Brunilda Nazario, MD
Ulcerative colitis can be a complicated, distressing, and confusing illness. Your doctor can help make sense of it. But the first step is knowing what questions to ask. Here's a checklist of questions suggested by experts in inflammatory bowel diseases (IBD), along with notes on what your doctor may discuss with you.
"Diet doesn't cause ulcerative colitis, and special diets can't cure the disease," says Walter J. Coyle, MD, director of the Gastrointestinal Program at Scripps Clinic Medical Center. "But it can help to avoid foods that your body has trouble tolerating or foods that irritate your bowels."
Your doctor may give you a checklist of some foods that frequently cause problems, including "gassy" foods like broccoli, cauliflower, beans, and whole grains. Some dietitians recommend eating five or six small meals rather than two or three large ones. Drinking plenty of fluids, especially water, can also help.
But remember: No two ulcerative colitis sufferers are alike. A food that bothers one person may cause no problems at all in someone else. Although a variety of popular IBD diets have received a lot of hype, doctors say no one diet has been proven to effectively treat the disease.
Doctors and dietitians encourage patients to keep a food-and-symptoms diary for several weeks. "By keeping track of what you eat and how you feel afterwards, you can identify specific foods that exacerbate your symptoms," says dietitian Tracie Dalessandro, RD, author of What to Eat With IBD.
A dietitian may also want to review your diary to make sure that you're eating a well-balanced diet that includes all the nutrition you need.
Many experts recommend keeping a diary for at least three weeks. Keep in mind that your goal should be to eat as wide a variety of foods as you can to assure well-balanced nutrition. "Diets that eliminate many foods are hard to follow and may result in nutrient deficiencies," says Dalessandro.
During a flare-up, the large intestines become inflamed, causing diarrhea and discomfort. Many experts recommend going on a non-residue diet -- one that eliminates foods that are hard to digest or that contain indigestible fiber. That means avoiding fruits and vegetables, nuts and seeds, and whole grains.
Some doctors recommend a liquid diet during severe flare-ups. With no food passing through the large intestines, the bowels have time to heal. A low-residue diet is also recommended for people who have developed a narrowing of the lower small intestine, called the ileum.
Again, keep in mind that no two people respond the same way. "Some patients do well on a low-fiber, low-residue diet, but every patient is different," says David T. Rubin, MD, co-director of the Inflammatory Bowel Disease Center at the University of Chicago.
Severe nutritional deficiencies are typically associated with Crohn's disease, which affects the small intestine, where most nutrients are absorbed. Because ulcerative colitis affects the large intestine, it can cause severe and sometimes bloody diarrhea, putting patients at risk for iron deficiency and anemia.
You can measure your iron level with a simple blood test.
Ulcerative colitis can also deplete stores of folate. That's especially dangerous for women of child-bearing age, since folate deficiency is linked to birth defects. Fluid loss from diarrhea can also cause electrolyte imbalances.
Severe infections can occur in the large intestine, but they are uncommon. Ulcerative colitis is also associated with a higher risk of colon cancer. For that reason, doctors recommend frequent colonoscopy examinations. Your doctor may discuss other risks with you.
If you smoke, set a goal to stop. Studies show that smoking exacerbates the symptoms of inflammatory bowel disease, especially Crohn's. Smoking also adds to cancer risk.
Finding ways to alleviate stress may also help you control your symptoms. Stress doesn't cause inflammatory bowel disease, but it can make your symptoms feel worse and may trigger flare-ups. Many patients find that moderate exercise, relaxation techniques, or soaking in a warmth bath are helpful.
Doctors have a growing list of drugs to treat ulcerative colitis. Patients are most often prescribed drugs known as aminosalicylates (5-ASA preparations), which work to reduce inflammation in the bowel wall and work to prevent flare-ups. They work well for mild to moderate disease of the colon. Brand names include Pentasa, Asacol, Colasal, and Azulfidine.
Corticosteroids are prescribed to bring the disease into remission. For moderate to severe inflammatory bowel disease these medications are given intravenously in the hospital.
A new drug called infliximab, which blocks one of the chemicals involved in inflammation, is also available. It is often recommended as an alternative to corticosteroids, which can have serious long-term adverse effects. This drug helps bring the disease under control and maintains the disease in remission.
Your doctor will discuss the best medication given your symptoms and overall health.
Anti-inflammatory drugs such as 5-ASAs are used to stop mild flares. To treat more severe flares, doctors usually turn to more potent medications, such as corticosteroids.
Doctors have a wide variety of tests that are useful in diagnosing and monitoring inflammatory bowel diseases. A variety of imaging tests, including colonoscopies, are performed to assess the bowels. Biopsies are sometimes taken to look at cells in the lining of the intestines. Blood tests are used to detect nutritional deficiencies and anemia, a common side effect of ulcerative colitis. Stool specimens can detect infections in the intestines.
The only true cure for ulcerative colitis is the removal of the colon, a procedure called a colectomy. However this means that a permanent external bag to drain the stool is needed. Surgery is considered a last resort, performed when the disease does not respond to medication. Surgery is also indicated when there are precancerous or cancerous lesions of the colon.
The answer depends on many things, including the severity of your disease, your overall health, and how well you respond to treatment. Many people effectively manage their symptoms with proper diet and medication and maintain a high quality of life. Your doctor can help give you an idea of what to expect.
Seksik, P. Inflammatory Bowel Disease, Dec 9, 2008.Emedicine: "Ulcerative Colitis."
David T. Rubin, MD, co-director, Inflammatory Bowel Disease Center, University of Chicago.Walter J. Coyle, MD, director, Gastrointestinal Program, Scripps Clinic Medical Center, La Jolla, Calif.
Crohn's & Colitis Foundation of America.
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