aminosalicylates: This type of medication include sulfasalazine (Azulfidine), mesalamine (Delzicol, Rowasa, others), balsalazide (Colazal) and olsalazine (Dipentum). Which medication you take and how you take it, by mouth or as an enema or suppository, depends on the area of your colon that’s affected.
- Corticosteroids: These medications, which include prednisone and budesonide, are generally reserved for moderate to severe ulcerative colitis that doesn’t respond to other treatments. Corticosteroids suppress the immune system.
Immune System Suppressors
These medications also reduce inflammation, but they do so by suppressing the immune system response that starts the process of inflammation. For some patients, a combination of these medications works better than one medication alone.
Immunosuppressant medications include the following:
- Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan): These are commonly used immunosuppressants for the treatment of inflammatory bowel disease. They are often used in combination with medications known as biologics. Taking them requires that you follow up closely with your provider and have your blood checked regularly to look for side effects, including effects on the liver and pancreas.
- Cyclosporine (Gengraf, Neoral, Sandimmune): This medication is typically reserved for people who haven’t responded well to other medications. Cyclosporine has the potential for serious side effects and is not for long-term use.
- Small molecule medications: More recently, orally delivered agents, also known as “small molecules,” have become available for IBD treatment. These include tofacitinib (Xeljanz), upadacitinib (Rinvoq) and ozanimod (Zeposia). These medications may be effective when other therapies don’t work. Main side effects include the increased risk of shingles infection and blood clots.The U.S. Food and Drug Administration (FDA) recently issued a warning about tofacitinib, stating that preliminary studies show an increased risk of serious heart-related problems and cancer from taking this medication.
Biologics
This class of therapies targets proteins made by the immune system. Types of biologics used to treat ulcerative colitis include:
- Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi): These medications, called tumor necrosis factor (TNF) inhibitors, work by neutralizing a protein produced by your immune system. They are for patients with severe ulcerative colitis who don’t respond to or can’t tolerate other treatments. TNF inhibitors are also called biologics.
- Vedolizumab (Entyvio): This medication is approved for treatment of ulcerative colitis for patients who don’t respond to or can’t tolerate other treatments. It works by blocking inflammatory cells from getting to the site of inflammation.
- Ustekinumab (Stelara): This medication is approved for treatment of ulcerative colitis for patients who don’t respond to or can’t tolerate other treatments. It works by blocking a different protein that causes inflammation.
Other Medications
Ulcerative colitis patients may need additional medications to manage specific symptoms of UC. Your healthcare provider may recommend one or more of the following medications.
- Anti-diarrheal medications: For severe diarrhea, loperamide (Imodium A-D) may be effective. These medications may increase the risk of an enlarged colon (toxic megacolon).
- Pain relievers: For mild pain, your doctor may recommend acetaminophen (Tylenol, others), but not ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) and diclofenac sodium, which can worsen symptoms and increase the severity of disease.
- Antispasmodics: Sometimes health care providers will prescribe antispasmodic therapies to help with cramps.
- Iron supplements: If you have chronic intestinal bleeding, you may develop iron deficiency anemia and be given iron supplements.
Other Treatment Options
Aminosalicylates: In the past, 5-ASA played a key role in treating the symptoms of ulcerative colitis. These are still an option, but current guidelines recommend focusing on long-term treatment to prevent symptoms from occurring in the first place.
Steroids: These can help manage inflammation if aminosalicylates do not help. However, long-term use can have adverse effects, and experts recommend minimizing their use.
Surgery
If other treatments do not provide relief for UC, surgery may be an option.
Some surgical options include:
- Colectomy: A doctor removes part or all of the colon.
- Ileostomy: A surgeon makes an incision in the stomach, extracts the end of the small intestine, and connects it to an external pouch, called a Kock pouch. The pouch then collects waste material from the intestine.
- Ileoanal pouch: A surgeon constructs a pouch from the small intestine and connects it to the muscles surrounding the anus. The ileoanal pouch is not an external pouch. Sometimes it is called a J-pouch.
According to the American Gastroenterological Association, around 10–15% of people with ulcerative colitis will need a colectomy.
Natural Remedies and Lifestyle Changes
Some home care strategies and remedies may help manage the symptoms of ulcerative colitis.
Natural Medicine
Following are some options that UC patients may use:
- Herbal remedies: Other research from 2019 found that some herbal remedies may help reduce symptoms and manage the condition. Examples include aloe vera gel and wheatgrass juice.
- Fruits and other plant-based foods: Research shows that ingredients naturally present in blueberries, black raspberries, cocoa, Indian quince, green teak grapes, olive oil, and Indian gooseberries may have a beneficial health effects.
- Probiotics: A 2019 review suggests that some probiotics may help manage IBD.
- Spices: Garlic, turmeric, fenugreek, saffron, and tamarind may help with IBD symptoms.
Research has not yet confirmed the possible benefits of the options above, but moderate amounts appear safe to add to the diet. However, it is worth checking with your doctor.
Lifestyle Changes
Researchers have discovered that the following lifestyle changes may help with UC:
- Education: The more a UC patient knows about a health condition, the more in control they tend to feel. Research shows, that learning about ulcerative colitis can help ease anxiety and lead to effective coping and management techniques, .
- Exercise: Research suggests that aerobic exercise may have an anti-inflammatory effect, which could benefit patients with ulcerative colitis. One 2019 study, for example, found that combining exercise with an anti-inflammatory diet could have a positive effect.
- Mindfulness: In a 2020 study, 37 patients with ulcerative colitis engaged in a mindfulness-based intervention that involved four online therapy and four face-to-face sessions. After 6 months, the participants had lower markers of inflammation than 20 participants who did not have the sessions.
Support
Developing a virtual or face-to-face support network that includes members of a community and medical professionals can make managing ulcerative colitis easier for people and their loved ones.
Cancer Surveillance
Ulcerative colitis patients will need more-frequent screening for colon cancer because of the increased risk. The recommended schedule will depend on the location of the disease and how long you have had it. Patients with inflammation of the rectum, also known as proctitis, are not at increased risk of colon cancer.
If your disease involves more than your rectum, you will require a surveillance colonoscopy every 1 to 2 years. This begins as soon as eight years after diagnosis if the majority of colon is involved. Or 15 years after diagnosis if only the left side of your colon is involved.
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