Colitis – Ulcerative Colitis
Colitis is a chronic inflammatory disease of the colon, which is relatively common but remains poorly understood.
Diagnosis must be made by a healthcare practitioner—typically a gastroenterologist. Irritable bowel syndrome, a completely unrelated and less serious condition, was sometimes called mucous colitis in the past. About 50% of people with irritable bowel syndrome go on to develop more severe colitis conditions such as Crohn’s or spastic colitis. As a result, the general term “colitis“ is still sometimes used inappropriately. It is critical that people who are diagnosed with “colitis” find out whether they have irritable bowel syndrome or colitis.
Your Checklist for Colitis
What are the symptoms of colitis?
Colitis is characterized by frequent abdominal pain and bloody diarrhea. Other symptoms may include fatigue, weight loss, decreased appetite, and nausea.
The over the counter antidiarrheal drug loperamide (Imodium A-D®) may be used in ulcerative colitis patients with diarrhea. Anal irritation and loose stools may sometimes be improved by giving bulk-forming laxative such as methylcellulose (Citrucel®) or psyllium (Fiberall®, Konsyl®, Metamucil®, Perdiem®).
Diphenoxylate with atropine (Lomotil®) is the prescription drug most often used to control diarrhea. Cramps may be treated with anticholinergic drugs, such as L-hyoscyamine (Levsin®, Levbid®) and belladonna (Belladonna Tincture®). These drugs must be used with extreme caution to prevent toxic dilation of the colon. Sulfasalazine (Azulfidine®) is used in individuals with mild to moderate colitis. Oral corticosteroids, such as prednisone (Deltasone®), may be used during acute flare-ups however, long-term corticosteroid therapy may be more harmful than good. Therapy with corticosteroids, such as hydrocortisone enema (Cortenema®) is commonly recommended. Mesalamine (Asacol®, Pentasa®, Rowasa®) may be prescribed in some cases, as an enema, orally, or in suppository form. Certain immunosuppressive drugs may also be effective, including azathioprine (Imuran®), cyclosporine (Sandimmune®), and6-mercaptopurine (Purinethol®). Secondary bacterial infections are managed with antibiotics.
Other treatment of colitis includes avoiding raw fruits and vegetables. Sometimes a milk-free diet is suggested. Toxic colitis, a grave medical emergency complication of UC, is treated intensively in emergency departments with antibiotics, such as tobramycin (Nebcin®), amikacin (Amikin®), and gentamicin (Garamycin®), intravenous fluid replacement, and either corticosteroids or adrenocorticotropic hormone (ACTH). Emergency surgical removal of the colon is sometimes necessary in the most severe cases. Elective surgery may be recommended for milder cases.
Dietary changes that may be helpful
Some studies have shown that high sugar intake is associated with an increase in risk for colitis. Other research has failed to find any association between colitis and sugar intake. Until more is known, persons with inflammatory bowel diseases, including ulcerative colitis, should consider limiting their intake of sugar.
In two studies, people with a high intake of animal fat, cholesterol, or margarine had a significantly increased risk of colitis, compared with people who consumed less of these fats. Although these associations do not prove cause-and-effect, reducing one’s intake of animal fats and margarine is a means of improving overall health and possibly UC as well.
There is preliminary evidence that people who eat fast food at least twice a week have nearly four times the risk of developing colitis than people who do not eat fast food.
More than a half-century ago, several doctors reported that food allergies play an important role in some cases of ulceratve colitis. Since that time, many doctors have observed that avoidance of allergenic foods will often reduce the severity of colitis and can sometimes completely control the condition. In other old studies, milk has been reported to trigger colitis, and people with UC were found to have antibodies to milk in their blood, a possible sign of allergy. Today the relationship between food allergies and UC remains controversial and is not generally accepted by the conventional medical community. People who wish to explore the possibility that food sensitivities may trigger their symptoms may wish to consult with an appropriate healthcare provider.
In a preliminary study, patients with mild to moderate ulcerative colitis experienced significant improvement after receiving grams (about 1 oz) per day of a germinated barley product for four weeks.13 Controlled trials are needed to confirm this report.
Lifestyle changes that may be helpful
For unknown reasons, smokers have a lower risk of colitis. The nicotine patch has actually been used to induce remissions in people with colitis, although this treatment has been ineffective in preventing relapses. On the other hand, Crohn’s disease, which is in many ways similar to colitis, is made worse by smoking. Despite the possible protective effect of smoking in people with colitis, a strong case can be made that risks of smoking outweigh the benefits; even the use of nicotine patches carries its own side effects and remains experimental.
Nutritional supplements that may be helpful
Colitisis linked to an increased risk of colon cancer. Studies have found that people with colitis who take folic acid supplements or who have high blood levels of folic acid have a reduced risk of colon cancer compared with people who have colitis and do not take folic acid supplements. Although these associations do not prove that folic acid was responsible for the reduction in risk, this vitamin has been shown to prevent experimentally induced colon cancer in animals. Moreover, low blood folic acid levels have been found in more than half of all people with colitis. People with colitis who are taking the drug sulfasalazine, which inhibits the absorption of folic acid, are at a particularly high risk of developing folic acid deficiency. Folic acid supplementation may therefore be important for many people with colitis. Since taking folic acid may mask a vitamin B12 deficiency, however, people with UC who wish to take folic acid over the long term should have their vitamin B12 status assessed by a physician.
Alcohol consumption is known to promote folic acid deficiency and has also been linked to an increased risk of colon cancer. People with colitis should, therefore, keep alcohol intake to a minimum.
Preliminary and double-blind trials have found that fish oil supplementation reduces inflammation, decreases the need for anti-inflammatory drugs, and promotes normal weight gain in people with colitis. However, fish oil has not always been effective in clinical trials for colitis. Amounts used in successful clinical trials provided 3.2 grams of EPA and 2.2 grams of DHA per day—the two important fatty acids found in fish oil.
A fatty acid called butyrate, which is synthesized by intestinal bacteria, serves as fuel for the cells that line the small intestine. Administration of butyrate by enema has produced marked improvement in people with colitis in most, but not all, preliminary trials. Butyrate taken by mouth is not likely to be beneficial, as sufficient quantities do not reach the colon by this route. Although butyrate enemas are not widely available, they can be obtained by prescription through a compounding pharmacy, which prepares customized prescription medications to meet individual patient needs.
In a preliminary trial, 6 of 13 people with ulcerative colitis went into remission after taking 200 mg per day of DHEA for eight weeks. This large amount of DHEA has the potential to cause adverse side effects and should only be used under the supervision of a doctor.
In preliminary and double-blind trials, a probiotic supplement (in this case, a non-disease-causing strain of Escherichia coli) was effective at maintaining remission in people with colitis. In a double-blind trial, a combination probiotic supplement containing Lactobacilli, Bifidobacteria, and a beneficial strain of Streptococcus has been shown to prevent pouchitis, a common complication of surgery for colitis. People with chronic relapsing pouchitis received either 3 grams per day of the supplement or placebo for nine months. Eighty-five percent of those who took the supplement had no further episodes of pouchitis during the nine-month trial, whereas 100% of those receiving placebo had relapses within four months. Preliminary evidence suggests that combination probiotic supplements may be effective at preventing UC relapses as well.
In a preliminary trial, people with colitis significantly improved on a sugar-free, low-allergen diet with additional nutritional supplementation that included a multivitamin-mineral supplement (2–6 tablets per day); a fish oil supplement (400 mg per day); borage oil (400 mg per day); flaxseed oil (400 mg per day); and a probiotic formula containing Lactobacillus acidophilus and other species of beneficial bacteria. Some participants received slight variations of this regimen. Since so many different supplements were given and since the trial was not controlled, it is not possible to say which, if any, of the nutrients was responsible for the improvement observed by the researchers.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
A small clinical study found that people with colitis taking 550 mg of boswellia gum resin three times daily for six weeks had similar improvement in symptoms and the severity of their disease as people with colitis taking the drug sulfasalazine. Overall, 82% of patients receiving boswellia, along with 75% of patients taking sulfasalazine, went into remission.
In a preliminary trial, people with colitis remained in remission just as long when they took 20 grams of ground psyllium seeds twice daily with water as when they took the drug mesalamine. The combination of the two was slightly more effective than either alone. Controlled trials are now needed to confirm a therapeutic effect of psyllium for colitis.
In a controlled trial, supplementation with wheat grass juice for one month resulted in clinical improvement in 78% of people with ulcerative colitis, compared with 30% of those receiving a placebo. The amount of wheat grass used was 20 ml per day initially; this was increased by 20 ml per day to a maximum of 100 ml per day (approximately 3.5 ounces).
German doctors practicing herbal medicine often recommend chamomile for people with colitis. A cup of strong tea drunk three times per day is standard, along with enemas using the tea when it reaches body temperature.
Enemas of oil of St. John’s wort may also be beneficial. Consult with a doctor before using St. John’s wort oil enemas.
Aloe vera juice has anti-inflammatory activity and been used by some doctors for people with colitis. In a double-blind study of people with mildly to moderately active ulcerative colitis, supplementation with aloe resulted in a complete remission or an improvement in symptoms in 47% of cases, compared with 14% of those given a placebo (a statistically significant difference).47 No significant side effects were seen. The amount of aloe used was 100 ml (approximately 3.5 ounces) twice a day for four weeks. Other traditional anti-inflammatory and soothing herbs, including calendula, flaxseed, licorice, marshmallow, myrrh, and yarrow. Many of these herbs are most effective, according to clinical experience, if taken internally as well as in enema form. Enemas should be avoided during acute flare-ups but are useful for mild and chronic inflammation. It is best to consult with a doctor experienced with botanical medicine to learn more about herbal enemas before using them. More research needs to be done to determine the effectiveness of these herbs.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.