Ulcerative colitis and anemia: What is the link?

People living with ulcerative colitis (UC) are at an increased risk of developing anemia. Anemia can be serious, but is treatable.

UC is a form of inflammatory bowel disease that causes inflammation in the large intestine.

People with UC are at risk of developing anemia, a condition in which there are lower levels of red blood cells and the protein hemoglobin in the blood. This can be due to problems caused by UC, including reduced iron absorption, reduced absorption of other vitamins and minerals, and blood loss.

Learn more about the link between UC and anemia, including symptoms, treatment options, and long-term outlook.

People with UC are at risk of developing anemia. Roughly 1 in 3 people who live with UC also have anemia.

In UC and Crohn’s disease, another form of inflammatory bowel disease, inflammation in the intestine can prevent the body from absorbing iron properly. This can cause low iron levels, leading to anemia.

Intestinal bleeding may also result in blood loss, causing anemia. Anemia in people with UC could result from reduced absorption of vitamins and minerals, including vitamin B1 and folic acid. Some UC medications may also cause anemia.

Not everyone with anemia will experience symptoms, so it is important those with UC get a test for anemia.

If a person does experience symptoms of anemia, these may include:

• headaches
• lack of appetite
• difficulty with concentration or cognitive function
• irritability
• fatigue
• tingling in the hands or feet
• numbness in the hands or feet
• cold hands and feet

If anemia gets worse, more symptoms may develop. These include:

• abnormal menstrual bleeding
• ulcers in the mouth
• blue-ish color in the whites of the eyes
• brittle nails
• lightheadedness
• low libido in males
• inflamed or sore tongue
• shortness of breath

Doctors can diagnose anemia through a blood test to see if there are low levels of red blood cells and hemoglobin.

To diagnose anemia, a doctor may recommend tests for:

• complete blood count
• vitamin B12 levels
• iron levels
• folic acid levels
• reticulocyte count, the amount of immature red blood cells in the blood

A doctor may also do a physical exam to check for:

• rapid heart rate
• pale skin
• slight fever
• heart murmur
• low pressure, particularly upon standing

While anemia can be serious, it is also treatable.

Treatment options for anemia in people will UC will depend on the cause of the anemia and whether the UC is active.

A doctor will decide what treatment option is best, taking into account:

• whether UC is active
• whether other medical problems are present
• whether other nutritional deficiencies are present

Iron supplements

Iron supplements are one option for treating anemia in people with UC.

People who have UC in remission can take iron supplements orally. If someone with UC is in remission and can tolerate foods with iron, doctors recommend they begin to incorporate those foods into their diet.

If a person has UC that is not in remission, they may need to receive iron via an infusion with an IV line. This may also be the best option for those who cannot tolerate oral iron supplements.

Other medications

A doctor may prescribe other supplements to counteract the reduced absorption of certain vitamins and minerals due to UC.

Supplements may include vitamin B12 and folic acid.

Blood transfusion

In some cases, doctors may use a blood transfusion to treat severe anemia.

Before a blood transfusion, a healthcare professional will test a person’s blood to identify their blood type.

They will then insert an IV line into a blood vessel to deliver healthy blood. Typically, a blood transfusion will take 1–4 hours to complete.

A blood transfusion helps increase the hemoglobin and oxygen levels in the blood.

Managing UC to treat anemia

Getting UC under control through appropriate treatment may help treat anemia. There is no cure for UC, but a multifaceted approach to treatment can help manage the disease.

Treatment options for UC may include:

• Medications: Possible medications include aminosalicylates, corticosteroids, immunomodulators, targeted synthetic small molecules, and biologics. Medication can help limit flare-ups and reduce inflammation.
• Diet: Working with a doctor or dietitian to avoid foods that aggravate the digestive system may improve symptoms.
• Surgery: Between 25–33% of people with UC do not benefit from medical therapy. For these people, doctors may recommend a surgery such as a colectomy.

If a person is experiencing symptoms of anemia or unusual blood loss, they should call a doctor.

It is important for those living with UC to be aware of symptoms that may indicate a flare-up or worsening of the condition.

Symptoms that may indicate a change in a person’s condition and require a call to the doctor may include:

• weight loss
• loss of appetite
• frequent, watery diarrhea
• diarrhea that contains blood, mucus, or pus
• pain in the abdomen
• a sense of urgency to have a bowel movement
• fatigue

Any sudden or severe symptom requires attention from a doctor. In some cases, certain symptoms may warrant an emergency call to the doctor or a trip to the emergency room.

These symptoms include:

• new rectal bleeding
• significant amounts of rectal bleeding
• a drastic change in bowel movements without passing gas
• persistent vomiting and no bowel movements
• severe abdominal pain that persists for more than an hour
• a high temperature

Those with ulcerative colitis (UC) are at risk of developing anemia due to reduced iron absorption and potential blood loss. Certain medications and reduced absorption of minerals may also play a role in those with UC developing anemia.

Not everyone with anemia will experience symptoms, and it is important those with UC get a blood test to check if they have anemia.

While anemia can be serious, it is treatable. Treating anemia may involve taking oral iron or intravenous supplements. Managing UC will also help in the treatment of anemia.

ANEMIA | Crohn’s & Colitis Foundation

Modified: February 3, 2020

Dear @[email protected],

Your healthcare team has discussed the following subject with you: anemia. Here is some additional information. Let us know if you have any questions regarding this information.

People with Crohn’s disease or ulcerative colitis are at risk for anemia. If you have anemia, you have less blood to carry oxygen to the rest of your body. Approximately one in three people with Crohn’s disease or ulcerative colitis have anemia. The most common symptom is feeling tired. Other symptoms can include dizziness, headaches, cold hands or feet, pale skin, and shortness of breath.

The most common cause of anemia is low iron. With inflammatory bowel disease (IBD), long-term irritation and swelling (inflammation) in your intestines can interfere with your body’s ability to use and absorb iron properly. Other causes include slow blood loss from intestinal bleeding, poor absorption of vitamins and minerals (like vitamin B12 and folic acid), or from medications.

Not everyone experiences symptoms, so it is important that you get tested with a simple blood test to find out if you may have anemia. Iron deficiency, or low iron levels, can be serious, but treatable. Individuals with Crohn’s disease or ulcerative colitis that are in remission (or those without symptoms and without inflammation of the intestine) can take oral iron supplements. If you have Crohn’s disease or ulcerative colitis that is not in remission, or you cannot tolerate oral iron, then you may need intravenous (IV) iron. Other important factors in treatment include whether your IBD is under control, if you have other nutritional needs or deficiencies, and other medical problems you may have. You can discuss what options are best for you with your healthcare team and come to a mutual agreement.

Please be sure to follow up with your provider with any questions.

Your provider can also discuss the Crohn’s & Colitis Foundation’s IBD Anemia Care Pathway with you at your visit. The pathway uses guideline recommendations to identify and manage anemia. This resource is supported by Luitpold Pharmaceuticals

For further information, please check out https://www.crohnscolitisfoundation.org/diet-and-nutrition/supplementation or follow this link:

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Ulcerative colitis

Ulcerative colitis (UC) is a chronic relapsing inflammatory disease of the colon, characterized by the presence of ulcers on its mucous membrane. As a result, abdominal pain, diarrhea, false urge to empty the intestines may appear. It is also possible to develop life-threatening complications – intestinal bleeding and colorectal cancer.

The cause of UC is still not exactly known. It is assumed that the main role in the development of the disease is played by immune and genetic factors.

Ulcerative colitis most commonly affects people between 15 and 30 years of age. The disease proceeds in periods: there are exacerbations and remissions (weakening of the manifestations of the disease up to their complete disappearance), and remission can sometimes last for years.

Drugs that suppress the immune system are commonly used for treatment. However, in some cases, only surgical treatment is possible.

Synonyms Russian

Nonspecific ulcerative colitis, NUC.

Synonyms English

Ulcerative Colitis,Colitis ulcerosa, UC.

Symptoms

The most common symptoms of UC are:

• chronic diarrhea with blood in the stool, sometimes mucus,
• abdominal pain, possibly of a cramping nature,
• feeling of incomplete emptying of the bowels and false urge to empty,
• anal fissures,
• intestinal bleeding,
• general weakness and malaise,
• temperature increase,
• loss of appetite and body weight,
• anemia due to bleeding and malabsorption of iron.

A number of symptoms are due to immune disorders:

• joint pain,
• inflammation of the eyes,
• skin lesions in the form of red, bumpy, painful rashes,
• pain in the right hypochondrium as a result of involvement in the pathological process of the liver,
• discomfort and pain in the lumbar region, indicating damage to the kidneys or the presence of stones in them.

General information

Ulcerative colitis is a chronic disease characterized by a relapsing course and the presence of inflammation and ulcers on the colonic mucosa.

The cause of UC is currently unknown. It is assumed that mainly disorders in the immune system and burdened heredity contribute to the disease.

Normally, human cells of the immune system synthesize antibodies to protect the body from foreign influences.

In some, the immune system produces too many antibodies against cells in its own mucosa. Thus, the pathological process acquires an autoimmune character. This explains the presence of systemic manifestations of the disease in patients: arthritis, conjunctivitis, chronic hepatitis, erythema nodosum (bump-like, painful formations on the skin). The drug therapy of UC is based on the same version, since all the drugs used suppress the immune system.

People with a family history of UC are more likely to develop the disease than people with an uncomplicated heredity.

Increase the risk of getting sick with UC stressful influences and the nature of nutrition, as well as past intestinal infections.

Normally, water, trace elements and bile acids are absorbed in the large intestine. In chronic inflammation, this process is disrupted, the mucous membrane becomes thinner and ulcers appear on it, which can bleed. The result is a constant irritation of the intestines, which provokes diarrhea and abdominal pain. In addition, given the decrease in appetite, all this reduces the intake of nutrients, so that their level in the blood decreases, which is manifested by anemia, osteoporosis, protein deficiency, lack of glucose in the blood, hypovitaminosis.

Metabolic disorders occurring in the body can lead to impaired kidney function and the formation of stones in them.

With this pathology, only the superficial sections of the colon mucosa are affected. The inflammatory process is continuous, that is, starting in the rectum, it captures all parts of its mucosa, leaving no healthy fragments. In the future, inflammation can also continuously spread to the overlying parts of the colon.

During the course of the disease, periods of exacerbation and remission are distinguished, which can last for months or even years. At the same time, such patients have a high probability of intestinal bleeding, colorectal cancer, intestinal perforation, toxic megacolon (cessation of intestinal motility and expansion of the intestine), which can seriously threaten their lives.

Who is at risk?

• Persons whose relatives had ulcerative colitis.
• Young people under 30.
• Quitting smoking – this can provoke an exacerbation of UC.
• Long-term users of painkillers (non-steroidal anti-inflammatory drugs): ibuprofen, naproxen, aspirin.
• Residents of metropolitan areas.

Diagnostics

• Immunological examination of blood allows to detect antibodies to the cytoplasm of own neutrophils, which confirms the autoimmune nature of the disease and is quite specific for ulcerative colitis. Under the action of such antibodies, neutrophils are destroyed, which contributes to inflammatory reactions.
• Complete blood count (without leukocyte formula and ESR). A decrease in hemoglobin indicates anemia; an increase in the level of leukocytes may indicate the addition of an infection.
• Blood chemistry – helps to identify malabsorption, in which the levels of total protein, glucose, cholesterol, electrolytes may be reduced. Changes in the concentration of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase indicate liver damage. The level of creatinine, urea can increase with kidney pathology.
• C-reactive protein, an increase in the level of which indicates the activity of the process.
• The fecal occult blood test allows you to determine the amount of blood in the stool that is not visible to the eye.
• Coprogram reflects the ability of the gastrointestinal tract to digest food.

Instrumental methods of examination are also used:

• sigmoidoscopy – examination of the rectum and sigmoid colon;
• irrigoscopy – X-ray examination with the introduction of barium into the colon, allows you to explore the relief of the mucosa;
• fibrocolonoscopy – examination of the colon with an endoscope, which allows you to see changes in the mucosa and take a biopsy from the affected areas;
• Ultrasound of the abdominal cavity and kidneys allows you to assess the condition of the intestinal wall, as well as the liver, gallbladder, pancreas, to identify changes in the kidneys;
• a histological examination of a biopsy (a piece of the intestinal mucosa taken during endoscopic examination) usually allows you to finally determine the type of disease.

Treatment

Treatment usually begins with 5-aminosalicylic acid preparations. With its insufficient effectiveness, glucocorticosteroid hormones are used. The reserve drugs are cytostatics. All of these drugs affect the immune system by suppressing its excess function. Thus, there is a decrease in the synthesis of antibodies against the own mucous membrane and the activity of inflammation is reduced.

When an infectious process is attached, antibiotics are indicated.

If therapy fails, surgery is performed.

In rare cases, biological therapy is used with antibodies that suppress the excessive function of one’s own immune system, and therefore the activity of the inflammatory process.

During periods of remission, maintenance therapy is given, usually 5-aminosalicylic acid preparations.

Recommended tests

• CBC
• Serum iron
• Serum potassium, sodium, chloride
• Serum calcium
• Cholesterol, total
• Alanine aminotransferase (ALT)
• Aspartate aminotransferase (AST)
• Alkaline phosphatase, total
• Serum albumin
• Total protein in whey
• Serum creatinine
• Serum urea
• Plasma glucose
• C-reactive protein, quantitatively
• Circulating immune complexes (CIC)
• Anti-neutrophil cytoplasmic antibodies, IgG
• Diagnosis of inflammatory bowel disease (antibodies to intestinal goblet cells and pancreatic ducts)

Clinical Hospital | Ulcerative colitis – causes, symptoms and treatment

Non-specific ulcerative colitis is a chronic autoimmune inflammatory disease of the colon mucosa, which significantly reduces the patient’s quality of life and, if not treated promptly, can lead to serious complications.

At the initial stage of development, conservative treatment can be dispensed with, at more advanced stages one has to turn to minimally invasive surgical interventions.

Causes of occurrence

To date, no single cause of the development of the disease has been identified. There are several factors that significantly increase the risk of developing ulcerative colitis:

• Hereditary predisposition.

• Improper nutrition.

• The presence of concomitant diseases of the gastrointestinal tract.

• Weakened immunity.

• Frequent stressful situations.

• Long-term use of drugs.

• Bad habits.

Symptoms

Signs of ulcerative colitis may vary depending on the form of the pathological process, as well as the severity. As a rule, the first and obvious symptom is diarrhea, most often with an admixture of blood or mucus.

In addition, the following symptoms may be observed:

• Pain in the lower abdomen, most often occurs before a bowel movement.

• An increase in body temperature is possible, which indicates the presence of an inflammatory process.

• Lethargy, weakness, general malaise.

• False urge to defecate.

• Frequent stools, may occur up to 15 times a day.

• In some cases, constipation may occur, which alternates with diarrhea.

• Loss of appetite and weight loss.

• Often anemia (iron deficiency) develops against the background of the disease.

• Bloating, rumbling of the abdomen.

The manifestation of ulcerative colitis can also be reflected outside the gastrointestinal tract. For example, the owners of this diagnosis have problematic skin: acne, inflammatory rashes, eczema, etc. Ulcers in the oral cavity, lacrimation and photophobia, decreased vision, joint damage, pathology of the liver and biliary tract can also be observed.

Diagnosis

To establish a diagnosis, the patient needs to specify information about the conditions that preceded the appearance of the clinic of the disease, the frequency of stool per day, its characteristics, etc. Then the doctor prescribes some types of laboratory and instrumental diagnostics to help determine the severity of the disease:

• Colonoscopy.

• Irrigoscopy.

• ultrasound.

• Biopsy followed by histological examination may be required.

• Complete blood count.

• Biochemical analysis.

• Coprogram, stool test for calprotectin (intestinal inflammation detector) and occult blood.

• Cultures for bacterial infection.

Methods of treatment

Treatment of ulcerative colitis is mainly symptomatic, its main goal is to achieve and maintain remission. As a rule, various groups of medications are prescribed for this diagnosis: non-steroidal anti-inflammatory drugs, antibacterial drugs, analgesic antispasmodics, prokinetics, sorbents, etc. .

In cases where conservative therapy does not give a positive result and frequent exacerbations occur, surgical intervention may be required.