Ulcerative Colitis: 7 Things Doctors Want You to Know
Medically Reviewed By William C. Lloyd III, MD, FACS
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You can live well with ulcerative colitis.In the past 20 years, there’s been significant progress in treating ulcerative colitis, or UC, a chronic form of inflammatory bowel disease. Find out what some top gastroenterologists have to say about managing your condition, achieving remission, and keeping your life on track while avoiding complications down the line. -
1. “Don’t wait to see your provider if you have symptoms of possible ulcerative colitis.”“Most commonly patients develop diarrhea or blood in their stools or rectal bleeding,” says Bincy P. Abraham, MD, a gastroenterologist at Houston Methodist Hospital in Houston. “If we get to [patients] early enough and treat them effectively with the right drugs, most are able to get feeling normal,” says Corey Siegel, MD, gastroenterologist at Dartmouth-Hitchcock Medical Center in Lebanon, N. H. “If you ignore the symptoms, they may still be treated, but you risk damage to the bowel, and the bowel doesn’t function as it once did,” adds Dr. Siegel.
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2. “What you eat may matter less than you think when you have ulcerative colitis.”“Although it’s very intuitive that diet should make a big difference in healing UC, we haven’t been able to establish anything that consistently works,” says Dr. Siegel. Even so, “The data suggests that the best diet for these people is a well-balanced, healthy diet high in fruits, vegetables and fresh foods—trying to avoid preservatives and emulsifiers,” says Adam Cheifetz, MD, gastroenterologist at Beth Israel Deaconess Medical Center in Boston. As far as taking probiotics to treat UC, the jury is still out, though there is some evidence they can keep people with mild disease in remission.
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3. “The symptoms may be similar, but Crohn’s disease and UC are different.”“Crohn’s and UC are both part of the broader umbrella of inflammatory bowel diseases. With ulcerative colitis, it involves only the colon. Crohn’s disease can be anywhere from the mouth through the esophagus, stomach, small intestine, colon—and causes a lot of perianal problems like fissures or fistulas around the anus,” says Dr. Siegel. “Crohn’s involves deeper layers of the bowel, where ulcerative colitis involves just the very top layer of the bowel, something called the mucosa. Crohn’s can cause more complications,” he says.
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4. “How you take your UC meds is as important as what you take.”Doctor may prescribe steroids or topical medicine for a short time, but unless your UC is mild, most treatment today involves biologic drugs, which work on the immune system and help control inflammation. It’s essential to take them as prescribed to maintain the drug’s effectiveness. “When [patients] don’t take the prescribed medication at the dose that’s prescribed, there’s a much higher risk of flare,” says Dr. Cheifetz. “I am aggressive about making sure they have enough drug in their system. The goal is really to fool the body into thinking the drug is part of them.”
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5. “Even if you’re UC isn’t acting up, make sure you follow up with us.”“What [patients] often underestimate is the adverse event of having active disease. If you have severe disease and ongoing inflammation, the higher the risk of developing [colon] cancer. There’s also the risk of malnutrition or anemia,” says Siobhan Proksell, MD, gastroenterologist at the University of Pittsburgh Medical Center. “Patients who’ve had the disease for a certain period of time are at a slightly higher risk of colon cancer, and they should be getting colonoscopies on a regular basis, on the order of every 1 to 3 years once they’ve had the disease for 8 years,” adds Dr. Cheifetz.
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6. “Doctors want UC patients to do their homework.”“I think patients need to take an active role in their treatment. They should know how extensive their disease is, what medications they’ve been on, what’s worked, what hasn’t, and if they’ve had side effects, what were they,” says Dr. Cheifetz. “When you are going to do renovations [on a house], you probably are going to talk to a few contractors. This is way more important than that—this is your body, this is your life—so you need to make sure you are getting care from a provider with whom you can develop a good relationship,” notes Dr. Proksell.
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7. “If you have UC, tell us if your treatment isn’t providing full results.”“We have lots of ways to manage and treat ulcerative colitis and get [it] into remission. Sometimes patients feel a little bit better and that’s a huge difference for them, but they think that may be all that we can get to,” says Dr. Abraham. In truth, “If they’re not back to complete normal, they really need to tell their physicians.” Adds Dr. Siegel: “Goal number one is making the patient feel better and goal number two is healing the colon. If we don’t do both of those, the long-term outcomes aren’t going to be nearly as good.” “Healing is our gold standard,” says Dr. Abraham.
Ulcerative Colitis: 7 Things Doctors Want You to Know
