Ulcerative colitis: Wikis

  
  

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Ulcerative colitis
Classification and external resources
.
Endoscopic image of a sigmoid colon afflicted with ulcerative colitis.^ Surveillance for colonic carcinoma in ulcerative colitis .

^ Ulcerative colitis affects the colon and the rectum.
  • CIGNA - Ulcerative colitis: Should I have surgery? 18 January 2010 5:11 UTC www.cigna.com [Source type: General]

^ Ulcerative colitis Images .
  • Ulcerative Colitis | LIVESTRONG.COM 18 January 2010 5:11 UTC www.livestrong.com [Source type: General]

Note the vascular pattern of the colon granularity and focal friability of the mucosa.
ICD-10 K51.
ICD-9 556
OMIM 191390
DiseasesDB 13495
MedlinePlus 000250
eMedicine med/2336
MeSH D003093
.Ulcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD).^ Ulcerative colitis and Crohn's disease are inflammatory bowel diseases.

^ What are the types of inflammatory bowel disease?
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

^ Alternative Names: Inflammatory bowel disease; Colitis - ulcerative Highlights: Drug Approval .
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

.Ulcerative colitis is a form of colitis, a disease of the intestine, specifically the large intestine or colon, that includes characteristic ulcers, or open sores, in the colon.^ Ectopic colonic mucosa in ulcerative colitis and in Crohn's disease of the colon .

^ Ulcerative colitis is a disease that causes inflammation and sores (ulcers) in the lining of the large intestine, or colon.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

^ Is ulcerative colitis a hereditary disease?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

.The main symptom of active disease is usually constant diarrhea mixed with blood, of gradual onset.^ Symptoms can develop gradually or have a sudden onset.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC nortonhealthcare.adam.com [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ Constipation in Crohn's disease is usually a symptom of obstruction in the small intestine.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ Symptoms typically begin insidiously with persistent diarrhea followed by the appearance of blood, mucus, and pus in the stool.
  • Ulcerative Colitis - University of Michigan Pediatric Surgery, Ann Arbor 18 January 2010 5:11 UTC surgery.med.umich.edu [Source type: Academic]

.Ulcerative colitis is, however, believed to have a systemic etiology that leads to many symptoms outside the intestine.^ Ulcerative Colitis symptom?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ The inflammation is what causes the symptoms of ulcerative colitis.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

^ Diagnosis of ulcerative colitis can be suspected from the symptoms.
  • Ulcerative Colitis Treatments, Ulcerative Colitis Diagnosis, Ulcerative Colitis Symptoms 18 January 2010 5:11 UTC gicare.com [Source type: Academic]

.Because of the name, IBD is often confused with irritable bowel syndrome ("IBS"), a troublesome, but much less serious, condition.^ Some people who have ulcerative colitis also have irritable bowel syndrome (IBS) , which is not as serious as ulcerative colitis.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

^ Irritable bowel syndrome .
  • Ulcerative Colitis: Diagnosis and Treatment - November 1, 2007 - American Family Physician 18 January 2010 5:11 UTC www.aafp.org [Source type: Academic]

^ IBS, irritable bowel syndrome.
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

.Ulcerative colitis has similarities to Crohn's disease, another form of IBD. Ulcerative colitis is an intermittent disease, with periods of exacerbated symptoms, and periods that are relatively symptom-free.^ Ectopic colonic mucosa in ulcerative colitis and in Crohn's disease of the colon .

^ Ulcerative colitis and Crohn's disease are inflammatory bowel diseases.

^ Ulcerative Colitis symptom?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

.Although the symptoms of ulcerative colitis can sometimes diminish on their own, the disease usually requires treatment to go into remission.^ Ulcerative Colitis symptom?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ Ulcerative colitis treatment typically begins with prescription medications to put the disease in remission.
  • Ulcerative Colitis Alternative Cures 18 January 2010 5:11 UTC www.healthguidance.org [Source type: FILTERED WITH BAYES]

^ Medicines usually are the treatment of choice for ulcerative colitis .
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

.Ulcerative colitis occurs in 35–100 people for every 100,000 in the United States,[1] or less than 0.1% of the population.^ Ulcerative colitis can occur at any age, but ulcerative colitis often affects people in their 30s.
  • OhioHealth - Ulcerative colitis 18 January 2010 5:11 UTC www.ohiohealth.com [Source type: General]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.cnn.com [Source type: General]

^ People with ulcerative colitis have a higher than normal risk for anemia.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

^ It seems to "run" in families and it is suspected that the immune system of people with ulcerative colitis may be reacting to normal intestinal bacteria, causing inflammation.
  • Ulcerative Colitis Alternative Cures 18 January 2010 5:11 UTC www.healthguidance.org [Source type: FILTERED WITH BAYES]

.The disease is more prevalent in northern countries of the world, as well as in northern areas of individual countries or other regions.^ Ulcerative colitis is more prevalent among whites than people of other races.

^ A barium enema, along with colonoscopy, remains useful in the diagnosis of colon cancer, ulcerative colitis, and other diseases of the colon, but endoscopy is more accurate and informative.

^ Fistulas (tracts between areas of the intestine or between the intestine and other organs) and strictures (scarring) are common with Crohn’s disease but very rare with ulcerative colitis.

.Although ulcerative colitis has no known cause, there is a presumed genetic component to susceptibility.^ Cause of ulcerative colitis and contributing factors?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ There is no known cause for ulcerative colitis , but treatment is available to reduce the number of flar...
  • Ulcerative Colitis | LIVESTRONG.COM 18 January 2010 5:11 UTC www.livestrong.com [Source type: General]

^ The exact causes of ulcerative colitis are unknown.

.The disease may be triggered in a susceptible person by environmental factors.^ Tumor necrosis factor may a particularly potent immune factor in Crohn's disease.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ Tumor necrosis factor may be a particularly potent immune factor in Crohn's disease.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ IBD appears to be due to an interaction of many complex factors including genetics, impaired immune system response, and environmental triggers.

.Although dietary modification may reduce the discomfort of a person with the disease, ulcerative colitis is not thought to be caused by dietary factors.^ Kono S. Dietary and other risk factors of ulcerative colitis.
  • Ulcerative Colitis | David Lloyd 18 January 2010 5:11 UTC www.davidlloyd.co.uk [Source type: Academic]

^ Is ulcerative colitis a hereditary disease?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ Or disease-causing bacteria and viruses may play a role in triggering ulcerative colitis.
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

.Although ulcerative colitis is treated as though it were an autoimmune disease, there is no consensus that it is such.^ (Antibiotics, which are used to treat Crohn's disease, are also not helpful for ulcerative colitis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC nortonhealthcare.adam.com [Source type: Academic]

^ Is ulcerative colitis a hereditary disease?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ There is a cure for ulcerative colitis.
  • CIGNA - Ulcerative colitis: Should I have surgery? 18 January 2010 5:11 UTC www.cigna.com [Source type: General]

.Treatment is with anti-inflammatory drugs, immunosuppression, and biological therapy targeting specific components of the immune response.^ Biologic response modifiers are genetically engineered drugs that target specific proteins involved with the body's inflammatory response.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

^ Biologic response modifiers are genetically engineered drugs that target specific proteins involved with the body’s inflammatory response.

^ Biologic response modifiers are drugs that interfere with the inflammatory response.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

.Colectomy (partial or total removal of the large bowel through surgery) is occasionally necessary, and is considered to be a cure for the disease.^ Surgery to remove the colon is the only cure for the disease.
  • CIGNA - Ulcerative colitis: Should I have surgery? 18 January 2010 5:11 UTC www.cigna.com [Source type: General]

^ It removes the large intestine and the lining of the rectum, but you can still have nearly normal bowel movements after the surgery.
  • CIGNA - Ulcerative colitis: Should I have surgery? 18 January 2010 5:11 UTC www.cigna.com [Source type: General]

^ Surgical removal of the colon cures the disease and returns good health and a normal lifestyle to the patient.
  • Ulcerative Colitis Treatments, Ulcerative Colitis Diagnosis, Ulcerative Colitis Symptoms 18 January 2010 5:11 UTC gicare.com [Source type: Academic]

Contents

Causes

.While the cause of ulcerative colitis is still unknown, several, possibly interrelated, causes have been suggested.^ I had severe ulcerative colitis for 18 years.
  • Earth Clinic's best remedies to Cure Ulcerative Colitis or Crohn's Disease. 18 January 2010 5:11 UTC www.earthclinic.com [Source type: General]

^ The exact causes of ulcerative colitis are unknown.

^ The inflammation is what causes the symptoms of ulcerative colitis.
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

Some think that the smallest illness could spark the disease.

Genetic factors

A genetic component to the etiology of ulcerative colitis can be hypothesized based on the following:[2]
  • Aggregation of ulcerative colitis in families.
  • Identical twin concordance rate of 10% and dizygotic twin concordance rate of 3%[3]
  • Ethnic differences in incidence
  • Genetic markers and linkages
.There are 12 regions of the genome which may be linked to ulcerative colitis.^ The symptoms of ulcerative colitis may include: .
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

^ It seems to "run" in families and it is suspected that the immune system of people with ulcerative colitis may be reacting to normal intestinal bacteria, causing inflammation.
  • Ulcerative Colitis Alternative Cures 18 January 2010 5:11 UTC www.healthguidance.org [Source type: FILTERED WITH BAYES]

^ There's no known cure for ulcerative colitis, but therapies are available that may dramatically reduce the signs and symptoms of ulcerative colitis and even bring about a long-term remission.
  • OhioHealth - Ulcerative colitis 18 January 2010 5:11 UTC www.ohiohealth.com [Source type: General]

This includes chromosomes 16, 12, 6, 14, 5, 19, 1, 16, and 3 in the order of their discovery.[4] .However, none of these loci has been consistently shown to be at fault, suggesting that the disorder arises from the combination of multiple genes.^ However, a 2005 study suggested that these routine endoscopies may not be necessary.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ In either case, multiple genetic factors are likely to be responsible for susceptibility to these disorders.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

.For example, chromosome band 1p36 is one such region thought to be linked to inflammatory bowel disease.^ Inflammatory bowel disease .

^ What are the types of inflammatory bowel disease?
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

^ Dysplasia in inflammatory bowel disease .

[5] .Some of the putative regions encode transporter proteins such as OCTN1 and OCTN2. Other potential regions involve cell scaffolding proteins such as the MAGUK family.^ An increased number of white blood cells or elevated levels of inflammatory markers such as C-reactive protein may indicate the presence of inflammation.

.There are even HLA associations which may be at work.^ Even though there is little scientific proof that it works, many people with ulcerative colitis consider nontraditional or complementary medicine in addition to prescription medicines.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

In fact, this linkage on chromosome 6 may be the most convincing and consistent of the genetic candidates.[4]
.Multiple autoimmune disorders have been recorded with the neurovisceral and cutaneous genetic porphyrias including ulcerative colitis, Crohn's disease, celiac disease, dermatitis herpetiformis, diabetes, systemic and discoid lupus, rheumatoid arthritis, ankylosing spondylitis, scleroderma, Sjogren's disease and scleritis.^ Ectopic colonic mucosa in ulcerative colitis and in Crohn's disease of the colon .

^ (Antibiotics, which are used to treat Crohn's disease, are also not helpful for ulcerative colitis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

^ Is ulcerative colitis a hereditary disease?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

.Physicians should be on high alert for porphyrias in families with autoimmune disorders and care must be taken with potential porphyrinogenic drugs, including sulfasalazine.^ Ulcerative colitis being a pitta predominant disease, therefore, care should be taken to calm the pitta by diet and lifestyle modification.
  • Colitis Treatment medicine and Diet | Cure symptoms of Ulcerative, Ulcerosa, Collagenous, pseudomembranous, ischemic, microscopic, lymphocytic, crohns types of Colitis 18 January 2010 5:11 UTC www.biogetica.com [Source type: FILTERED WITH BAYES]

^ Because some vitamins, such as A and D, can be toxic high doses, patients should discuss specific dosages with their physicians.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ Once toxic megacolon is diagnosed, the patient must be immediately admitted to an intensive care unit where he or she can be monitored by intensivists and a team of physicians and surgeons.
  • Ulcerative Colitis II, El Salvador Atlas of Gastrointestinal Video Endoscopy 18 January 2010 5:11 UTC www.gastrointestinalatlas.com [Source type: FILTERED WITH BAYES]

Environmental factors

.Many hypotheses have been raised for environmental contributants to the pathogenesis of ulcerative colitis.^ Cause of ulcerative colitis and contributing factors?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ Many people who have ulcerative colitis are so familiar with the course of their condition that they can handle minor flare-ups on their own.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

^ TLR4,9 encoded by gene polymorphisms is suggested to be responsible for the aetiology and pathogenesis of ulcerative colitis 23 (fig 1).
  • What is the origin of ulcerative colitis? Still more questions than answers -- Lukas et al. 82 (972): 620 -- Postgraduate Medical Journal 18 January 2010 5:11 UTC pmj.bmj.com [Source type: Academic]

They include the following:
.
  • Diet: as the colon is exposed to many dietary substances which may encourage inflammation, dietary factors have been hypothesized to play a role in the pathogenesis of both ulcerative colitis and Crohn's disease.^ Ulcerative colitis and Crohn's disease are inflammatory bowel diseases.

    ^ Ulcerative colitis is a disease that causes inflammation and sores (ulcers) in the lining of the large intestine, or colon.
    • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

    ^ (Antibiotics, which are used to treat Crohn's disease, are also not helpful for ulcerative colitis.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
    • Ulcerative colitis 18 January 2010 5:11 UTC nortonhealthcare.adam.com [Source type: Academic]

    .There have been few studies to investigate such an association, but one study showed no association of refined sugar on the prevalence of ulcerative colitis.^ There is a cure for ulcerative colitis.
    • CIGNA - Ulcerative colitis: Should I have surgery? 18 January 2010 5:11 UTC www.cigna.com [Source type: General]

    ^ Is there a cure for ulcerative colitis?
    • CIGNA - Ulcerative colitis: Should I have surgery? 18 January 2010 5:11 UTC www.cigna.com [Source type: General]

    ^ Some studies have also reported that appendectomy (removal of the appendix) protects against ulcerative colitis.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

    [6]
  • .
  • Diet: A diet low in fermentable dietary fiber may affect ulcerative colitis incidence.
  • Breastfeeding: There have been conflicting reports of the protection of breastfeeding in the development of inflammatory bowel disease.^ Inflammatory bowel disease .

    ^ Ulcerative colitis is a condition that can affect anyone.
    • Ulcerative Colitis Alternative Cures 18 January 2010 5:11 UTC www.healthguidance.org [Source type: FILTERED WITH BAYES]

    ^ Ulcerative colitis and Crohn's disease are inflammatory bowel diseases.

    .One Italian study showed a potential protective effect.^ One small 2000 study showed no benefit with standard (unfractionated) heparin, however, and it caused significant bleeding complications.
    • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

    ^ Mercaptopurine (Purinethol) is one of the drugs used for maintenance therapy, and a 2000 study suggested that it may have fewer adverse effects than its parent drug, azathioprine.
    • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

    ^ In one early study, it achieved remission rates of over 70% in patients with UC and caused few side effects.
    • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

    [7]
  • .
  • Several scientific studies have posted that Accutane is a possible trigger of Crohn's Disease and Ulcerative colitis in some individuals.^ Ectopic colonic mucosa in ulcerative colitis and in Crohn's disease of the colon .

    ^ Ulcerative colitis and Crohn's disease are inflammatory bowel diseases.

    ^ (Antibiotics, which are used to treat Crohn's disease, are also not helpful for ulcerative colitis.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
    • Ulcerative colitis 18 January 2010 5:11 UTC nortonhealthcare.adam.com [Source type: Academic]

    Three cases in the United States have gone to trial thus far, with all three resulting in multi-million dollar judgements against the makers of isotretinoin. There are an additional 425 cases pending.[8][9][10][11][12]

Autoimmune disease

.Some sources list ulcerative colitis as an autoimmune disease,[13] a disease in which the immune system malfunctions, attacking some part of the body.^ Some aspects of the epidemiology of ulcerative colitis .

^ People with ulcerative colitis have abnormalities of the immune system.
  • Colitis Treatment medicine and Diet | Cure symptoms of Ulcerative, Ulcerosa, Collagenous, pseudomembranous, ischemic, microscopic, lymphocytic, crohns types of Colitis 18 January 2010 5:11 UTC www.biogetica.com [Source type: FILTERED WITH BAYES]

^ Some studies have also reported that appendectomy (removal of the appendix) protects against ulcerative colitis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

.In contrast to Crohn's disease, which can affect areas of the gastrointestinal tract outside of the colon, ulcerative colitis usually involves the rectum and is confined to the colon, with occasional involvement of the ileum.^ Ectopic colonic mucosa in ulcerative colitis and in Crohn's disease of the colon .

^ Ulcerative colitis and Crohn's disease are inflammatory bowel diseases.

^ It usually affects the lower section (sigmoid colon) and the rectum.
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

.This so-called "backwash ileitis" can occur in 10–20% of patients with pancolitis and is believed to be of little clinical significance.^ The British Society of Gastroenterology recommends initial colonoscopy eight to 10 years after disease onset for patients with pancolitis and 15 to 20 years after the onset of left-sided disease, with follow-up colonoscopies every three years in the second decade of the disease.
  • Ulcerative Colitis: Diagnosis and Treatment - November 1, 2007 - American Family Physician 18 January 2010 5:11 UTC www.aafp.org [Source type: Academic]

^ As many as 10% of patients with IBD have findings and symptoms that match the criteria for both disorders, at least in the early stages (which is called indeterminate colitis).
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Mural thickening of the terminal ileum may be visualized in 10-25% of patients; such thickening is caused by backwash ileitis, which occurs as a result of the reflux of colonic contents into the distal ileum.
  • Ulcerative Colitis II, El Salvador Atlas of Gastrointestinal Video Endoscopy 18 January 2010 5:11 UTC www.gastrointestinalatlas.com [Source type: FILTERED WITH BAYES]

[14] .Ulcerative colitis can also be associated with comorbidities that produce symptoms in many areas of the body outside the digestive system.^ Ulcerative Colitis symptom?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ The inflammation is what causes the symptoms of ulcerative colitis.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

^ What are the symptoms of ulcerative colitis?
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

.Surgical removal of the large intestine often cures the disease.^ Removal of the large intestine (colon) cures ulcerative colitis.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

^ Disease in the left side of the large intestine.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ It removes the large intestine and the rectum.
  • CIGNA - Ulcerative colitis: Should I have surgery? 18 January 2010 5:11 UTC www.cigna.com [Source type: General]

[15]

Alternative theories

.Levels of sulfate-reducing bacteria tend to be higher in persons with ulcerative colitis.^ This form of ulcerative colitis tends to be the mildest.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.cnn.com [Source type: General]

^ An understanding of the role of indigenous bacteria in promoting the development of healthy mucosal barrier function brings new light to the fundamental causes of ulcerative colitis.
  • What is the origin of ulcerative colitis? Still more questions than answers -- Lukas et al. 82 (972): 620 -- Postgraduate Medical Journal 18 January 2010 5:11 UTC pmj.bmj.com [Source type: Academic]

^ Malnutrition may occur in ulcerative colitis, although it tends to be less severe than with Crohn’s disease.

This could mean that there are higher levels of hydrogen sulfide in the intestine. .An alternative theory suggests that the symptoms of the disease may be caused by toxic effects of the hydrogen sulfide on the cells lining the intestine.^ Prescription medicines may be used to treat mild symptoms and keep the disease in remission.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

^ Constipation in Crohn's disease is usually a symptom of obstruction in the small intestine.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Consequently, the loss of a tolerance to bacterial antigens may cause chronic intestinal inflammation later on.
  • What is the origin of ulcerative colitis? Still more questions than answers -- Lukas et al. 82 (972): 620 -- Postgraduate Medical Journal 18 January 2010 5:11 UTC pmj.bmj.com [Source type: Academic]

[16][17] .It may be caused by occlusions in the capillaries of the subepithelial linings, degenerated fibers beneath the mucosa and infiltration of the lamina propria with plasma cells.^ Heavy infiltration of inflammatory cells in the lamina propria.
  • Ulcerative Colitis II, El Salvador Atlas of Gastrointestinal Video Endoscopy 18 January 2010 5:11 UTC www.gastrointestinalatlas.com [Source type: FILTERED WITH BAYES]

^ Histologic findings in early stages of ulcerative colitis are characterized by mucosal infiltration by acute inflammatory cells, including neutrophils, lymphocytes, plasma cells, and macrophages.
  • Ulcerative Colitis II, El Salvador Atlas of Gastrointestinal Video Endoscopy 18 January 2010 5:11 UTC www.gastrointestinalatlas.com [Source type: FILTERED WITH BAYES]

^ Multinucleated stromal giant cells of the colonic lamina propria in ulcerative colitis .

Epidemiology

.The incidence of ulcerative colitis in North America is 10–12 cases per 100,000 per year, with a peak incidence of ulcerative colitis occurring between the ages of 15 and 25. There is thought to be a bimodal distribution in age of onset, with a second peak in incidence occurring in the 6th decade of life.^ I had severe ulcerative colitis for 18 years.
  • Earth Clinic's best remedies to Cure Ulcerative Colitis or Crohn's Disease. 18 January 2010 5:11 UTC www.earthclinic.com [Source type: General]

^ Ulcerative colitis can occur at any age, but ulcerative colitis often affects people in their 30s.
  • OhioHealth - Ulcerative colitis 18 January 2010 5:11 UTC www.ohiohealth.com [Source type: General]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.cnn.com [Source type: General]

^ There is a cure for ulcerative colitis.
  • CIGNA - Ulcerative colitis: Should I have surgery? 18 January 2010 5:11 UTC www.cigna.com [Source type: General]

.The disease affects females more than males.^ Extensive colitis tends to cause more severe symptoms than proctitis, but some people have a large amount of the colon affected without having severe symptoms.
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

^ Children born to mothers with this disease are more than twice as likely to be below normal weight and to have birth defects.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

^ One study reported that patients with ulcerative colitis were more likely to have a history of depression or anxiety than those without inflammatory bowel disease.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

[18]
.The geographic distribution of ulcerative colitis and Crohn's disease is similar worldwide,[19] with highest incidences in the United States, Canada, the United Kingdom, and Scandinavia.^ Ectopic colonic mucosa in ulcerative colitis and in Crohn's disease of the colon .

^ Ulcerative colitis and Crohn's disease are inflammatory bowel diseases.

^ (Antibiotics, which are used to treat Crohn's disease, are also not helpful for ulcerative colitis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC nortonhealthcare.adam.com [Source type: Academic]

.Higher incidences are seen in northern locations compared to southern locations in Europe [20] and the United States.^ At present, the incidence of ulcerative colitis seems to be increasing in central and eastern Europe, whereas it has been stable over the past 20 years in western Europe and the Scandinavian region.
  • What is the origin of ulcerative colitis? Still more questions than answers -- Lukas et al. 82 (972): 620 -- Postgraduate Medical Journal 18 January 2010 5:11 UTC pmj.bmj.com [Source type: Academic]

[21]
.As with Crohn's disease, the prevalence of ulcerative colitis is greater among Ashkenazi Jews and decreases progressively in other persons of Jewish descent, non-Jewish Caucasians, Africans, Hispanics, and Asians.^ Differences between ulcerative colitis and Crohn's disease .

^ Ulcerative colitis and Crohn's disease are inflammatory bowel diseases.

^ (Antibiotics, which are used to treat Crohn's disease, are also not helpful for ulcerative colitis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC nortonhealthcare.adam.com [Source type: Academic]

[14]

Clinical presentation

GI symptoms

.The clinical presentation[18] of ulcerative colitis depends on the extent of the disease process.^ I'm 18 years old and I have Ulcerative Colitis .
  • Ulcerative Colitis | LIVESTRONG.COM 18 January 2010 5:11 UTC www.livestrong.com [Source type: General]

^ Is ulcerative colitis a hereditary disease?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ I had severe ulcerative colitis for 18 years.
  • Earth Clinic's best remedies to Cure Ulcerative Colitis or Crohn's Disease. 18 January 2010 5:11 UTC www.earthclinic.com [Source type: General]

.Patients usually present with diarrhea mixed with blood and mucus, of gradual onset.^ Ulcerative colitis usually causes bloody diarrhea or mucus in stools.
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

^ DIAGNOSIS — The diagnosis of toxic megacolon should be considered in all patients presenting with abdominal distension and acute or chronic diarrhea.
  • Ulcerative Colitis II, El Salvador Atlas of Gastrointestinal Video Endoscopy 18 January 2010 5:11 UTC www.gastrointestinalatlas.com [Source type: FILTERED WITH BAYES]

^ In this setting patients are more likely to present with diarrhea as a result of the diminished absorptive capacity of the colon, accompanied by rectal bleeding, urgency and tenesmus.
  • Ulcerative Colitis II, El Salvador Atlas of Gastrointestinal Video Endoscopy 18 January 2010 5:11 UTC www.gastrointestinalatlas.com [Source type: FILTERED WITH BAYES]

.They also may have signs of weight loss, and blood on rectal examination.^ Cramping abdominal pain may be diffuse or localized, and patients are more likely to have weight loss, systemic or extraintestinal symptoms, and anemia.
  • Ulcerative Colitis II, El Salvador Atlas of Gastrointestinal Video Endoscopy 18 January 2010 5:11 UTC www.gastrointestinalatlas.com [Source type: FILTERED WITH BAYES]

^ Patients with ulcerative colitis may experience reduced appetite and weight loss.

^ Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.cnn.com [Source type: General]

.The disease is usually accompanied with different degrees of abdominal pain, from mild discomfort to severely painful cramps.^ Abdominal pain, often described as cramping.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

^ Sometimes, the diarrhea is accompanied by abdominal cramps.
  • Ulcerative Colitis | LIVESTRONG.COM 18 January 2010 5:11 UTC www.livestrong.com [Source type: General]

^ Cramping abdominal pain may be diffuse or localized, and patients are more likely to have weight loss, systemic or extraintestinal symptoms, and anemia.
  • Ulcerative Colitis II, El Salvador Atlas of Gastrointestinal Video Endoscopy 18 January 2010 5:11 UTC www.gastrointestinalatlas.com [Source type: FILTERED WITH BAYES]

.Ulcerative colitis is associated with a general inflammatory process that affects many parts of the body.^ Ulcerative colitis affects the colon and the rectum.
  • CIGNA - Ulcerative colitis: Should I have surgery? 18 January 2010 5:11 UTC www.cigna.com [Source type: General]

^ Ulcerative colitis affects everyone differently.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

^ Diffuse duodenitis associated with ulcerative colitis .

.Sometimes these associated extra-intestinal symptoms are the initial signs of the disease, such as painful, arthritic knees in a teenager.^ Constipation in Crohn's disease is usually a symptom of obstruction in the small intestine.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss.
  • OhioHealth - Ulcerative colitis 18 January 2010 5:11 UTC www.ohiohealth.com [Source type: General]

^ Kidney stones are painful and common complications in people with inflammatory bowel disease (IBD), particularly in people who have had intestinal surgery.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

.The presence of the disease cannot be confirmed, however, until the onset of intestinal manifestations.^ Mural thickening is a common manifestation of inflammatory bowel disease; in general, however, ulcerative colitis produces less wall thickening than does Crohn disease.
  • Ulcerative Colitis II, El Salvador Atlas of Gastrointestinal Video Endoscopy 18 January 2010 5:11 UTC www.gastrointestinalatlas.com [Source type: FILTERED WITH BAYES]

Extent of involvement

Diagram of the Human Intestine
.Ulcerative colitis is normally continuous from the rectum up the colon.^ Surveillance for colonic carcinoma in ulcerative colitis .

^ Ulcerative colitis affects only the colon and rectum.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

^ Ulcerative colitis affects the colon and the rectum.
  • CIGNA - Ulcerative colitis: Should I have surgery? 18 January 2010 5:11 UTC www.cigna.com [Source type: General]

The disease is classified by the extent of involvement, depending on how far up the colon the disease extends:
  • Distal colitis, potentially treatable with enemas:[15]
    • Proctitis: Involvement limited to the rectum.
    • Proctosigmoiditis: Involvement of the rectosigmoid colon, the portion of the colon adjacent to the rectum.
    • Left-sided colitis: Involvement of the descending colon, which runs along the patient's left side, up to the splenic flexure and the beginning of the transverse colon.
  • Extensive colitis, inflammation extending beyond the reach of enemas:
    • Pancolitis: Involvement of the entire colon, extending from the rectum to the cecum, beyond which the small intestine begins.

Severity of disease

.
Colonic pseudopolyps of a patient with intractable ulcerative colitis.
^ Ulcerative colitis is characterized by diffuse, superficial inflammation of the colonic mucosa that begins in the rectum and extends proximally to involve any contiguous length of colon.
  • Ulcerative Colitis II, El Salvador Atlas of Gastrointestinal Video Endoscopy 18 January 2010 5:11 UTC www.gastrointestinalatlas.com [Source type: FILTERED WITH BAYES]

^ Mesalamine is used to treat ulcerative colitis (a condition in which part or all of the lining of the colon [large in...
  • Ulcerative Colitis | LIVESTRONG.COM 18 January 2010 5:11 UTC www.livestrong.com [Source type: General]

^ Some people with severe ulcerative colitis need urgent surgery to remove their colon.
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

Colectomy specimen.
.In addition to the extent of involvement, UC patients may also be characterized by the severity of their disease.^ Moreover, at least 11% of patients with ulcerative colitis have extraintestinal manifestations that include joint involvement (enteropathic arthritis), hepatobiliary disease (primary sclerosing cholangitis), and several types of eye and skin lesions.
  • What is the origin of ulcerative colitis? Still more questions than answers -- Lukas et al. 82 (972): 620 -- Postgraduate Medical Journal 18 January 2010 5:11 UTC pmj.bmj.com [Source type: Academic]

^ The extent and the location of the disease varies and may involve only the rectum (ulcerative proctitis), or the entire colon (pancolitis).
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ Patients with ulcerative colitis may be at higher risk for Hodgkin's disease, according to a 2000 study.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

[15]
.
  • Mild disease correlates with fewer than four stools daily, with or without blood, no systemic signs of toxicity, and a normal erythrocyte sedimentation rate (ESR).^ Twelve-month remission rates of up to 64% have been reported in ulcerative colitis patients with mild to moderate disease.
    • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

    ^ Children born to mothers with this disease are more than twice as likely to be below normal weight and to have birth defects.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
    • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

    ^ In rare cases, severe disease causes the colon to swell to many times its normal size ( toxic megacolon ).
    • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
    • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

    .There may be mild abdominal pain or cramping.^ There is no cramping or pain involved.
    • WebMD News Watch: GI Docs Talk Science, Find Time for Stress Relief 18 January 2010 5:11 UTC blogs.webmd.com [Source type: General]

    ^ Abdominal pain, often described as cramping.
    • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
    • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
    • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

    ^ There may be some abdominal pain and tenderness.
    • Ulcerative Colitis -- eCureMe.com 18 January 2010 5:11 UTC www.ecureme.com [Source type: FILTERED WITH BAYES]

    .Patients may believe they are constipated when in fact they are experiencing tenesmus, which is a constant feeling of the need to empty the bowel accompanied by involuntary straining efforts, pain, and cramping with little or no fecal output.^ You also may have rectal pain and an urgent need to empty your bowels.
    • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]

    ^ In fact, you may feel better than before surgery because you may no longer have painful symptoms.
    • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]

    ^ The pouch is able to collect waste material, and the patient can pass bowel movements normally through the anus, although they may be watery and more frequent.
    • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

    .Rectal pain is uncommon.
  • Moderate disease correlates with more than four stools daily, but with minimal signs of toxicity.^ There is a slightly higher than average risk for mouth sores and infections in people with ulcerative colitis , but they are uncommon and lower than those with Crohn's disease.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
    • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

    ^ There is a slightly higher than average risk for mouth sores and infections in UC, but they are uncommon and lower than those with Crohn's disease.
    • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

    ^ Diarrhea Rectal bleeding and bloody stool Difficulty or pain when passing stool Abdominal cramps Other Symptoms .

    .Patients may display anemia (not requiring transfusions), moderate abdominal pain, and low grade fever, 38 to 39 °C (100 to 102 °F).
  • Severe disease, correlates with more than six bloody stools a day, and evidence of toxicity as demonstrated by fever, tachycardia, anemia or an elevated ESR.
  • Fulminant disease correlates with more than ten bowel movements daily, continuous bleeding, toxicity, abdominal tenderness and distension, blood transfusion requirement and colonic dilation (expansion).^ Abdominal tenderness, tachycardia, anemia, leukocytosis, and hypoalbuminemia are common.
    • Ulcerative Colitis II, El Salvador Atlas of Gastrointestinal Video Endoscopy 18 January 2010 5:11 UTC www.gastrointestinalatlas.com [Source type: FILTERED WITH BAYES]

    ^ Clinically, the patient with toxic megacolon presents as severely ill with a fever, tachycardia, dehydration, abdominal pain and distention).
    • Ulcerative Colitis II, El Salvador Atlas of Gastrointestinal Video Endoscopy 18 January 2010 5:11 UTC www.gastrointestinalatlas.com [Source type: FILTERED WITH BAYES]

    ^ He is having bloody stools and very painful abdominal cramps.
    • Earth Clinic's best remedies to Cure Ulcerative Colitis or Crohn's Disease. 18 January 2010 5:11 UTC www.earthclinic.com [Source type: General]

    .Patients in this category may have inflammation extending beyond just the mucosal layer, causing impaired colonic motility and leading to toxic megacolon.^ Toxic megacolon is characterized by extreme inflammation and distention of the colon.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
    • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
    • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

    ^ Untreated toxic megacolon can cause the colon to leak or rupture, which can be fatal.
    • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
    • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

    ^ Could lead to toxic megacolon.

    .If the serous membrane is involved, colonic perforation may ensue.^ The extent and the location of the disease varies and may involve only the rectum (ulcerative proctitis), or the entire colon (pancolitis).
    • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

    ^ Surgeries may also be required because of hemorrhage, chronic illness, perforation of the colon, or to prevent colon cancer.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
    • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]
    • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

    ^ If sigmoidoscopy indicates ulcerative colitis, the doctor may order a colonoscopy to confirm the diagnosis and to identify how much of the colon is involved.

    Unless treated, fulminant disease will soon lead to death.

Extraintestinal features

Patients with ulcerative colitis can occasionally have aphthous ulcers involving the tongue, lips, palate and pharynx
Pyoderma gangrenosum on the leg of a patient with Crohn's disease.
.As ulcerative colitis is believed to have a systemic (i.e., autoimmune) origin, patients may present with comorbidities leading to symptoms and complications outside the colon.^ Ulcerative Colitis symptom?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ Surveillance for colonic carcinoma in ulcerative colitis .

^ Ulcerative colitis is considered serious if the following symptoms are present: .
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

These include the following:

Similar conditions

.
Endoscopic image of ulcerative colitis affecting the left side of the colon.
^ Ulcerative colitis affects only the colon and rectum.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

^ Ulcerative colitis affects the colon and the rectum.
  • CIGNA - Ulcerative colitis: Should I have surgery? 18 January 2010 5:11 UTC www.cigna.com [Source type: General]

^ Left-sided colitis.
  • OhioHealth - Ulcerative colitis 18 January 2010 5:11 UTC www.ohiohealth.com [Source type: General]

.The image shows confluent superficial ulceration and loss of mucosal architecture.^ The image shows confluent superficial ulceration, and loss of mucosal architecture.
  • Ulcerative Colitis II, El Salvador Atlas of Gastrointestinal Video Endoscopy 18 January 2010 5:11 UTC www.gastrointestinalatlas.com [Source type: FILTERED WITH BAYES]

^ Endoscopic images show multiple ulcerations in the rectal area, with the first ulcer immediate to the pectinate line, with a more severe pattern of ulceration above the rectosigmoid juction.
  • Ulcerative Colitis II, El Salvador Atlas of Gastrointestinal Video Endoscopy 18 January 2010 5:11 UTC www.gastrointestinalatlas.com [Source type: FILTERED WITH BAYES]

^ Chronic form, showing mucosal ulceration with residual foci of elevated and hyperemic mucosa.

Crohn's disease may be similar in appearance, a fact that can make diagnosing UC a challenge.
The following conditions may present in a similar manner as ulcerative colitis, and should be excluded:

Comparison to Crohn's disease

.The most common disease that mimics the symptoms of ulcerative colitis is Crohn's disease, as both are inflammatory bowel diseases that can affect the colon with similar symptoms.^ Inflammatory bowel disease .

^ Giant and symptomatic inflammatory polyps of the colon in idiopathic inflammatory bowel disease .

^ Ectopic colonic mucosa in ulcerative colitis and in Crohn's disease of the colon .

.It is important to differentiate these diseases, since the course of the diseases and treatments may be different.^ It is important to differentiate between them, since they require different treatments.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ The two disorders, however, also have different symptoms and is it important to differentiate between them, since the require different treatments.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ Sexual function may be impaired, not only because of the emotional impact, but also by treatment side effects and complications of the diseases, such as fistulas.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

.In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis.^ In some cases, surgery may be needed.
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

^ In some cases, you may be able to consult with your doctor on the phone for minor problems.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]

^ During the 1990s, some insights into the cell-to-cell mediators (cytokines) were obtained with the conception of the “Th1 and Th2 paradigm” in Crohn’s disease (Th1) and ulcerative colitis (Th2).
  • What is the origin of ulcerative colitis? Still more questions than answers -- Lukas et al. 82 (972): 620 -- Postgraduate Medical Journal 18 January 2010 5:11 UTC pmj.bmj.com [Source type: Academic]

Comparisons of various factors in Crohn's disease and ulcerative colitis
Crohn's Disease Ulcerative Colitis
Involves terminal ileum? Commonly Seldom
Involves colon? Usually Always
Involves rectum? Seldom Usually
Peri-anal involvement? Commonly Seldom
Bile duct involvement? Not associated Higher rate of Primary sclerosing cholangitis[22]
Distribution of Disease Patchy areas of inflammation Continuous area of inflammation
Endoscopy Linear and serpiginous (snake-like) ulcers Continuous ulcer
Depth of inflammation May be transmural, deep into tissues Shallow, mucosal
Fistulae, abnormal passageways between organs Commonly Seldom
Biopsy May have non-necrotizing non-peri-intestinal crypt granulomas[23][24] Crypt abscesses and cryptitis
Surgical cure? Often returns following removal of affected part Usually cured by removal of colon, can be followed by pouchitis
Smoking Higher risk for smokers Lower risk for smokers
Autoimmune disease? Generally regarded as an autoimmune disease No consensus
Cancer risk? Lower than ulcerative colitis Higher than Crohn's

Diagnosis and workup

General

H&E stain of a colonic biopsy showing a crypt abscess, a classic finding in ulcerative colitis
The initial diagnostic workup for ulcerative colitis includes the following:[1][15]
.Although ulcerative colitis is a disease of unknown causation, inquiry should be made as to unusual factors believed to trigger the disease.^ Ulcerative colitis: Should I have surgery?
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]

^ Is ulcerative colitis a hereditary disease?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ The exact causes of ulcerative colitis are unknown.

[15] .Factors may include: recent cessation of tobacco smoking; recent administration of large doses of iron or vitamin B6; hydrogen peroxide in enemas or other procedures.^ Other symptoms may include: .

^ Other severe side effects of infliximab may include psoriasis, heart failure, liver failure, aplastic anemia, nervous system disorders, and allergic reactions.

^ Recently discovered technologies have clarified the role of bacterial species, which may account for intestinal dysbiosis, as a factor triggering ulcerative colitis.
  • What is the origin of ulcerative colitis? Still more questions than answers -- Lukas et al. 82 (972): 620 -- Postgraduate Medical Journal 18 January 2010 5:11 UTC pmj.bmj.com [Source type: Academic]

Endoscopic

Biopsy sample (H&E stain) that demonstrates marked lymphocytic infiltration (blue/purple) of the intestinal mucosa and architectural distortion of the crypts.
.The best test for diagnosis of ulcerative colitis remains endoscopy.^ What tests are used to diagnose ulcerative colitis?
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

^ About 5 - 8% of patients with ulcerative colitis will develop colorectal cancer within 20 years of their ulcerative colitis diagnosis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC nortonhealthcare.adam.com [Source type: Academic]

^ Immunohistochemical assessment of Ki67 and p53 expression assists the diagnosis and grading of ulcerative colitis-related dysplasia .

Full colonoscopy to the cecum and entry into the terminal ileum is attempted only if diagnosis of UC is unclear. Otherwise, a flexible sigmoidoscopy is sufficient to support the diagnosis. .The physician may elect to limit the extent of the exam if severe colitis is encountered to minimize the risk of perforation of the colon.^ The extent and the location of the disease varies and may involve only the rectum (ulcerative proctitis), or the entire colon (pancolitis).
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ Some people with severe ulcerative colitis need urgent surgery to remove their colon.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

^ Extensive colitis tends to cause more severe symptoms than proctitis, but some people have a large amount of the colon affected without having severe symptoms.
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

Endoscopic findings in ulcerative colitis include the following:
.Ulcerative colitis is usually continuous from the rectum, with the rectum almost universally being involved.^ Ulcerative colitis almost always involves the lower left colon and rectum.

^ The extent and the location of the disease varies and may involve only the rectum (ulcerative proctitis), or the entire colon (pancolitis).
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ Removal of the colon to cure ulcerative colitis involves one of these surgeries: .
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

.There is rarely peri-anal disease, but cases have been reported.^ Neuroendocrine neoplasms arising in inflammatory bowel disease: a report of 14 cases .

^ In rare cases, severe disease causes the colon to swell to many times its normal size ( toxic megacolon ).
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]

^ Although stress is not a cause of inflammatory bowel disease, there are reports of an association between stress and symptom flare-ups.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

.The degree of involvement endoscopically ranges from proctitis or inflammation of the rectum, to left sided colitis, to pancolitis, which is inflammation involving the ascending colon.^ Ulcerative colitis almost always involves the lower left colon and rectum.

^ Disease in the left side of the colon.

^ Ulcerative colitis also may be defined by the part of the large intestine affected: the rectum (proctitis), the left side of the colon (left-sided colitis), or the entire colon (pancolitis).
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

Histologic

.Biopsies of the mucosa are taken to definitively diagnose UC and differentiate it from Crohn's disease, which is managed differently clinically.^ Children with UC are at slightly higher than average risk for delayed growth, but their risk is lower than the risk is for people with Crohn's disease.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ There is a slightly higher than average risk for mouth sores and infections in UC, but they are uncommon and lower than those with Crohn's disease.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Ectopic colonic mucosa in ulcerative colitis and in Crohn's disease of the colon .

Microbiological samples are typically taken at the time of endoscopy. .The pathology in ulcerative colitis typically involves distortion of crypt architecture, inflammation of crypts (cryptitis), frank crypt abscesses, and hemorrhage or inflammatory cells in the lamina propria.^ The inflammation is what causes the symptoms of ulcerative colitis.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

^ Inflammatory bowel disease - ulcerative colitis .
  • Ulcerative Colitis | LIVESTRONG.COM 18 January 2010 5:11 UTC www.livestrong.com [Source type: General]

^ Removal of the colon to cure ulcerative colitis involves one of these surgeries: .
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

.In cases where the clinical picture is unclear, the histomorphologic analysis often plays a pivotal role in determining the diagnosis and thus the management.^ Alicaforsen is an antisense drug that inhibits an intercellular adhesion molecule (ICAM-1) thought to play a pivotal role in the inflammatory process.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

.By contrast, a biopsy analysis may be indeterminate, and thus the clinical progression of the disease must inform its treatment.^ If you don't have any symptoms of ulcerative colitis or if your disease is not active (in remission ), you may not need treatment.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]

^ It is used for patients with rheumatoid arthritis and may be helpful for patients with UC. Recent clinical trials have reported promising results for treatment of refractory UC. .
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ If your symptoms are caused by ulcerative colitis, delaying the diagnosis and treatment may make the disease worse and increase your risk of complications.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]

Course and complications

Progression or remission

.Patients with ulcerative colitis usually have an intermittent course, with periods of disease inactivity alternating with "flares" of disease.^ Is ulcerative colitis a hereditary disease?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ Patients with ulcerative colitis usually improve on IV iron alone.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ The course of ulcerative colitis is unpredictable.

.Patients with proctitis or left-sided colitis usually have a more benign course: only 15% progress proximally with their disease, and up to 20% can have sustained remission in the absence of any therapy.^ Disease in the left side of the large intestine.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ Disease in the left side of the colon.

^ The goal of therapy is to induce and maintain remission, and to improve the quality of life for people with ulcerative colitis.
  • Ulcerative Colitis Symptoms 18 January 2010 5:11 UTC www.iifar.org [Source type: Academic]

.Patients with more extensive disease are less likely to sustain remission, but the rate of remission is independent of the severity of disease.^ Malnutrition may occur in ulcerative colitis, although it tends to be less severe than with Crohn’s disease.

^ Inflammatory bowel disease can increase patients’ susceptibility to Clostridium difficile , a species of intestinal bacteria that causes severe diarrhea.

^ Children born to mothers with this disease are more than twice as likely to be below normal weight and to have birth defects.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

Ulcerative colitis and colorectal cancer

.There is a significantly increased risk of colorectal cancer in patients with ulcerative colitis after 10 years if involvement is beyond the splenic flexure.^ I'm 18 years old and I have Ulcerative Colitis .
  • Ulcerative Colitis | LIVESTRONG.COM 18 January 2010 5:11 UTC www.livestrong.com [Source type: General]

^ About 5 - 8% of patients with ulcerative colitis will develop colorectal cancer within 20 years of their ulcerative colitis diagnosis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC nortonhealthcare.adam.com [Source type: Academic]

^ I had severe ulcerative colitis for 18 years.
  • Earth Clinic's best remedies to Cure Ulcerative Colitis or Crohn's Disease. 18 January 2010 5:11 UTC www.earthclinic.com [Source type: General]

.Those with only proctitis or rectosigmoiditis usually have no increased risk.^ Suppose the drug only helps a very small number of people and there's no way to tell ahead of time who those people are.

^ They inhibit certain rapidly growing immune system cells, including those that produce antibodies, causing an increased risk for infections.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

[15] .It is recommended that patients have screening colonoscopies with random biopsies to look for dysplasia after eight years of disease activity.^ Correlation with disease activity and dysplasia .

^ The American Cancer Society recommends that patients with inflammatory bowel disease at these stages receive colonoscopies (screening tests for colorectal cancer) every 1 - 2 years with biopsies to test for dysplasia (precancerous changes in cells).

^ Doctors also advise that patients with ulcerative colitis receive regular (every 1 – 3 years) colonoscopy exams to help screen for cancer.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

[25]

Primary sclerosing cholangitis

.Ulcerative colitis has a significant association with primary sclerosing cholangitis (PSC), a progressive inflammatory disorder of small and large bile ducts.^ Neoplastic progression in ulcerative colitis.

^ Ulcerative colitis can lead to complications, such as inflammation and scarring of the bile ducts (primary sclerosing cholangitis).
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

^ Cancer of the bile ducts associated with ulcerative colitis .

.As many as 5% of patients with ulcerative colitis may progress to develop primary sclerosing cholangitis.^ It is used for patients with rheumatoid arthritis and may be helpful for patients with ulcerative colitis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

^ The symptoms of ulcerative colitis may include: .
  • Ulcerative Colitis | MeritCare Health System 18 January 2010 5:11 UTC www.meritcare.com [Source type: FILTERED WITH BAYES]

^ Ulcerative colitis may also be called colitis or proctitis.
  • Ulcerative Colitis Symptoms 18 January 2010 5:11 UTC www.iifar.org [Source type: Academic]

[26]

Mortality

.The effect of ulcerative colitis on mortality is unclear, but it is thought that the disease primarily affects quality of life, and not lifespan.^ Is ulcerative colitis a hereditary disease?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ How will ulcerative colitis affect my life?
  • Ulcerative Colitis, SVCMC; New York NY 18 January 2010 5:11 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]

^ Ulcerative colitis is a disease that affects the large intestine.
  • Ulcerative Colitis | LIVESTRONG.COM 18 January 2010 5:11 UTC www.livestrong.com [Source type: General]

Treatment

.Standard treatment for ulcerative colitis depends on extent of involvement and disease severity.^ Treatment for ulcerative colitis depends on the seriousness of the disease.
  • Ulcerative Colitis Symptoms 18 January 2010 5:11 UTC www.iifar.org [Source type: Academic]

^ The symptoms of ulcerative colitis depend in part on how widespread the disease is and the severity of the inflammation.

^ I had severe ulcerative colitis for 18 years.
  • Earth Clinic's best remedies to Cure Ulcerative Colitis or Crohn's Disease. 18 January 2010 5:11 UTC www.earthclinic.com [Source type: General]

.The goal is to induce remission initially with medications, followed by the administration of maintenance medications to prevent a relapse of the disease.^ These drugs are used to prevent relapses and maintain remission in mild-to-moderate ulcerative colitis.

^ Immunosuppressants can prevent relapse, even when used alone, and in some studies have proved to be effective for maintaining remissions in ulcerative colitis that have lasted at least 2 years.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ These drugs are used to prevent relapses and maintain remission in mild-to-moderate Crohn's disease.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

The concept of induction of remission and maintenance of remission is very important. .The medications used to induce and maintain a remission somewhat overlap, but the treatments are different.^ Studies show that nicotine patches help to induce remission and reduce symptoms in almost 40% of patients who use then for 4 weeks.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ The success of therapy is determined by its ability to induce and maintain remissions without causing significant side effects.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Ulcerative colitis Crohn's disease These two diseases are related, but they are considered separate disorders with somewhat different treatment options.

.Physicians first direct treatment to inducing a remission which involves relief of symptoms and mucosal healing of the lining of the colon and then longer term treatment to maintain the remission.^ The patient's condition is generally considered in remission when the intestinal lining has healed and symptoms, such as diarrhea, abdominal cramps, and tenesmus (straining painfully or ineffectively to defecate or urinate), are normal or close to normal.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ If you don't have any symptoms of ulcerative colitis or if your disease is not active (in remission ), you may not need treatment.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]

^ But since I've been having colitis symptoms, I'd like to first give my body a chance to heal from this.
  • Earth Clinic's best remedies to Cure Ulcerative Colitis or Crohn's Disease. 18 January 2010 5:11 UTC www.earthclinic.com [Source type: General]

Drugs used

Aminosalicylates

.Sulfasalazine has been a major agent in the therapy of mild to moderate UC for over 50 years.^ Rowasa relieves mild to moderately active UC and prevents relapse.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ Rowasa relieves mild-to-moderately active UC and prevents relapse.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Often not evident in mild or even moderately severe UC. .
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

In 1977 Mastan S. Kalsi et al. determined that .5-aminosalicylic acid (5-ASA and mesalazine) was the therapeutically active compound in sulfasalazine.^ Aminosalicylates contain the compound 5-aminosalicylic acid, or 5-ASA, which helps reduce inflammation.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

^ Mesalamine is an aminosalicylate (the common name of the compound 5-aminosalicylic acid or 5-ASA).
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Effect of topical 5-aminosalicylic acid (5-ASA) therapy on rectal mucosal biopsy morphology in chronic ulcerative colitis .

.Since then many 5-ASA compounds have been developed with the aim of maintaining efficacy but reducing the common side effects associated with the sulfapyridine moiety in sulfasalazine.^ (Mesalamine side effects are the same as in sulfasalazine.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ The success of therapy is determined by its ability to induce and maintain remissions without causing significant side effects.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Aminosalicylates contain the compound 5-aminosalicylic acid, or 5-ASA, which helps reduce inflammation.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

[27]
  • Mesalazine, also known as 5-aminosalicylic acid, mesalamine, or 5-ASA. Brand name formulations include Apriso, Asacol, Pentasa, Mezavant, Lialda, and Salofalk.
  • Sulfasalazine, also known as Azulfidine.
  • Balsalazide, also known as Colazal or Colazide (UK).
  • Olsalazine, also known as Dipentum.

Corticosteroids

Immunosuppressive drugs

Biological treatment

.Low Molecular Weight Heparin (LMWH) e.g.^ Experts hope that other forms of heparin, notably low-molecular weight heparin, may prove to be beneficial.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ Some evidence is suggesting that specific forms of heparin, notably low-molecular weight heparin, may prove to be beneficial for patients with IBD. .
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

clexane is used in acute management of the flare of UC.

Surgery

.Unlike Crohn's disease, ulcerative colitis can generally be cured by surgical removal of the large intestine.^ Ectopic colonic mucosa in ulcerative colitis and in Crohn's disease of the colon .

^ Medical and surgical procedures for ulcerative colitis?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ (Antibiotics, which are used to treat Crohn's disease, are also not helpful for ulcerative colitis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

This procedure is necessary in the event of: exsanguinating hemorrhage, frank perforation or documented or strongly suspected carcinoma. .Surgery is also indicated for patients with severe colitis or toxic megacolon.^ It is also more common in ulcerative colitis patients who also have toxic megacolon.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ It is also more common in patients with ulcerative colitis who also have toxic megacolon.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Some people with severe ulcerative colitis need urgent surgery to remove their colon.
  • CIGNA - Ulcerative Colitis 18 January 2010 5:11 UTC www.cigna.com [Source type: FILTERED WITH BAYES]

.Patients with symptoms that are disabling and do not respond to drugs may wish to consider whether surgery would improve the quality of life.^ Studies report that surgery improves the quality of life in most patients.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Drugs cannot cure inflammatory bowel disease, but they can help reduce the inflammation and accompanying symptoms in up to 80% of patients.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Studies indicate that infliximab may reduce ulcerative colitis symptoms and help patients achieve remission.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

.Ulcerative colitis is a disease that affects many parts of the body outside the intestinal tract.^ Is ulcerative colitis a hereditary disease?
  • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

^ Ulcerative colitis is an inflammatory disease of the large intestine.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ Between 10% and 20% of people with ulcerative colitis have family members with the disease.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

.In rare cases the extra-intestinal manifestations of the disease may require removal of the colon.^ Different brands affect different regions in the intestine: Pentasa is an oral sustained-release mesalamine that is released from the stomach through the intestine and so is useful for disease in the both small intestine and colon.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ Intestinal wall ultrasound may be useful for identifying the extent and severity of Crohn's disease.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Enemas, suppositories, and, in limited cases, foam preparations may be used for mild to moderate ulcerative colitis located in the left section of the colon, the rectum, and anus.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

[15]

Alternative treatments

.About 21% of inflammatory bowel disease patients use alternative treatments.^ Dysplasia in inflammatory bowel disease.

^ Inflammatory bowel disease .

^ Precancer and cancer in inflammatory bowel disease .

[28] .A variety of dietary treatments show promise, but they require further research before they can be recommended.^ More scientific research is needed before it can be recommended for...
  • Ulcerative Colitis | LIVESTRONG.COM 18 January 2010 5:11 UTC www.livestrong.com [Source type: General]

^ It is important to differentiate between them, since they require different treatments.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

[29]
.In vitro research, animal evidence, and limited human study suggest that melatonin may be beneficial.^ A 2001 study reported that patients with ulcerative colitis were more likely to have a history of depression or anxiety than those without IBD. Some researchers suggest that depression may alter the immune system and make people more susceptible to ulcerative colitis.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ A 2001 study reported that patients with ulcerative colitis were more likely to have a history of depression or anxiety than those without the IBD. Some researchers suggest that depression may alter the immune system and make people more susceptible to ulcerative colitis.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ One study suggested that the W shape may produce better long-term results than the more standard J shape.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

[30]

Smoking

.Unlike Crohn's disease, ulcerative colitis has a lesser prevalence in smokers than non-smokers.^ BD), which includes Crohn's disease and ulcerative colitis .
  • Ulcerative Colitis | LIVESTRONG.COM 18 January 2010 5:11 UTC www.livestrong.com [Source type: General]

^ Ectopic colonic mucosa in ulcerative colitis and in Crohn's disease of the colon .

^ (Antibiotics, which are used to treat Crohn's disease, are also not helpful for ulcerative colitis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

.Nonetheless, the risks of smoking contraindicate using cigarettes as a treatment for ulcerative colitis.^ Used to have ulcerative colitis .
  • Ulcerative Colitis | LIVESTRONG.COM 18 January 2010 5:11 UTC www.livestrong.com [Source type: General]

^ Mesalamine is used to treat ulcerative colitis (a condition in which part or all of the lining of the colon [large in...
  • Ulcerative Colitis | LIVESTRONG.COM 18 January 2010 5:11 UTC www.livestrong.com [Source type: General]

^ IPAA triples the risk of infertility in women with ulcerative colitis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

.Patients who choose to use smoking as a treatment should give serious consideration to the links between smoking cessation and the onset or relapse of ulcerative colitis.^ It is used for patients with rheumatoid arthritis and may be helpful for patients with ulcerative colitis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

^ It is also more common in ulcerative colitis patients who also have toxic megacolon.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ It is also more common in patients with ulcerative colitis who also have toxic megacolon.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

[31][32]

Dietary modification

Dietary fibre, meaning indigestible plant matter, has been recommended for decades in the maintenance of bowel function. Of peculiar note is fibre from brassica, which seems to contain soluble constituents capable of reversing ulcers along the entire human digestive tract before it is cooked.[33] Oatmeal is also commonly prescribed.

Fats and oils

  • Fish oil. .Eicosapentaenoic acid (EPA), derived from fish oil.^ Omega-3 fatty acids, found plentifully in oily fish, flaxseed, and canola oils, may help people with inflammatory bowel disease.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
    • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

    ^ Omega-3 fatty acids, found plentifully in oily fish, flaxseed, and canola oils, may help people with IBD (inflammatory bowel disease).
    • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

    ^ Such studies are significant because fish oil contain omega-3 fatty acids, which are thought to have anti-inflammatory effects.
    • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

    .This is an Eicosanoid that inhibits leukotriene activity, the latter which may be a key factor of inflammation.^ This compound inhibits factors in the immune system, importantly, the cytokines that cause inflammation.
    • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

    ^ Mesalamine is the common name of the compound 5-aminosalicylic acid or 5-ASA, which inhibits factors in the immune system, importantly, the cytokines that cause inflammation.
    • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

    ^ Researchers suggest that this activity may cause persistent damage once the inflammatory process has triggered IBD. Genetic Factors .
    • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

    .As an IBD therapy, there are no conclusive studies in support and no recommended dosage.^ There has been some concern that the disease itself may promote bone loss, although a 2000 study found no evidence for this.
    • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

    But dosages of EPA between 180 to 1500 mg/day are recommended for other conditions, most commonly cardiac.[34]
  • .
  • Short chain fatty acid (butyrate) enema.^ Treatment of refractory distal ulcerative colitis with short chain fatty acid enemas.
    • Ulcerative Colitis - [Alternative Medicine] 18 January 2010 5:11 UTC www.peacehealth.org [Source type: Academic]
    • Ulcerative Colitis 18 January 2010 5:11 UTC www.gnc.co.uk [Source type: Academic]
    • Ulcerative Colitis | David Lloyd 18 January 2010 5:11 UTC www.davidlloyd.co.uk [Source type: Academic]

    ^ Scheppach W. Treatment of distal ulcerative colitis with short-chain fatty acid enemas.
    • Ulcerative Colitis - [Alternative Medicine] 18 January 2010 5:11 UTC www.peacehealth.org [Source type: Academic]
    • Ulcerative Colitis 18 January 2010 5:11 UTC www.gnc.co.uk [Source type: Academic]
    • Ulcerative Colitis | David Lloyd 18 January 2010 5:11 UTC www.davidlloyd.co.uk [Source type: Academic]

    ^ Fatty acids such as butyrate have shown mixed results.
    • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

    The colon utilizes butyrate from the contents of the intestine as an energy source. The amount of butyrate available decreases toward the rectum. .Inadequate butyrate levels in the lower intestine have been suggested as a contributing factor for the disease.^ In the intestinal tract, this whole grain increases levels of a fatty acid called butyrate, which may help reduce GI symptoms due to ulcerative colitis.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
    • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
    • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

    ^ They may be administered rectally in patients who have mild-to-moderate disease that occurs only in the lower intestine.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
    • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
    • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

    ^ In ulcerative colitis the ileum (the lower part of the small intestine) is often dilated while it is narrowed in Crohn's disease.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
    • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
    • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

    This might be addressed through butyrate enemas. The results however are not conclusive.

Herbals

.
  • Herbal medications are used by patients with ulcerative colitis.^ Medical and surgical procedures for ulcerative colitis?
    • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

    ^ It is used for patients with rheumatoid arthritis and may be helpful for patients with ulcerative colitis.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

    ^ X-rays of the abdomen are also useful when a patient has a severe attack of ulcerative colitis.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
    • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
    • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

    .Compounds that contain sulphydryl may have an effect in ulcerative colitis (under a similar hypothesis that the sulpha moiety of sulfasalazine may have activity in addition to the active 5-ASA component).^ Enemas, suppositories, and, in limited cases, foam preparations may be used for mild to moderate ulcerative colitis located in the left section of the colon, the rectum, and anus.
    • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

    ^ Aminosalicylates contain the compound 5-aminosalicylic acid, or 5-ASA, which helps reduce inflammation.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
    • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

    ^ Studies indicate that infliximab may reduce ulcerative colitis symptoms and help patients achieve remission.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

    [35] .One randomized control trial evaluated the over-the-counter medication methionine-methyl sulphonium chloride (abbreviated MMSC, but more commonly referred to as Vitamin U) and found a significant decreased rate of relapse when the medication was used in conjunction with oral sulfasalazine.^ The company I used to work for is a major seller of generic medications in addition to patented ones, and they provide free samples of both as a marketing tool.

    ^ If the bowel movements decrease, maybe you have just found one irritant to avoid.
    • Active Manuka Honey is used for Acid Reflux, Heartburn, Stomach Ulcers, now available in the USA 18 January 2010 5:11 UTC www.manukahoneyusa.com [Source type: General]

    [36]

Bacterial recolonization

  • Probiotics may have benefit. .One study which looked at a probiotic known as VSL#3 has shown promise for people with ulcerative colitis.^ The goal of therapy is to induce and maintain remission, and to improve the quality of life for people with ulcerative colitis.
    • Ulcerative Colitis Symptoms 18 January 2010 5:11 UTC www.iifar.org [Source type: Academic]

    ^ Some studies have also reported that appendectomy (removal of the appendix) protects against ulcerative colitis.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

    ^ Ulcerative colitis is not caused by emotional distress or sensitivity to certain foods or food products, but these factors may trigger symptoms in some people.
    • Ulcerative Colitis Symptoms 18 January 2010 5:11 UTC www.iifar.org [Source type: Academic]

    [37]
  • Fecal bacteriotherapy involves the infusion of human probiotics through fecal enemas.[38] .It suggests that the cause of ulcerative colitis may be a previous infection by a still unknown pathogen.^ And a 2001 study suggested it may be helpful for ulcerative colitis.
    • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

    ^ A 2001 study reported that patients with ulcerative colitis were more likely to have a history of depression or anxiety than those without IBD. Some researchers suggest that depression may alter the immune system and make people more susceptible to ulcerative colitis.
    • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

    ^ There is a slightly higher than average risk for mouth sores and infections in people with ulcerative colitis , but they are uncommon and lower than those with Crohn's disease.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
    • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

    .This initial infection resolves itself naturally, but somehow causes an imbalance in the colonic bacterial flora, leading to a cycle of inflammation which can be broken by "recolonizing" the colon with bacteria from a healthy bowel.^ Microscopic colitis causes chronic watery diarrhea, but the colon lining shows little or no signs of inflammation.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
    • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
    • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]
    • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

    ^ In addition, a stool sample allows the doctor to detect whether the bleeding or infection in the colon or rectum is caused by bacteria, virus or parasites.
    • Colitis Treatment medicine and Diet | Cure symptoms of Ulcerative, Ulcerosa, Collagenous, pseudomembranous, ischemic, microscopic, lymphocytic, crohns types of Colitis 18 January 2010 5:11 UTC www.biogetica.com [Source type: FILTERED WITH BAYES]

    ^ Patients with ulcerative colitis are particularly susceptible to Clostridium difficile , a nasty bacterial infection that causes severe diarrhea.
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
    • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

    .There have been several reported cases of patients who have remained in remission for up to 13 years.^ Twelve-month remission rates of up to 64% have been reported in ulcerative colitis patients with mild to moderate disease.
    • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

    ^ Infliximab (Remicade) is helpful for promoting remission and healing in patients with moderate-to-severe ulcerative colitis who have not responded to other drugs, according to a 2006 review in the Cochrane Database .
    • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
    • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

    ^ Studies show that nicotine patches help to induce remission and reduce symptoms in almost 40% of patients who use then for 4 weeks.
    • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

    [39]

Intestinal parasites

.Inflammatory bowel disease is less common in the developing world.^ Prevalence and mechanism of nonsteroidal anti-inflammatory drug-induced clinical relapse in patients with inflammatory bowel disease.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ People with inflammatory bowel disease should limit fats.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ The parasite induces production of specific T cells, called TH-2, which are immune factors that may be protective against overactivity of cytokines that trigger inflammatory bowel disease.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

.Some have suggested that this may be because intestinal parasites are more common in underdeveloped countries.^ A 2001 study reported that patients with ulcerative colitis were more likely to have a history of depression or anxiety than those without the IBD. Some researchers suggest that depression may alter the immune system and make people more susceptible to ulcerative colitis.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ One study suggested that the W shape may produce better long-term results than the more standard J shape.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ Genetic factors appear to be more important in Crohn's disease, although there is evidence that both conditions have some genetic defects in common.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

.Some parasites are able to reduce the immune response of the intestine, an adaptation that helps the parasite colonize the intestine.^ Regular colonoscopy exams, and some types of anti-inflammatory drugs, may help reduce cancer risk.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Often, genetic problems in the intestine enable viruses or bacteria to trigger an immune response that causes inflammation and injury in the intestines.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ In the intestinal tract, this whole grain increases levels of a fatty acid called butyrate, which may help reduce GI symptoms due to ulcerative colitis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

.The decrease in immune response could reduce or eliminate the inflammatory bowel disease.^ Inflammatory bowel disease - ulcerative colitis .
  • Ulcerative Colitis | LIVESTRONG.COM 18 January 2010 5:11 UTC www.livestrong.com [Source type: General]

^ Prevalence and mechanism of nonsteroidal anti-inflammatory drug-induced clinical relapse in patients with inflammatory bowel disease.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Behavioral therapy may be helpful in treating IBS. (No psychologic therapy improves inflammatory bowel disease.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

.Helminthic therapy using the whipworm Trichuris suis has been shown in a randomized control trial from Iowa to show benefit in patients with ulcerative colitis.^ It is used for patients with rheumatoid arthritis and may be helpful for patients with ulcerative colitis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

^ Used to have ulcerative colitis .
  • Ulcerative Colitis | LIVESTRONG.COM 18 January 2010 5:11 UTC www.livestrong.com [Source type: General]

^ X-rays of the abdomen are also useful when a patient has a severe attack of ulcerative colitis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

.The therapy tests the hygiene hypothesis which argues that the absence of helminths in the colons of patients in the developed world may lead to inflammation.^ It may affect the entire colon, form a string of contiguous ulcers in one part of the colon, or develop as multiple scattered clusters of ulcers skipping healthy tissue in between.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Some patients who take infliximab may be able to stop taking corticosteroids or avoid surgical removal of the colon.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Infliximab may also help heal ulcers and inflammation of the colon's inner lining (mucosa).
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

.Both helminthic therapy and fecal bacteriotherapy induce a characteristic Th2 white cell response in the diseased areas, which is somewhat paradoxical given that ulcerative colitis immunology was thought to classically involve Th2 overproduction.^ Inflammatory bowel disease - ulcerative colitis .
  • Ulcerative Colitis | LIVESTRONG.COM 18 January 2010 5:11 UTC www.livestrong.com [Source type: General]

^ They are important in the diagnosis of both ulcerative colitis and Crohn's disease.
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

^ Between 10% and 20% of people with ulcerative colitis have family members with the disease.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

[40]

Ongoing research

.Recent evidence from the ACT-1 trial suggests that infliximab may have a greater role in inducing and maintaining disease remission.^ Studies indicate that infliximab may reduce ulcerative colitis symptoms and help patients achieve remission.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

^ Anecdotal evidence suggests that HBOT may be effective for a small number of patients with severe perianal Crohn's disease who do not respond to other therapies.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

^ It is used for patients with rheumatoid arthritis and may be helpful for patients with UC. Recent clinical trials have reported promising results for treatment of refractory UC. .
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

.An increased amount of colonic sulfate-reducing bacteria has been observed in some patients with ulcerative colitis, resulting in higher concentrations of the toxic gas hydrogen sulfide.^ The risk of colon cancer increases in each decade after ulcerative colitis is diagnosed.
  • Ulcerative Colitis | LIVESTRONG.COM 18 January 2010 5:11 UTC www.livestrong.com [Source type: General]

^ Patients with ulcerative colitis have a higher than normal risk for cancers of the colon and rectum.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

^ It is also more common in ulcerative colitis patients who also have toxic megacolon.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

The role of hydrogen sulfide in pathogenesis is unclear. .It has been suggested that the protective benefit of smoking that some patients report is due to hydrogen cyanide from cigarette smoke reacting with hydrogen sulfide to produce the nontoxic isothiocyanate.^ Some studies have also reported that appendectomy (removal of the appendix) protects against ulcerative colitis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

^ A 2001 study reported that patients with ulcerative colitis were more likely to have a history of depression or anxiety than those without IBD. Some researchers suggest that depression may alter the immune system and make people more susceptible to ulcerative colitis.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ A 2001 study reported that patients with ulcerative colitis were more likely to have a history of depression or anxiety than those without the IBD. Some researchers suggest that depression may alter the immune system and make people more susceptible to ulcerative colitis.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

.Another unrelated study suggested sulphur contained in red meats and alcohol may lead to an increased risk of relapse for patients in remission.^ Patients with UC have a higher risk for skin disorders and may experience ulcer eruptions called pyoderma gangrenosum that heal in the center and spread.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ A 2001 study reported that patients with ulcerative colitis were more likely to have a history of depression or anxiety than those without IBD. Some researchers suggest that depression may alter the immune system and make people more susceptible to ulcerative colitis.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Patients with UC have an increased risk of developing other inflammatory and autoimmune conditions such as arthritis, asthma, bronchitis, psoriasis, and multiple sclerosis.
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

[16]
.There is much research currently being done to elucidate further genetic markers in ulcerative colitis.^ There is a slightly higher than average risk for mouth sores and infections in people with ulcerative colitis , but they are uncommon and lower than those with Crohn's disease.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

^ The prodromal period in ulcerative colitis is much shorter (about a year).
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Ulcerative colitis being a pitta predominant disease, therefore, care should be taken to calm the pitta by diet and lifestyle modification.
  • Colitis Treatment medicine and Diet | Cure symptoms of Ulcerative, Ulcerosa, Collagenous, pseudomembranous, ischemic, microscopic, lymphocytic, crohns types of Colitis 18 January 2010 5:11 UTC www.biogetica.com [Source type: FILTERED WITH BAYES]

.Linkage with Human Leukocyte Antigen B-27, associated with other autoimmune diseases, has been proposed.^ People who are left-handed have a significantly higher risk for both inflammatory bowel diseases as well as for certain other diseases associated with immune system abnormalities.
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]

^ People who are left handed have a significantly higher risk for both IBDs as well as for certain other diseases associated with immune abnormalities.
  • Ulcerative Colitis: Inflammatory Bowel Disease 18 January 2010 5:11 UTC www.preventdisease.com [Source type: Academic]

.Low dose naltrexone is under study for treatment of Crohn's disease and ulcerative colitis.^ (Antibiotics, which are used to treat Crohn's disease, are also not helpful for ulcerative colitis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

^ They are important in the diagnosis of both ulcerative colitis and Crohn's disease.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]
  • Ulcerative colitis - Edward Hospital, Naperville IL Area 18 January 2010 5:11 UTC www.edward.org [Source type: Academic]
  • Ulcerative colitis 18 January 2010 5:11 UTC www.bcbswny.com [Source type: Academic]

^ Some studies have also reported that appendectomy (removal of the appendix) protects against ulcerative colitis.
  • Ulcerative colitis: the causes, diagnosis, treatment, and prevention of ulcerative ... 18 January 2010 5:11 UTC www.henryfordhealth.org [Source type: Academic]

See also

References

  1. ^ a b Ulcerative colitis at eMedicine
  2. ^ Orholm M, Binder V, Sørensen TI, Rasmussen LP, Kyvik KO (2000). "Concordance of inflammatory bowel disease among Danish twins. Results of a nationwide study". Scand. J. Gastroenterol. 35 (10): 1075–81. doi:10.1080/003655200451207. PMID 11099061.  
  3. ^ Tysk C, Lindberg E, Jarnerot G, Floderus-Myrhed B (1988). ""Ulcerative colitis and Crohn's disease in an unselected population of monozygotic and dizygotic twins. A study of heritability and the influence of smoking". Gut 29: 990–996. doi:10.1136/gut.29.7.990. PMID 3396969.  
  4. ^ a b Baumgart DC, Carding SR (2007). ""Inflammatory bowel disease: cause and immunobiology"". The Lancet 369 (9573): 1627–1640. doi:10.1016/S0140-6736(07)60750-8. PMID 17499605.  
  5. ^ Cho JH, Nicolae DL, Ramos R, et al. (2000). "Linkage and linkage disequilibrium in chromosome band 1p36 in American Chaldeans with inflammatory bowel disease". Hum. Mol. Genet. 9 (9): 1425–32. doi:10.1093/hmg/9.9.1425. PMID 10814724. http://hmg.oxfordjournals.org/cgi/content/full/9/9/1425.  
  6. ^ Järnerot G, Järnmark I, Nilsson K (1983). "Consumption of refined sugar by patients with Crohn's disease, ulcerative colitis, or irritable bowel syndrome". Scand. J. Gastroenterol. 18 (8): 999–1002. PMID 6673083.  
  7. ^ Corrao G, Tragnone A, Caprilli R, et al. (1998). "Risk of inflammatory bowel disease attributable to smoking, oral contraception and breastfeeding in Italy: a nationwide case-control study. Cooperative Investigators of the Italian Group for the Study of the Colon and the Rectum (GISC)". Int J Epidemiol 27 (3): 397–404. doi:10.1093/ije/27.3.397. PMID 9698126. http://ije.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=9698126.  
  8. ^ "Roche Found Liable in First Of 400 Suits Over Accutane". Washington Post. 2007-05-29. http://www.washingtonpost.com/wp-dyn/content/article/2007/05/29/AR2007052901946.html.  
  9. ^ Reddy D, Siegel CA, Sands BE, Kane S (2006). "Possible association between isotretinoin and inflammatory bowel disease". Am. J. Gastroenterol. 101 (7): 1569–73. doi:10.1111/j.1572-0241.2006.00632.x. PMID 16863562.  
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