ULCERATIVE COLITIS

What is ulcerative colitis?

Ulcerative colitis is an inflammatory bowel disease (IBD) which, according to NHS Choices, affects around 1 in every 420 people in the UK; this amounts to approximately 150,000 people.

It is a chronic condition, which means that it is ongoing and life-long. However, there may be periods of good health (remission), as well as periods of more active flare-ups (relapses).

When active, it causes persistent inflammation and ulcers in the innermost layers of the large intestine (colon) and rectum. Small open sores develop on the surface of the lining and these can bleed and produce pus and mucus.

The inflammation can span anywhere from a few inches to the entire length of the intestine and the ulcers form where the inflammation has killed the cells that usually line the colon. This, in turn, causes the colon to empty frequently, leading to diarrhoea (one of the classic symptoms of this condition).

Ulcerative colitis is similar to Crohn's disease (another IBD), but Crohn's can develop anywhere in the digestive tract (including the small intestine, mouth, esophagus and stomach), often in patches, and can spread deeper into the tissue. In contrast, ulcerative colitis is usually uniform throughout the colon and confined to the innermost layers of tissue.

Having said that, ulcerative colitis is a systemic disease, the effects of which can impact on other parts of the body (particularly if not managed appropriately). For example, the condition is also associated with arthritis, eye infections, liver disease, skin rashes, blood clots and gallstones.

Ulcerative colitis causes

Research has yet to identify a single definitive cause of ulcerative colitis, but it is now generally thought to be an autoimmune condition. This means that the body's immune system malfunctions and mistakenly attacks healthy tissue.

The current prevailing theory is that the immune system mistakes harmless bacteria inside the colon as a threat and attacks the tissues of the colon, causing it to become inflamed. However, exactly what causes the immune system to behave in this way is unclear.

One theory suggests that some unknown 'trigger', possibly a virus or bacterium, interacts with the body's immune system to trigger an inflammatory reaction in the intestinal wall.

Most experts think it is a combination of genetic and environmental factors, including the overuse of medication (such as antibiotics) and poor diet. Studies have revealed that a person with a parent who has colitis is 5 times more likely to have the condition themselves.

It is also worth noting that Irritable Bowel Syndrome (IBS), often confused with ulcerative colitis because of the common overlap of symptoms, is a separate condition. Colitis is not always a feature of IBS.

Ulcerative colitis symptoms

Ulcerative colitis can develop at any age, but it is most often diagnosed between 15 and 25.

It is more common in white people of European descent (especially those descended from Ashkenazi Jewish communities) and black people. The condition is rarer in people of Asian background. Both men and women seem to be equally affected.

As already mentioned, the symptoms of ulcerative colitis can vary and overlap with a number of other IBDs (making professional rather than self diagnosis a must). However, the most common symptoms tend to include:

- recurring diarrhoea (which may contain blood, mucus or pus)
- abdominal pain
- cramps and nausea
- fatigue
- the need to empty your bowels frequently.

The severity of symptoms will vary, depending on how much of the colon and rectum is inflamed and how severe the inflammation is. For some people, the condition has a significant impact on their everyday lives, while others may go for weeks or even months with only very mild symptoms.

Either way, it is essential to manage ulcerative colitis appropriately in order to avoid unnecessary damage to the intestinal tract and adverse consequences for the health of the body as a whole.

If you have symptoms of ulcerative colitis and you haven't been diagnosed with the condition, you should see your GP as soon as possible. They can then arrange the appropriate tests to help determine what may be causing your symptoms.

Living with ulcerative colitis

As there is no known outright “cure” for ulcerative colitis, once it is diagnosed the primary approach for treating it is to try to minimise the incidence of flare-ups, while promoting longer periods of remission to allow the colon time to heal.

In terms of how this approach is enacted in everyday life, different people tend to adopt different methods, including:

- dietary changes (for instance avoiding foods that are known to cause or contribute to flare-ups)
- and supplementation (for instance to support digestion, lower levels of inflammation, a healthy balance of gut microflora, gut wall integrity, nutrient absorption and the healing process generally).

Often, the precise approach will depend on the severity of symptoms. For the most severe cases, medication and surgery may be suggested.

Ulcerative colitis diet

Ulcerative colitis is more common in the developed world, which makes it likely that diet has a role to play in the development and persistence of the condition. In any case, if sufferers find that certain foods aggravate symptoms, it makes sense to avoid those.

Specific dietary advice would obviously need to be tailored to the requirements of the individual and dispensed by a qualified professional (such as a dietitian or nutritionist).

However, as a broad rule of thumb, it is generally recommended to avoid a high intake of foods that can place an unnecessary strain on the digestive tract or contribute to inflammation. For example, foods that are processed or high in saturated fat, as well as acid-forming food and drink such as meat, sugar, alcohol, caffeine and dairy - it is interesting to note that many people with ulcerative colitis are also lactose intolerant.

Relatively moderate dietary changes such as these have seen good results in helping to minimise symptoms. Many sufferers also choose to supplement their diet, for the additional support mentioned above.

Probiotic supplements (sometimes referred to as friendly bacteria or good bacteria) are particularly popular, as they can be an angry digestive tract's best friend in a number of ways:

- They can help your body to digest food: both proteins and fats can be broken down into amino acids and fatty acids by Lactobacilli bacteria, while lactose (the sugar in milk) can be broken down into glucose and galactose. This added support for the digestive process can help to alleviate some of the strain caused by persistent inflammation.

- They can help your body to absorb calcium and other minerals and manufacture vitamins (notably vitamin B12, vitamin K and folic acid). This is particularly important for those with chronic inflammation of the gut, which can interfere with nutrient absorption and result in deficiencies – particularly where the diet is limited. Individuals with ulcerative colitis often experience reduced appetite and weight loss.

Ulcerative colitis has been proven [http://www.medscape.com/viewarticle/722838_3] to respond especially favourably to Lactobacillus salivarius (a particular strain of Lactobacillus). One of the specific ways in which it is thought to help is by promoting the healing and repair of the digestive tract.

When inflamed, the digestive tract can become abnormally permeable – widely believed to be involved in the development of food allergies, intolerances and detoxification problems. This combination of factors can also contribute to other inflammatory conditions, such as arthritis.

Other supplements that are popular with colitis sufferers include: gentle colon cleansers, digestive enzymes, cleanse and detox supplements and nutrients-fortified daily shakes (particularly those that are dairy-free and gluten-free).