Malnutrition and IBD | Crohn’s & Colitis Foundation

Managing your diet and nutrition is crucial when you have Crohn’s disease or ulcerative colitis. We can help you get you started on the path to a healthier life by understanding how inflammatory bowel disease (IBD) affects your body’s nutrition.

Crohn’s disease and ulcerative colitis can impact your body’s ability to properly digest food and absorb nutrients, which may lead to serious vitamin deficiencies and malnutrition.

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Malnutrition and IBD
Inflammatory bowel diseases may cause a variety of symptoms and complications, which, if not addressed, can lead to nutrient deficiencies and malnutrition. Watch and listen to learn more.

Malnutrition and the GI Tract

Intestinal inflammation, IBD-related complications, and certain medications can make it difficult for you to maintain healthy nutrition. For example:

• Small intestine inflammation can cause problems digesting food and absorbing nutrients.

• Large intestine (including colon and rectum) inflammation can cause problems absorbing water and electrolytes.

Signs You May Be Malnourished

Even mild cases of malnutrition can make it more difficult for your body to bounce back after an illness. Signs of malnourishment include:

• Under-eating and/or severely restricting the variety and types of foods eaten

• Weight loss

• General fatigue and low energy

• Weakness

• Loss of muscle mass

• Vitamin and mineral deficiency

Causes of Malnutrition

In addition to intestinal inflammation, common symptoms of Crohn’s disease and ulcerative colitis can contribute to malnutrition.

• Severe diarrhea can cause dehydration, which means your body may be depleted of fluids, nutrients, and necessary electrolytes such as  sodium, potassium, magnesium, phosphorus, and zinc. It can also lead to weight loss.

• Abdominal pain and nausea can reduce your appetite, making it difficult for you to consume enough calories and sufficient nutrients.

• Rectal bleeding from ulcers in your intestines can lead to iron deficiencies and anemia.

• Frequent bowel movements can cause you to cut back on eating to avoid diarrhea or excessive trips to the restroom. Eating too little puts you at risk for becoming malnourished.

While medication is a common and useful treatment for IBD, certain IBD medications may interfere with your ability to maintain a healthy nutritional status:

• Corticosteroids, such as prednisone, may cause weight gain and increase your risk for diabetes. Long-term use can also cause a decrease in healthy muscle mass, as well as bone and skin strength.

• Sulfasalazine and methotrexate may interfere with the absorption of folic acid, a vitamin that promotes healthy cell growth.

Complications of Malnutrition

IBD-related malnutrition can cause serious complications if not treated and resolved. If you suspect that you or your loved one are experiencing malnutrition due to Crohn’s disease or ulcerative colitis, make an appointment with your doctor as soon as possible.

Malabsorption

Malabsorption makes it difficult to absorb necessary nutrients in the small intestine, such as proteins, fats, sugars, vitamins, and minerals. It can be caused by inflammation in the intestines.

The degree of malabsorption depends on how much of the small intestine is affected. Malabsorption and nutrient deficiencies are often more significant if larger sections of your small intestine are inflamed or have been surgically removed. If a significant portion of your  ileum, or the end section of your small intestine, is inflamed or removed, the absorption of fat-soluble vitamins A, D, E, K, and B12 will likely be affected.

Patients with ulcerative colitis may have less significant nutrient deficiencies, though severe diarrhea and blood loss can cause weight loss and anemia.

Stricture

A stricture is a narrowing of your intestine, created when scar tissue builds up after repeated cycles of inflammation and healing in the lining of the intestine. Strictures can make it difficult for digested food to pass through your intestine, and can eventually lead to a blockage.

High-fiber foods, such as fresh fruits and vegetables, may become stuck in the narrowed intestine, causing pain, bloating, or nausea. Low-fiber foods or liquid diets may be needed to reduce your symptoms if the stricture is mostly inflammatory. Your doctor may also prescribe medication to reduce inflammation or recommend surgery to repair or remove the stricture.

Decreased Bone Strength

Decreased bone strength is a common complication for people with IBD. This puts you at an increased risk of fractures.

Causes of decreased bone strength include:

• Poor absorption of calcium

• Vitamin D deficiency

• Decreased physical activity

• Inflammation

• Long-term use of certain medications, including corticosteroids

Growth Delays

This complication may occur in some children with IBD who experience chronic inflammation and malnutrition, or who take long-term corticosteroids. In approximately one-third of children with Crohn’s disease and one-tenth of children with ulcerative colitis, their final adult height is less than expected because of their IBD.

Good eating habits, adequate calorie intake, and control of the underlying disease are essential to minimize the negative effects of IBD on your child’s growth. Consult your child’s doctor or a registered dietitian if your child is not staying on their typical growth curve. It may be necessary to evaluate your child’s calorie and nutrient intake.
 

How to Avoid Malnutrition

There are steps you can take to maintain healthy nutrition even if your diet is limited by IBD.

• Get tested for vitamin and mineral deficiencies even if you aren’t showing symptoms of malnutrition.

• Avoid foods that worsen your symptoms.

• Work with your healthcare team to identify a list of foods that may help you maintain well-balanced nutrition.

Ulcerative Colitis, Weight Loss, and Body Image

It’s hard for Karis Lederman, 26, to talk about the rapid and dramatic weight loss she experienced after being diagnosed in December 2014 with ulcerative colitis, an inflammatory bowel disease (IBD).

“I was about 160 pounds before I was diagnosed — the heaviest I’ve ever been — and at my lowest since diagnosis I was 118 pounds, so I lost about 40 pounds,” says the Dallas-based producer. Today she’s doing better and says her weight has stabilized at about 125 pounds.

Before she knew she had ulcerative colitis, Lederman — like many young women — wanted to lose a few pounds. “My ideal goal weight was 135 pounds,” she says. “Even though I’ve lost that weight plus some, I’m not happy about how I got here because it wasn’t a healthy way. I would rather be 160 pounds and healthy than 125 pounds and sick.”

Ulcerative Colitis and Weight Loss

Marked by persistent diarrhea and abdominal pain, ulcerative colitis occurs when the lining of the colon becomes inflamed and tiny open sores that produce pus and mucus develop. It may affect as many as 700,000 Americans, according to the Crohn’s and Colitis Foundation of America.

Ulcerative colitis symptoms, like diarrhea and loss of appetite, can make maintaining a healthy weight a challenge for people like Lederman — and the weight loss they experience is sometimes misinterpreted by well-meaning strangers in a thin-obsessed culture.

“Although I’ve lost weight and in our society that generally means you’re more healthy or fit, I’m not as healthy as I was before I lost the weight,” she says. “I used to go to the gym at least two to four times a week before this started, and now it’s hard for me to get the strength to even walk my dogs some days.”

Lederman says she deals with this largely by making jokes. The first time someone at work asked her to share her weight-loss secret, she says she was taken aback. “This person didn’t know about my ulcerative colitis, so at first I didn’t know what to say,” she says. “I told him lightheartedly that I had started going to the hospital. This breaks the ice, where I can tell people about it and they feel more comfortable to ask questions.”

Her dramatic weight loss also meant a new wardrobe, but this also wasn’t something that Lederman was enthused about. “At first I only bought one pair of new jeans because I didn’t want to spend a bunch of money on new clothes when I thought I would quickly go back to my original weight,” she says.

Many people with an IBD like ulcerative colitis express body image dissatisfaction that negatively affects their quality of life, even when their disease is under control, according to research published in February 2015 in the journal Inflammatory Bowel Diseases. At highest risk for body image issues were females and those who had more severe disease, the study showed.

Improving Body Image With Ulcerative Colitis

For Lederman, wearing clothing that fit helped improve her self-esteem and body image. “I still keep all of my old clothes because I know with this disease that my weight can always fluctuate,” she says.

The support of family and friends helped her get through some of the darker days, she says. She also leans on people in an online community through the GI Monitor app.

“Even though my family is supportive, they can never truly know what I’m going through, and the people on this app do,” she says. “We ask each other for advice, tell each other our frustrations, and make each other laugh. I check the app several times a day. It’s been a saving grace.”

Support and education are essential, says Arun Swaminath, MD, director of the inflammatory bowel disease program at Lenox Hill Hospital in New York City. “Join a local or online support group and learn as much as you can about the disease,” he says.

Preventing Weight Loss During an Ulcerative Colitis Flare

While it can be hard to prevent weight loss during a major ulcerative colitis flare, Lederman says protein shakes have helped her.

There’s no one-size-fits-all diet advice to stave off weight loss for people with ulcerative colitis, Dr. Swaminath says. “I don’t recommend lots of fiber during a flare because it can cause bloating and diarrhea.” Getting the flare under control, he says, is the best way to stop weight loss.

Getting the Nutrients You Need

What you eat doesn’t cause or cure ulcerative colitis. But eating a diet that’s good for you is always a wise idea. It may even help you spend more time in remission and feel better.

Malnutrition isn’t usually a problem. Your small intestine is where you absorb vitamins, minerals, and proteins. And UC usually doesn’t affect that part of your body.

Still, it can be tricky to eat a well-balanced diet. Many people with UC find certain foods don’t agree with them. And loss of appetite or fear of eating can cause you to lose weight or miss out on nutrients.

The best time to think about nutrition is when you’re not having a flare.

The Best Diet for Ulcerative Colitis?

Most experts say that people with UC should simply try to eat a well-balanced diet whenever possible. This should include a variety of foods:

• Lean meat, fish, and poultry
• Low-fat dairy products
• Bread, cereal, and whole grains
• Fruits and vegetables
• Healthy fats such as vegetable oils

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Keep a food diary to help you figure out which foods cause problems for you and whether or not you’re getting enough nutrients.

If you lose weight because of your ulcerative colitis, try to eat five or six small meals and snacks during the day instead of two or three large meals.

When you have chronic diarrhea, drink plenty of water or other fluids to stay hydrated.

A dietitian can plan a diet that meets your calorie and nutrient needs. Before you take any dietary supplements, talk to your doctor or dietitian. Find out how to make a diet plan for ulcerative colitis.

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Avoid High-Fiber Foods?

You may not have to say goodbye to foods such as whole grains, fruits, and vegetables because you have UC. Besides its nutritional benefits, fiber soaks up extra water in your system and can firm stools.

Even if a high-fiber food seems to worsen your UC symptoms during a flare-up, it may be OK when the flare is over. The only way to know if a particular food is a problem for you is to remove it from your diet and then gradually start to eat it again.

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Aim for 20 to 30 grams of fiber a day. Steaming, baking, or stewing fruits and vegetables before eating them may be easier on your digestive tract than eating them raw.

If your doctor has recommended a low-fiber diet, you may miss out on the vitamins and minerals that are naturally in many high-fiber foods. Ask your doctor or dietitian if you should take a supplement. Know how to identify foods that can trigger ulcerative colitis flares.

Fish Oil and Flaxseed Oil

Fish oil — found in salmon, mackerel, sardines, herring, and black cod, as well as supplements — acts as an anti-inflammatory. Though early studies are mixed, fish oil and flaxseed oil may help tame colon inflammation. Learn more about the benefits of fish oil supplements.

Probiotic Supplements

Probiotics are “good” bacteria that live in your intestines. You can also find them in foods like yogurt and in supplements. Some researchers, as well as people with inflammatory bowel disease, think probiotics help ease symptoms.

Researchers think adding more probiotics to your digestive tract might help treat the disease. In European studies, the probiotic E. coli Nissle helped prevent UC flares, but it isn’t available in the U.S. Other studies are testing different probiotics to help control UC. If you and your doctor decide to try probiotics, you’ll need to keep taking enough of the right kind for it to work. Get more information on how probiotics can help ease symptoms of ulcerative colitis.

UC and Lactose Intolerance

People with UC often think they have lactose intolerance, which means they can’t properly digest the sugar in milk and milk products, because some symptoms are similar. But UC doesn’t make you more likely to have lactose intolerance. Your doctor can do a simple test to find out.

If you can, keep milk and dairy products in your diet. They are a very good source of calcium and vitamin D, which keep your bones healthy. Using steroids such as prednisone for a long time can thin your bones and make it harder for your body to absorb calcium, raising your chance of having osteoporosis.

If dairy products cause you discomfort, see if you can eat them in small amounts. Or try a lactase supplement to break down the lactose in dairy products.

If you just can’t stomach dairy products, your doctor may want you to take calcium and vitamin D supplements. Watch a video on how dairy affects ulcerative colitis.

What to Eat During a Flare Up

It may be best to avoid more fibrous foods like whole grains, greens, and nuts when you’re having a flare up. Instead, look for easy-to-digest foods like:

• White bread (instead of whole grain)
• Refined breakfast cereals like cornflakes (instead of oats, bran, or granola)
• White rice instead of harder-to-digest brown or wild rice
• Low-fiber fruits like bananas, cantaloupe, honeydew melon, and cooked fruits
• Fully cooked non-cruciferous vegetables like asparagus tips, potatoes, squash without the peel, seeds, or stalks
• Refined, low-fiber pasta and noodles
• Lean meat and fish
• Eggs

For some people with UC, it also helps to break meals up into five or six smaller meals instead of three larger ones. You can talk to your health care team about going on an elimination diet. That’s when you stop eating different foods one at a time to see which ones tend to cause symptoms so you can remove them from your diet. It’s important to work with your doctor or dietitian when you do this to make sure you get enough nutrients.

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If you find that you are losing weight during a flare up, talk to your health care team. They might need to test to see if you’re getting enough of certain vitamins and minerals. They also may be able to help you zero in on foods that worsen your symptoms and help you replace them with healthy alternatives that will help you maintain a healthy weight. These might include some of the foods above, like bananas, eggs, lean meat, and noodles.

If you still have trouble finding foods that agree with you or you continue to lose weight, talk to your doctor about possible liquid nutritional supplements.  

Multivitamins and Supplements

People with UC need to be especially careful to get enough folate, iron, and potassium.

Folate helps prevent cancer and birth defects. Some medications such as sulfasalazine (Azulfidine) can make it harder for your body to absorb folate.

Blood loss due to inflammation and ulcers in the colon can cause low iron levels. A simple blood test can tell.

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Diarrhea or taking steroids can cause low potassium and magnesium levels.

Talk to your doctor about whether these nutrients could be a problem for you. You may need to take vitamins just in case. Nutrition supplement drinks can also make up for missing nutrients, but they may cause diarrhea. Find out more on vitamins and supplements for ulcerative colitis.

Inflammatory Bowel Disease (IBD) and Loss of Appetite

One of the common signs of inflammatory bowel disease (IBD) is a lack of appetite. In the United States, we have an obesity epidemic, and a loss of appetite might seem desirable at times. It’s true that eating too much or eating unhealthy foods can lead to difficulty, but eating too little is also a problem. 

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A chronic illness, especially one that causes inflammation, may actually lead to an increased need for calories to fight the disease, rather than fewer calories. That means that people with IBD may need to eat more food in a flare-up, even though the trend is often to eat less. A lack of appetite can be a major obstacle to wellness, especially in people with IBD, who often have a difficult relationship with food. Not feeling like eating is common, but there are a variety of ways to stimulate your appetite and get more calories in your body.

Why IBD Causes A Lack of Appetite

There are several reasons why people with Crohn’s disease and ulcerative colitis experience a decrease in appetite. One main problem is that eating is often associated with symptoms such as nausea, pain, bloating, and diarrhea.  Another reason is that symptoms of nausea and diarrhea tend to make people feel less like eating. Complications from IBD, such as mouth ulcers, can also prevent people with IBD from eating certain types of foods. Fatigue can also be a factor — if you’re tired, you’re less likely to prepare and consume healthy meals.

Problems Caused by a Lack of Appetite

If eating causes pain or bloating and there is a general lack of appetite, people with IBD may not eat enough calories during the day. Not eating enough calories to sustain a healthy weight can result in weight loss and a lack of nutrients. Some people with chronic digestive diseases like IBD may need to take in more calories from food, and more nutrients in order to combat the lack of vitamins and minerals being taken up by the small intestine.

Dealing With a Loss of Appetite

Of course, the first step in treating a lack of appetite is to consult your healthcare team. Your gastroenterologist or internist can help you treat the IBD. Treating a flare-up of IBD will help increase appetite by relieving any negative symptoms that are associated with eating, as well as help you to feel better overall.

A dietitian can also help in making sure that you are eating the foods that will provide you with the nutrients you need. There are many factors that go into an eating plan, including age, weight, other diseases and conditions, and activity level. Eating when you’re in a flare-up might feel like a scattershot — you might only be eating the foods that you feel you can tolerate. A dietitian can evaluate your diet and help tweak it so that it’s the best it can be, considering any dietary restrictions.

Other Tips That May Help

While your healthcare team is working to get the flare-up under control, and you’re learning how to eat more healthfully, you can also try these other tips that might increase your appetite.

• Eating smaller meals is a good idea — whether or not IBD is flaring. Eating small meals has many benefits, including keeping your blood glucose level constant throughout the day, which in turn keeps your energy level up. Eating a smaller meal also means that you are not eating a larger, heavier meal. A larger meal is going to be more likely to lead to symptoms such as abdominal bloating, which is not desirable at any time, least of all during an IBD flare-up.
• Eating foods you enjoy can help in taking in more calories. Food should be healthful and nutritious, but it should also be something that you actually want to eat. Try incorporating your favorite foods, as long as you can tolerate them.
• While you need to drink plenty of fluids during the day, drinking can also make you feel full. If you find that you’re feeling full from drinking, you might try eating first, and then taking in your fluids. Drinks can also include calories, and in some cases, adding drinks with calories to your diet may be helpful (check with your doctor).

A Word From Verywell

It’s important to take in enough calories to keep the body nourished. Going for weeks or months eating little food or food devoid of nutrients can leave a body malnourished. Food and eating should be a pleasant experience, so taking any steps you can to make mealtime stress-free and enjoyable is important.

Ulcerative Colitis and Proctitis – Gastroenterologist

What Is Ulcerative Colitis?

Ulcerative colitis is a chronic disease of the colon (large intestine). The disease is marked by inflammation and ulceration of the colon lining which makes the colon empty frequently. Symptoms include diarrhea (sometimes bloody) and often crampy abdominal pain. The inflammation usually begins in the rectum and lower colon, but it may also involve the entire colon. When ulcerative colitis affects only the rectum, it is called ulcerative proctitis.

Ulcerative colitis differs from Crohn’s disease. Both diseases are called inflammatory bowel disease (IBD). Crohn’s disease can affect any part of the GI tract, whereas ulcerative colitis affects only the colon. The inflammation affects only the innermost lining of the colon, but in Crohn’s disease, it can affect the entire thickness. Inflammation from ulcerative colitis occurs in a continuous process – there are no areas of normal intestine between the areas of the diseased intestine. In contrast, “skip” areas may occur in Crohn’s disease.

What Are The Causes of Ulcerative Colitis?

We do not yet know what causes this disease. Studies indicate that the inflammation in ulcerative colitis involves a complex interaction of factors: the genes the person has inherited, the immune system, and something in the environment. Foreign substances (antigens) in the environment may be the direct cause of the inflammation, or they may stimulate the body’s defenses to produce an inflammation that continues without control. In patients with ulcerative colitis, once the patient’s immune system is “turned on,” it does not know how to properly “turn off.” As a result, inflammation damages the intestine and causes the symptoms of ulcerative colitis. One of the major goals of medical therapy is to help patients to better regulate their immune system.

What Are The Signs And Symptoms of Ulcerative Colitis?

Symptoms of ulcerative colitis include diarrhea (often bloody) which may be associated with crampy abdominal pain and sudden urgency to have a bowel movement. Diarrhea may begin slowly or quite suddenly. Loss of appetite, weight loss, and fatigue are also common symptoms. In cases of severe bleeding, anemia may occur. Approximately half of all patients with ulcerative colitis have relatively mild symptoms. The symptoms of ulcerative colitis tend to come and go, with fairly long periods in between flare-ups in which patients may experience no distress at all. These periods of remission can span months or even years, although symptoms do eventually return. Of note is that the disease is not always limited to the GI tract; it can also affect the joints, eyes, skin, and liver.

What Are The Risk Factors of Ulcerative Colitis?

It is estimated that as many as one million Americans have IBD — with that number evenly split between Crohn’s disease and ulcerative colitis. Males and females appear to be affected equally. The usual age of diagnosis with ulcerative colitis is in the mid-30’s, although the disease can occur at any age. Men are more likely than women to be diagnosed with ulcerative colitis in their 50s and 60s. The incidence is greater in whites than non-whites, and a higher incidence is found in Jews than in non-Jews.

IBD tends to run in families. Studies have shown that up to 20 percent of patients with ulcerative colitis will have a close relative with either Crohn’s disease or ulcerative colitis. There is no way to predict which, if any, family members will develop ulcerative colitis.

How is Ulcerative Colitis Diagnosed?

The diagnosis of ulcerative colitis is based on the patient’s clinical history, a physical exam and a series of tests which usually includes: stool studies, blood tests, and a colonoscopy.  Doctors rely on a combination of the patient’s history and physical exam, results of laboratory tests, X-rays (small bowel series), colonoscopy and recently, small bowel capsule endoscopy.

What Are Possible Treatments For Ulcerative Colitis?

Medications Used To Treat Ulcerative Colitis

Currently, there is no cure for ulcerative colitis. The goal of medical treatment, therefore, is to modulate the inflammatory response. Several groups of drugs are used to treat ulcerative colitis. They are:

1. 1. Aminosalicylates (5-ASA): These medications typically are used to treat mild to moderate symptoms.
   2. Corticosteroids: These drugs have significant short and long-term side effects and should not be used as a maintenance medication.
   3. Immune modifiers: Azathioprine (Imuran®), 6-MP (Purinethol®), and methotrexate are used to help decrease corticosteroid dosage and also to help heal fistulas. In addition, immune modifiers can help maintain disease remission.
   4. Antibiotics: metronidazole, ciprofloxacin, ampicillin, others.
   5. Biologic therapies. Infliximab (Remicade®). Infliximab is used for people with moderate-to-severe ulcerative colitis.

Role of Surgery

In one-quarter to one-third of patients with ulcerative colitis, medical therapy is not completely successful or complications arise. Under these circumstances, surgery may be considered. This operation involves the removal of the colon (colectomy). Ulcerative colitis is “cured” once the colon is removed.

Steps To Help With Ulcerative Colitis and Proctitis

Nutrition

There is no evidence that any particular foods cause or contribute to ulcerative colitis. Paying special attention to diet may help reduce symptoms, replace lost nutrients, and promote healing. Maintaining proper nutrition is important for the medical management of ulcerative colitis.

Except for restricting milk in lactose-intolerant patients, or restricting coffee when severe diarrhea occurs, most gastroenterologists recommend a well-balanced diet. A healthy diet should contain a variety of foods from all food groups. Meat, fish, poultry, and dairy products (if tolerated) are sources of protein; bread, cereal, starches, fruits, and vegetables are sources of carbohydrate; margarine and oils are sources of fat.

Emotional Factors

There is no evidence to show that stress, anxiety, or tension is responsible for ulcerative colitis. However, they may contribute to an exacerbation of the disease. The emotional distress that patients sometimes feel may be a reaction to the symptoms of the disease itself. Although formal psychotherapy is generally not necessary, some patients are helped considerably by speaking with a therapist who is knowledgeable about IBD or about chronic illness in general.

Symptoms, Treatment, Living With It & Diagnosis

Overview

The large intestine (also called the colon) consists of the ascending, transverse, descending,and sigmoid colon. The rectum is the last portion of the large intestine.

The large intestine (also called the colon) consists of the ascending, transverse, descending and sigmoid colon. The rectum is the last portion of the large intestine.

What is ulcerative colitis?

Ulcerative colitis (UC) causes irritation and ulcers (open sores) in the large intestine (also called the colon). It belongs to a group of conditions called inflammatory bowel disease (IBD). It often causes diarrhea with blood, cramping and urgency. Sometimes these symptoms can wake a person up at night to go to the bathroom as well.

The inflammation in ulcerative colitis usually starts in the rectum, which is close to the anus (where poop leaves your body). The inflammation can spread and affect a portion of, or the entire colon. When the inflammation occurs in the rectum and lower part of the colon it is called ulcerative proctitis. If the entire colon is affected it is called pancolitis. If only the left side of the colon is affected it is called limited or distal colitis.

The severity of UC depends on the amount of inflammation and the location. Everyone is a little different. You could have severe inflammation in the rectum (small area) or very mild inflammation in the entire colon (large area).

If you have ulcerative colitis, you may notice a pattern of flare-ups (active disease), when symptoms are worse. During times of remission, you might have little to no symptoms. The goal with therapy is to remain in remission as long as possible (years).

About half of the people diagnosed with ulcerative colitis have mild symptoms. Others suffer frequent fevers, bloody diarrhea, nausea and severe abdominal cramps. Ulcerative colitis may also cause problems such as arthritis, inflammation of the eye, liver disease and osteoporosis. It is not known why these problems occur outside the colon. Scientists think these complications may be the result of inflammation triggered by the immune system. Some of these problems go away when the colitis is treated.

Ulcerative colitis can occur in people of any age, but it usually starts between the ages of 15 and 30, and less frequently between 50 and 70 years of age. It affects men and women equally and appears to run in families, with reports of up to 20% of people with ulcerative colitis having a family member or relative with ulcerative colitis or Crohn’s disease. In addition, about 20% of patients are diagnosed before they are 20 years old and it can occur in children as young as two years of age.

What’s the difference between colitis and ulcerative colitis?

Colitis means your colon is inflamed, or irritated. This can be caused by many things, such as infections from viruses or bacteria. Ulcerative colitis is more severe because it is not caused by an infection and is lifelong.

How common is ulcerative colitis?

Ulcerative colitis isn’t an uncommon condition. Together with Crohn’s disease, another type of inflammatory bowel disease, it affects up to 1 in 250 people in North America and Europe.

Who gets ulcerative colitis?

Anyone at any age, including young children, can get ulcerative colitis. Your chance of getting it is slightly higher if you:

• Have a close relative with inflammatory bowel disease (IBD).
• Are between 15 and 30 years old, or older than 60.
• Are Jewish.
• Eat a high-fat diet.
• Use frequent nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen (Advil® or Motrin®).

Symptoms and Causes

What causes ulcerative colitis?

Researchers think the cause of ulcerative colitis is complex and involves many factors. They think it’s probably the result of an overactive immune response. The immune system’s job is to protect the body from germs and other dangerous substances. But, sometimes your immune system mistakenly attacks your body, which causes inflammation and tissue damage.

What are the symptoms of ulcerative colitis?

Ulcerative colitis symptoms often get worse over time. In the beginning, you may notice:

• Diarrhea or urgent bowel movements.
• Abdominal (belly) cramping.
• Tiredness.
• Nausea.
• Weight loss.
• Anemia (reduced number of red blood cells).

Later you may also have:

• Blood, mucous, or pus in bowel movements.
• Severe cramping.
• Fever.
• Skin rashes.
• Mouth sores.
• Joint pain.
• Red, painful eyes.
• Liver disease.
• Loss of fluids and nutrients.

Symptoms are similar in pediatric ulcerative colitis and may also include delayed or poor growth. Some ulcerative colitis symptoms in children can mimic other conditions, so it is important to report all symptoms to your pediatrician.

Diagnosis and Tests

How is ulcerative colitis diagnosed?

To diagnose ulcerative colitis in children, teenagers and adults, your healthcare provider has to rule out other illnesses. After a physical exam, your provider may order:

• Blood tests: Your blood can show signs of infection or anemia. Anemia is a low level of iron in your blood. It can mean you have bleeding in the colon or rectum.
• Stool samples: Signs of infection, parasites (tiny organisms that can live in a person’s body), and inflammation can show up in your poop.
• Imaging tests: Your healthcare provider may need a picture of your colon and rectum. You may have tests including a magnetic resonance imaging (MRI) scan or computed tomography (CT) scan.
• Endoscopic tests: An endoscope is a thin, flexible tube with a tiny camera. Specialized doctors can slide the endoscope in through the anus to check the health of the rectum and colon. Common endoscopic tests include colonoscopy and sigmoidoscopy.

Who diagnoses ulcerative colitis?

If you have symptoms of ulcerative colitis, your regular healthcare provider will probably refer you to a specialist. A gastroenterologist — a doctor who specializes in the digestive system — should oversee the care for adults. For young patients, a pediatric gastroenterologist who specializes in children should manage the care.

Management and Treatment

How is ulcerative colitis treated?

There’s no cure for ulcerative colitis, but treatments can calm the inflammation, help you feel better and get you back to your daily activities. Treatment also depends on the severity and the individual, so treatment depends on each person’s needs. Usually, healthcare providers manage the disease with medications. If your tests reveal infections that are causing problems, your healthcare provider will treat those underlying conditions and see if that helps.

The goal of medication is to induce and maintain remission, and to improve the quality of life for people with ulcerative colitis. Healthcare providers use several types of medications to calm inflammation in your large intestine. Reducing the swelling and irritation lets the tissue heal. It can also relieve your symptoms so you have less pain and less diarrhea. For children, teenagers and adults, your provider may recommend:

• Aminosalicylates: For mild to moderate ulcerative colitis, your healthcare provider may prescribe sulfasalazine (Azulfidine®). Let your provider know if you’re allergic to sulfa. He or she can prescribe a sulfa-free aminosalicylate instead, such as mesalamine (Canasa®, Delzicol®, Asacol® HD, Pentasa®, Lialda®, Apriso®). The medications come in both pill form and enema or suppository form, which can better reach the inflammation low down in the colon or rectum.
• Corticosteroids: If you have a severe form of ulcerative colitis, you may need a corticosteroid such as prednisone (Deltasone®) or budesonide (Entocort® EC, Uceris®). Because corticosteroids have serious side effects, healthcare providers only recommend them for short-term use. Other medications will be used to help maintain the remission.
• Immunomodulators: Your healthcare provider may recommend an immunomodulator. These medicines include 6-mercaptopurine (Purixan®, Purinethol®), azathioprine (Azasan® and Imuran®), or methotrexate (Trexall®). These medications help calm the overactive immune system.
• Biologics: Biologics treat moderate to severe ulcerative colitis by targeting parts of the immune system to quiet it down. Medications like infliximab (Remicade®), adalimumab (Humira®), golimumab (Simponi®), certolizumab pegol (Cimzia ®), vedolizumab (Entyvio®), and ustekinumab (Stelara®) are biologics.
• Janus kinase (JAK) inhibitors: Drugs like tofacitinib (Xeljanz®) stop one of your body’s enzymes (chemicals) from triggering inflammation.

Children and young teenagers are prescribed the same medications. In addition to medications, some doctors also recommend that children take vitamins to get the nutrients they need for health and growth that they may not have gotten through food due to the effects of the disease on the bowel. Ask your healthcare provider for specific advice about the need for vitamin supplementation for your child.

You might need surgery that removes your colon and rectum to:

• Avoid medication side effects.
• Stop uncontrollable symptoms.
• Prevent or treat colon cancer (people with ulcerative colitis are at greater risk).
• Eliminate life-threatening complications such as bleeding.

Can I get surgery for my ulcerative colitis?

Surgery is an option if medications aren’t working or you have complications, such as bleeding or abnormal growths. You might develop precancerous lesions, or growths that can turn into colorectal cancer. A doctor can remove these lesions with surgery (a colectomy) or during a colonoscopy.

Research shows that about 30% of people with ulcerative colitis need surgery sometime during their life. About 20% of children with ulcerative colitis will need surgery during their childhood years.

There are two kinds of surgery for ulcerative colitis:

Proctocolectomy and ileoanal pouch

The proctocolectomy and ileoanal pouch (also called J-pouch surgery) is the most common procedure for ulcerative colitis. This procedure typically requires more than one surgery, and there are several ways to do it. First, your surgeon does a proctocolectomy — a procedure that removes your colon and rectum. Then the surgeon forms an ileoanal pouch (a bag made from a part of the small intestine) to create a new rectum. While your body and newly made pouch is healing, your surgeon may perform a temporary ileostomy at the same time. This creates an opening (stoma) in your lower belly. Your small intestines attach to the stoma, which looks like a small piece of pink skin on your belly.

After you heal, waste from your small intestines comes out through the stoma and into an attached bag called an ostomy bag. The small bag lies flat on the outside of your body, below your beltline. You’ll need to wear the bag at all times to collect waste. You’ll have to change the bag frequently throughout the day.

Your medical team will teach you how to care for the stoma and empty the attached bag. You can also use a fabric cover for the pouch so that even when you’re undressed, the waste isn’t visible. With proper care, the pouch doesn’t smell and isn’t noticeable under clothes.

Once you and the ileoanal pouch have healed, your surgeon will discuss taking down the ileostomy.

Your new ileoanal pouch still collects stool. That allows waste to exit your body through your anus as it would normally. Afterward, because you have less space in your large intestine to store poop, you’ll have frequent bowel movements (on average four to eight times a day once your body has adjusted). But you should feel a lot better when you recover from the surgery. The pain and cramping from ulcerative colitis should be gone.

Proctocolectomy and ileostomy

If an ileoanal pouch won’t work for you, your healthcare team might recommend a permanent ileostomy (without an ileoanal pouch). Your surgeon does a proctocolectomy to remove your colon and rectum. The second part of this surgery, done at the same time, is to perform a permanent ileostomy (as described above).

Prevention

What causes ulcerative colitis flareups?

When you’re in remission from ulcerative colitis, you’ll want to do everything you can to prevent a flareup. Things that may cause a flareup include:

• Emotional stress: Get at least seven hours of sleep a night, exercise regularly and find healthy ways to relieve stress, such as meditation.
• NSAID use: For pain relief or a fever, use acetaminophen (Tylenol®) instead of NSAIDs like Motrin® and Advil®.
• Antibiotics: Let your healthcare provider know if antibiotics trigger your symptoms.

What role does diet and nutrition play in ulcerative colitis?

Diet does not cause the development of ulcerative colitis nor can any special diet cure the disease. However, the foods you or your child eat may play a role in managing symptoms and lengthening the time between flareups.

Some foods may make symptoms worse and should be avoided, especially during flareups. Foods that trigger symptoms are different from person to person. To narrow down what foods affect you, keep track of what you eat each day and how you feel afterward (a food journal).

Problem foods often include:

• Greasy foods.
• High sugar foods and drinks.
• Carbonated beverages.
• High-fiber foods.
• Alcohol.

In addition to the problem foods listed above, infants, children and teenagers can also experience issues with:

Keep a careful eye on your child’s diet and nutrition. Their appetite may decrease during a flareup and they might not eat enough to stay healthy, and grow. Also, the inflammation caused by ulcerative colitis may keep their digestive tract from absorbing enough nutrients. This can also affect your child’s health. For these reasons, you may have to increase the amount of calories your child consumes.

It’s best to work with your provider and nutritionist to come up with a personalized diet plan if you or your child has ulcerative colitis.

Outlook / Prognosis

What can I expect if I have a diagnosis of ulcerative colitis?

Ulcerative colitis is a lifelong condition that can have mild to severe symptoms. For most people, the symptoms come and go. Some people have just one episode and recover. A few others develop a nonstop form that rapidly advances. In up to 30% of people, the disease spreads from the rectum to the colon. When both the rectum and colon are affected, ulcerative symptoms can be worse and happen more often.

You may be able to manage the disease with medications. But surgery to remove your colon and rectum is the only “cure.” About 30% of people with ulcerative colitis need surgery.

Living With

When should I call my doctor about my ulcerative colitis?

Call your healthcare provider immediately if you have:

• Heavy, persistent diarrhea.
• Blood leaking from your anus with clots of blood in your stool.
• Constant pain and a high fever.

What is the best diet for ulcerative colitis?

There’s no single diet that works best for ulcerative colitis. If the disease damages the lining of the colon, your body might not absorb enough nutrients from food. Your healthcare provider may recommend supplemental nutrition or vitamins. It’s best to work with your provider and nutritionist to come up with a personalized diet plan.

How often do I need a colonoscopy?

Especially when you have symptoms or are just starting or changing medications, your doctor may want to periodically look at the inside of the rectum and colon to make sure the treatments are working and the lining is healing. How often this is needed is different for each person.

Ulcerative colitis also increases your chance of developing colon cancer. To look for early cancer signs, your healthcare provider may have you come in for a colonoscopy (a procedure to check the health of the colon) every one to three years.

How does pediatric ulcerative colitis affect my child’s mental/emotional health?

Like many conditions, ulcerative colitis can have a negative psychological effect, especially on children. They can experience physical, emotional, social and family problems. Because of the medications and/or general stress from the situation, your child may experience:

• Mood swings.
• Teasing from classmates.
• Anger, embarrassment and frustration.
• Worry about appearance and physical stamina.
• Vulnerability because their body doesn’t function normally.
• Poor concentration.
• Misunderstandings with friends and family.

Children need mutual support from all family members. It’s helpful for the entire family to learn about the disease and try to be empathetic. Seek out a psychiatrist and therapist to help your child manage such challenges of their ulcerative colitis.

Does ulcerative colitis make you immunocompromised?

Ulcerative colitis doesn’t make you immunocompromised. Some of the medicines that treat it may change the way your immune system responds. This change is different for each medication. Some of these changes may increase the risk of certain infections or other issues. A discussion with your health care team before starting a medication is the best way to understand these risks and ways to prevent them.

What should I ask my doctor?

If you have ulcerative colitis, you may want to ask your healthcare provider:

• How much of my large intestine is affected?
• What risks or side effects can I expect from the medication?
• Should I change my diet?
• Will ulcerative colitis affect my ability to get pregnant?
• What can I do at home to manage my symptoms?
• What are my surgical options?

What should I ask my doctor on behalf of my child or teenager?

Ask your healthcare provider the following questions in addition to the ones listed above:

• What vitamins should my child take?
• Will my other children have pediatric ulcerative colitis?
• Is my child at risk for other conditions?
• Can you recommend a psychiatrist or therapist to help my child with emotional issues related to pediatric ulcerative colitis?
• Is my child growing at a normal rate?
• What can I do to help my child cope at school?

A note from Cleveland Clinic

When you have ulcerative colitis, it’s essential to work closely with your healthcare team.

Take your medications as prescribed, even when you don’t have symptoms. Skipping medications you’re supposed to take can lead to flareups and make the disease harder to control. Your best shot at managing ulcerative colitis is to follow your treatment plan and talk to your healthcare provider regularly.

Resources

Cleveland Clinic Podcasts

Visit our Butts & Guts Podcasts page to learn more about digestive conditions and treatment options from Cleveland Clinic experts.

Colitis Diet | Meal Plan, Food to Eat & Avoid, PDF

More information about Ulcerative Colitis

According to George Washington University, colitis is a chronic digestive disease characterized by inflammation of the inner lining of the colon. Infection, loss of blood supply in the colon, Inflammatory Bowel Disease (IBD) and invasion of the colon wall with collagen or lymphocytic white blood cells are all possible causes of an inflamed colon.

The following diseases fall into the colitis/IBD category; they all can be treated with a combination of medication and improvements to your eating habits:

Ulcerative colitis:

Ulcerative colitis is a chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation and ulcers on the inner lining of your large intestine. Ulcerative colitis can develop at any age, but the disease is more likely to develop in people between the ages of 15 and 30. Read more below!

Crohn’s colitis:

Crohn’s disease is an inflammatory bowel disease that causes chronic inflammation of the gastrointestinal tract. Recent research suggests hereditary, genetic, and environmental factors contribute to Crohn’s disease development. In people with Crohn’s, harmless bacteria are mistaken for foreign invaders and the immune system mounts a response. The inflammation caused by the immune response does not go away. This leads to chronic inflammation, ulceration, and thickening of the intestinal wall.

Diversion colitis:

Diversion colitis involves inflammation in the large intestine brought on after surgical treatment that diverts the fecal stream away from the large intestine, usually to a temporary ileostomy or colostomy. It should not be confused with being a type of inflammatory bowel disease (IBD), even though it often mimics the symptoms of IBD. Diversion colitis can occur after surgical treatment for intestinal-related conditions such as fecal incontinence, bowel cancer, or spontaneous chronic constipation that is not related to an obvious underlying cause.

Ischemic colitis:

Ischemic colitis (IC) is an inflammatory condition of the large intestine, or colon. It develops when there isn’t enough blood flow to the colon. IC can occur at any age, but it’s most common among those over the age of 60.A buildup of plaque inside the arteries (atherosclerosis) can cause chronic, or long-term, IC. This condition may also go away with mild treatment, such as a short-term liquid diet and antibiotics.

Infectious colitis:

Colonic infection by bacteria, viruses, or parasites results in an inflammatory-type of diarrhea and accounts for the majority of cases presenting with acute diarrhea. These patients present with purulent, bloody, and mucoid loose bowel motions, fever, tenesmus, and abdominal pain.

Fulminant colitis:

Fulminant colitis is a somewhat rare but serious form of ulcerative colitis (UC). UC causes inflammation and sores in the lining of the colon. It doesn’t happen to most people who have UC. Less than 10% of people with it get fulminant colitis, usually during their first attack of symptoms. The whole lining of the colon becomes inflamed, causing severe symptoms like bloody diarrhea and belly pain. Fulminant colitis is a medical emergency. You’ll need to go to a hospital right away for treatment with medicine, and possibly surgery.

Collagenous colitis:

Collagenous colitis (CC) is a condition that affects your large intestine. It leads to episodes of watery diarrhea and belly pain. Your large intestine is part of your digestive (gastrointestinal or GI) tract. The GI tract goes from your mouth all the way to your rectal opening. The large intestine includes both the colon and the rectum. The large intestine receives the broken-down products of food from the small intestine. One of its main jobs is to reabsorb water and electrolytes, such as salt. The colon leads to the rectum. The rectum stores your bowel movements before your body eliminates them. In Collagenous colitis, inflammatory cells from your immune system travel to your large intestine. There they cause swelling and inflammation. In rare cases, these cells also go into the latter part of your small intestine.

Chemical colitis:

Chemical colitis is a type of colitis, an inflammation of the large intestine or colon, caused by the introduction of harsh chemicals to the colon by an enema or other procedure. Chemical colitis can resemble ulcerative colitis, infectious colitis and pseudomembranous colitis endoscopically.

Microscopic colitis:

Microscopic colitis is an inflammation of the large intestine (colon) that causes persistent watery diarrhea. The disorder gets its name from the fact that it’s necessary to examine colon tissue under a microscope to identify it, since the tissue may appear normal with a colonoscopy or flexible sigmoidoscopy. There are different subtypes of microscopic colitis: Collagenous colitis, in which a thick layer of protein (collagen) develops in colon tissue; Lymphocytic colitis, in which white blood cells (lymphocytes) increase in colon tissue; Incomplete microscopic colitis, in which there are mixed features of collagenous and lymphocytic colitis.

Lymphocytic colitis:

In lymphocytic colitis, inflammatory cells from your immune system travel to your large intestine. Here they cause swelling and inflammation of the tissues. In rare cases, these cells also invade the latter part of the small intestine. Immune cells (lymphocytes) may build up in the area as well. The inflammation may keep your large intestine from reabsorbing as much water as it should. This leads to diarrhea, belly pain, and other symptoms.

90,000 Ulcerative colitis, symptoms – Health Clinic 365 Yekaterinburg

Ulcerative colitis (NUC) is an inflammatory bowel disease (IBD) that, like Crohn’s disease, causes chronic inflammation of the digestive tract. symptoms of ulcerative colitis include, first of all, abdominal pain and diarrhea. In addition, if ulcerative colitis is severe, the patient may have fever, tachycardia (heart palpitations), and weight loss and wasting.Sometimes NUC also leads to life-threatening complications.

The pathological process in ulcerative colitis usually affects only the mucous membrane of the large intestine. Unlike UC, in Crohn’s disease, the affected area can be anywhere in the digestive tract and often spreads gradually into the deep layers of the intestinal wall.

Currently, there are no known cures for ulcerative colitis, but the available treatments can significantly reduce existing symptoms and even lead to long-term remission.

The large intestine consists of the cecum, colon and rectum. And the colon consists of four sections: the ascending colon, the transverse colon, the descending colon, and the sigmoid colon.

1 – cecum

2 – ascending part of the colon

3 – transverse part of the colon

4 – the descending part of the colon

5 – sigmoid colon,

6 – rectum

The symptoms of ulcerative colitis depend on the severity of inflammation of the intestinal wall and its location.

Classification of ulcerative colitis according to the severity of the course:

• Mild course – an admixture of blood is noted in less than 4 portions of feces per day.
• Average current – blood admixture is noted in more than 4 portions of feces per day.
• Severe course – an admixture of blood is noted in more than 4 portions of feces per day, a decrease in the level of albumin (blood protein fraction) is less than 30 g / l.

In addition, doctors classify ulcerative colitis according to the location of the lesions

Symptoms in ulcerative colitis, depending on the localization of the pathological process:

Ulcerative proctitis .In this form of ulcerative colitis, inflammation is limited to the lining of the rectum, and for some people, rectal (rectal) bleeding may be the only symptom of the disease. Also, the patient may feel pain in the rectal area, tenesmus (painful urge to defecate without stool discharge). This form of ulcerative colitis is usually mild.

Proctosigmoiditis . This type of UCN involves inflammation of the rectum and lower colon, i.e., inflammation of the rectum.e. of the sigmoid colon. It is characterized by symptoms such as loose stools with blood, abdominal pain and tenesmus.

Left-sided colitis . As the name suggests, inflammation spreads to the rectum, sigmoid colon, and descending colon. With left-sided colitis, the patient is worried about: diarrhea mixed with blood, spastic pain in the left abdomen, weight loss.

Pancolite . With this type of NUC, the pathological process captures the entire colon, the characteristic symptoms are: frequent diarrhea with an admixture of blood, abdominal pain, fatigue and significant weight loss.

Fulminant colitis (rapidly progressive, acute). It is a rare, life-threatening form of NUC in which inflammation spreads to the entire large intestine. This pathological process causes severe abdominal pain, profuse diarrhea (loose stools), and sometimes dehydration and shock. People with acute colitis are at risk of serious complications, including possible rupture of the intestine and toxic megacolon. These complications occur when the colon loops are severely swollen.

In NUC, periods of exacerbation of the disease alternate with periods of remission, the patient’s symptoms depend on the stage of the disease at the moment. But over time, the severity of the disease tends to remain the same. Most people with mild disease (such as ulcerative proctitis) will never develop severe colon disease such as pancolitis.

When to see a doctor.

See your doctor if you experience persistent bowel changes or if you have any signs and symptoms of ulcerative colitis, such as:

• Abdominal pain
• Blood in the stool
• An attack of diarrhea (loose stools) that does not work with conventional over-the-counter drugs.
• Unexplained fever lasting more than two days.

Although ulcerative colitis is usually not a life-threatening disease, in some cases it can cause serious complications, and it can also mask more severe diseases of the colon, such as colon cancer.

Differences between ulcerative colitis and Crohn’s disease

Ulcerative colitis

Ulcerative colitis, or ulcerative colitis (UC), is a chronic inflammatory disease of the colon mucosa resulting from interactions between genetic and environmental factors, characterized by exacerbations.It is found in 35 – 100 people for every 100,000 inhabitants, that is, it affects less than 0.1% of the population. Currently, in the English-language literature, the more correct term is “ulcerative colitis”.

Etiology

The etiology of UC is not precisely known. The following reasons are currently being considered:

1) Genetic predisposition (the presence of Crohn’s disease or ulcerative colitis in relatives increases the patient’s risk of developing ulcerative colitis). A large number of genes are being studied, for which a connection with the development of the disease is revealed.However, at present, the role of only genetic factors has not been proven, that is, the presence of mutations in a particular gene will not necessarily cause the development of ulcerative colitis;

2) The use of non-steroidal anti-inflammatory drugs for a long time increases the risk of developing the disease. Short courses of these drugs are probably safe;

3) Bacteria, viruses? – the role of these factors is not completely clear, but there is no evidence to date; Food allergies (milk and other foods), stress can provoke the first attack of the disease or its exacerbation, but do not play the role of an independent risk factor for the development of ulcerative colitis.Immunological disorders and autosensitization are factors that are undoubtedly involved in the pathogenesis of the disease;

Pathological Anatomy

In the acute stage of ulcerative colitis, exudative edema and plethora of the mucous membrane with thickening and smoothing of the folds are noted. As the process develops or becomes chronic, destruction of the mucous membrane increases and ulcerations are formed, penetrating only to the submucosal or, less often, to the muscle layer. Chronic ulcerative colitis is characterized by the presence of pseudopolyps (inflammatory polyps).They are islands of the mucous membrane, preserved during its destruction, or a conglomerate formed as a result of excessive regeneration of the glandular epithelium. In severe chronic disease, the intestine is shortened, its lumen is narrowed, there are no haustra. The muscularis is usually not involved in the inflammatory process. Ulcerative colitis strictures are uncommon. With ulcerative colitis, any part of the colon can be affected, but the rectum is always involved in a pathological process that has a diffuse continuous character.The intensity of inflammation in different segments can be different; changes gradually pass into the normal mucous membrane, without a clear border. Histological examination in the phase of exacerbation of ulcerative colitis in the mucous membrane reveals expansion of capillaries and hemorrhages, the formation of ulcers as a result of epithelial necrosis and the formation of crypt abscesses. There is a decrease in the number of goblet cells, infiltration of the lamina propria by lymphocytes, plasma cells, neutrophils and eosinophils.In the submucosal layer, the changes are insignificant, with the exception of cases of penetration of the ulcer into the submucosa.

Symptoms:

• Frequent diarrhea or mushy stools mixed with blood, pus and mucus.
• “False urge” to defecate, “imperative” or compulsory urge to defecate.
• pain in the abdomen (usually in the left half).
• fever (temperature from 37 to 39 degrees, depending on the severity of the disease).
• decreased appetite.
• weight loss (with prolonged and severe course).
• water-electrolyte disturbances of varying degrees.
• general weakness
• joint pain

Diagnostics

The diagnosis of ulcerative colitis in most cases is straightforward. Clinically, it is manifested by the presence of blood and mucus in the stool, increased stool frequency, and abdominal pain.Objective confirmation of the diagnosis occurs after fibroilecolonoscopy with examination of the ileum and histological examination of biopsy specimens; up to this point, the diagnosis is preliminary.

In the clinical analysis of blood – signs of inflammation (an increase in the total number of leukocytes, stab leukocytes, platelets, increased ESR) and anemia (a decrease in the level of erythrocytes and hemoglobin).

In the biochemical analysis of blood, there are signs of an inflammatory process (an increase in the level of C-reactive protein, gamma globulins), anemia (a decrease in the level of serum iron), immune inflammation (circulating immune complexes, class G immunoglobulins are increased).

One of the modern markers for the diagnosis of inflammatory bowel diseases (including ulcerative colitis) is fecal calprotectin. With an exacerbation, its level rises (above 100-150).

In some cases, the diagnosis of ulcerative colitis may be wrong. Other pathologies mimic this disease, in particular, acute intestinal infections (dysentery), protozoal invasions (amoebiasis), Crohn’s disease, helminthic invasions, colon cancer.

To exclude infections, it is necessary to obtain a negative culture of feces, the absence of antibodies to pathogens in the blood.A number of intestinal infections are identified or excluded by determining the pathogen by PCR in feces. The same method determines the presence of helminths in the feces (it is also advisable to determine antibodies to helminths in the patient’s blood). It must be remembered that the identification of helminths does not exclude the diagnosis of ulcerative colitis.

Differential diagnosis between ulcerative colitis and Crohn’s disease is difficult. Ulcerative colitis affects only the large intestine (in rare cases, with total defeat of the colon, retrograde ileitis is observed, when ileocolonoscopy reveals nonspecific inflammation of the ileal mucosa).Ulcerative colitis is characterized by continuous lesion of the colon mucosa, whereas in Crohn’s disease it is most often segmental lesion (for example, sigmoiditis and ileitis). It is also important to conduct a histological study taken from different parts of the colon and ileum. Determination of specific antibodies often helps distinguish ulcerative colitis from Crohn’s disease. For example, antibodies to the cytoplasm of neutrophils with a perinuclear type of fluorescence (p-ANCA) are more characteristic of ulcerative colitis (detected in 35-85% of patients), and in Crohn’s disease they are found only in 0-20% of cases.

Patient notes | p4spb

CROWN DISEASE.

Crohn’s disease is a chronic inflammatory disease that mainly affects the gastrointestinal tract. Although any part of the gastrointestinal tract, from the mouth to the anal canal (anus), can be involved, most often the end of the small intestine (ileum) and / or the large intestine (colon and rectum) is affected.

Crohn’s disease is a chronic disease and can be exacerbated many times during a

life.Some patients have long-term remissions, sometimes for several years, without any symptoms of the disease. It is not possible to predict when remission will begin or when symptoms of the disease will return. What are the symptoms of Crohn’s disease?

Since Crohn’s disease can affect any part of the digestive tract, symptoms of the disease can vary dramatically from one patient to another. The most common symptoms are cramps, abdominal pain, diarrhea (diarrhea) mixed with blood and mucus, fever, weight loss, and bloating.However, not all patients experience all of these symptoms, and some do not experience any of them. Other symptoms may include pain in or out of the anus, skin lesions, rectal abscess, anal fissure, and joint pain (arthritis).

General symptoms of Crohn’s disease:

• Abdominal pain

• Diarrhea

• Fever

• Weight loss

• Bloating

• Pain in the anus during bowel movements

• Lesions of the perianal skin

• Abscesses of the rectum

• Anal fissure

• Joint pain

Who is affected by the disease?

The disease affects all age groups, but most of the patients are young people between the ages of 16 and 40.Crohn’s disease occurs most commonly in people living in northern countries. The disease affects men and women equally and is often common in some families. About 20 percent of patients with Crohn’s disease have a relative, most often a brother or sister, and sometimes a parent or child, with some form of inflammatory bowel disease.

Crohn’s disease and a similar disease ulcerative colitis are often described collectively as inflammatory bowel disease.About two million people in the United States alone suffer from Crohn’s disease or ulcerative colitis.
What causes Crohn’s disease?

The exact cause of the disease is not known. Today, the most common theories of the onset of the disease are based on immunological and / or bacterial causes. Crohn’s disease is not contagious; it has a minor genetic (hereditary) predisposition. An x-ray of the small intestine can be used to diagnose Crohn’s disease.
How is Crohn’s disease treated?

Initial treatment is almost always conservative (non-surgical). Currently, there is no universal treatment for Crohn’s disease, but therapy with one or more drugs is aimed at early treatment of the disease and relief of its symptoms. The most common drugs are corticosteroids such as prednisolone and methylprednisolone, as well as various anti-inflammatory drugs.

Other drugs are often used, such as 6-mercaptopurine and azathioprine, which have immunosuppressive effects. Metronidazole, an antibiotic that acts on the immune system, is often effective in patients with perianal Crohn’s disease.

Surgery may be indicated for more common and complex cases of Crohn’s disease. Sometimes, with the development of formidable complications of the disease, such as bleeding, acute intestinal obstruction or bowel perforation, it is necessary to perform emergency surgical interventions.

Other, less urgent indications for surgery include the formation of abscesses, intestinal fistulas (pathological messages from various parts of the gastrointestinal tract), severe forms of perianal lesions, and the absence of the effect of conservative treatment.

Not all patients with complicated Crohn’s disease require surgery. This decision is best made after consulting a gastroenterologist and coloproctologist surgeon.
Should we try to avoid CD surgery at all costs?

Although medical (conservative) treatment is preferred as an initial step, it is important to understand that about 3/4 of all patients eventually need surgical treatment.Many patients mistakenly believe that surgery for Crohn’s disease is dangerous or inevitably leads to complications.

Surgery is not a “panacea”, but many patients will not need additional surgeries after one operation. The most common treatment is conservative therapy with limited bowel resection (removal of only the affected area of ​​the bowel).

Surgical treatment often results in long-term relief of Crohn’s disease symptoms, reducing or eliminating the need for continued medication.Surgical treatment is best performed by a coloproctologist surgeon who works in a clinic that has experience in the complex treatment of patients with Crohn’s disease.

How to gain weight with NUC and CD?

Rice

Surely many of the people with ulcerative colitis (UC) and Crohn’s disease (CD) want to gain weight. However, attempts are in vain, and the patient becomes depressed or, even worse, continues to lose weight.

So how can you gain weight with NUC and CD? Today I will offer you a number of working methods that I used in exacerbation and I use to this day, but already in remission.Despite the fact that there is nothing supernatural in the information below, many patients with inflammatory bowel disease ask the same type of questions. Let’s dot the “i” s!

Remission

Of course, the most obvious and most productive way to gain weight is to go into remission. Your body regains the function, lost during an exacerbation, to properly assimilate food, saturating itself with the necessary amount of BJU (proteins, fats and carbohydrates), vitamins and minerals.If, even while in remission, you cannot gain the cherished kilograms, pay attention to the required number of calories, calculating the need.

“Liquid” diet

A few words about the “liquid” diet were said in the article “How to eat with CD”. Its main concept is that a person will receive all the necessary nutrients from liquid food, which, in turn, will minimize the load on the gastrointestinal tract system .

In fact, there is “where to roam”: you can grind almost any food, making an impromptu cocktail from the ingredients.In addition, there is a wide variety of ready-made mixtures on sale. Among them:

• Nutrien.
• Pentamen.
• Nutridrink.
• Alfare.
• Modular.
• Nutricomp and many others other

If you like to take risks and are ready to experiment on yourself, you can try popular sports nutrition such as protein and gainer. As a rule, in addition to BJU, sports nutrition contains a wide variety of different vitamins and amino acids.This is due to the fact that athletes require a lot more nutrients than “normal” people. However, it is just for the benefit of people with NNC and BC!

Reusable Meals

If your goal is to gain weight, the standard breakfast-lunch-dinner scheme will not work for you. You should eat 5-6 times a day in medium, let’s say, portions. We focus on complex carbohydrates and animal proteins.

“Complex” carbohydrates are those that are not absorbed immediately, but over a long period of time.You can get complex carbohydrates from buckwheat, rice, pasta. I would advise you to pay attention to brown rice . In fact, this is the same ordinary rice that we all know, but with one big difference – brown rice does not undergo such a strong grinding. Thanks to this, the upper shell of rice and the embryo are preserved, in which all the nutrients and valuable substances of this product are concentrated. It is because of the color of the preserved shell that this rice is called “brown”.

It is still easier with animal proteins than with complex carbohydrates.Animal proteins can be obtained from animal products. For example, eggs, meat, fish, caviar, etc. Animal proteins differ from plant proteins in the most complete set of amino acids, which will have a positive effect both on the progress in weight gain and on your general well-being.

It should be noted that as the weight increases, the volume of BZHU required for the subsequent mass collection increases. Therefore, again, calculate your calorie needs, guided by a simple instruction.

I propose an example of a daily diet for weight gain with NUC and CD:

1. Breakfast. Oatmeal in water with butter, 2 boiled chicken eggs, white toasted bread with hard cheese.
2. Second breakfast. 100 g of chicken breast, 300 g of boiled buckwheat, butter, stewed carrots.
3. Lunch. Soup with meat, 200 g of chicken breast, 300 g of brown rice, 1 boiled chicken egg, stewed broccoli.
4. Afternoon snack. Black tea with breadcrumbs and hard cheese.
5. Dinner. 100 g of chicken breast, 300 g of boiled buckwheat, butter, stewed tomatoes.
6. Before bed. 300 g fat cottage cheese with honey, 1 boiled chicken egg.

Naturally, this diet can only be followed if the products included in it are well tolerated. By the way, check out our article on food allergies.

Minimizing calorie expenditure

With this point, in fact, everything is elementary. Calories are energy. We, even in a state of rest, need energy, i.e.because despite the fact that you, for example, are lying on the couch, your internal organs and systems are in working order.

As the load increases, the calorie intake increases. Walking or running, swimming or skydiving … Yes, even when you eat, you still waste energy.

In short, you should be consuming more calories than you expend. Of course, lying for days without movement is not only harmful, but also, for the most part, impossible (we will not take into account the “special”, not very happy, cases).I remember that during the most severe exacerbation in 2013, it was even difficult for me to sit down, let alone get up. Except for going to the restroom, I spent almost a month on the bed in the hospital. After being able to stand up again, my bones and joints ached for a couple of weeks.

You can learn more about calories from the article on gaining muscle mass with ectomorphs with NUC.

This will probably end. As it was said in the preface, I was not going to discover a new America here.I hope you will find application of the knowledge gained.

Treatment of ulcerative colitis in Moscow, Lyublino ☑

Disorders in the work of the gastrointestinal tract for modern people are not at all uncommon. Spicy, fried, fatty, smoked, salty – all these unhealthy foods provoke gastritis. This is the most common scenario, but it could be different. If the inflammatory process begins unnoticed by the patient and does not manifest itself for some time, this can lead to the development of ulcerative colitis.Colitis occurs as a result of inflammation left untreated. The sluggish course of the disease at an early stage contributes to its transformation into a chronic form. Colitis occurs with periods of exacerbations that occur in response to certain irritating factors.

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Types of colitis

There are four main types of colitis.Each of them can occur both on its own and in combination with other types of the disease. Depending on the localization of inflammation, colitis is of four types:

1. Left-hand.
2. Regional. It proceeds with a local lesion of the colon. A small area of ​​inflamed mucosa can expand over time and progress to a more serious stage.
3. Nonspecific ulcerative proctitis. Regional inflammation of the terminal region of the colon.
4. Total non-specific. Inflammation affects almost the entire surface of the large intestine, in some cases penetrates into the deeper layers of tissues. If you do not treat a mild regional form of colitis, the pathology develops into a total one.

The sooner the patient seeks help, the easier it will be to get rid of colitis.

According to the severity, colitis is divided into types:

• Light form. The stool becomes soft, infrequent, blood impurities may be observed.The indicators of clinical analyzes remain normal, the general well-being of the patient does not change.
• Medium severity. Loose stools with obvious blood impurities, fever may appear, blood test parameters change. The general condition is satisfactory, attacks of tachycardia and general weakness may occur.
• Severe form. The manifestations of anemia become pronounced, the patient suffers from severe diarrhea, the temperature may rise, the general condition becomes severe or very difficult.

In severe ulcerative colitis, urgent hospitalization and surgical treatment are indicated. Treatment for a mild form is carried out without inpatient treatment and takes a couple of weeks.

Ulcerative colitis is divided into types depending on the characteristics of the course:

• Acute form – the course of the disease with obvious sudden attacks. The decisive role is played by the influence of external irritating factors.
• Chronic. The course is sluggish, with periodic exacerbations. The main factor provoking the appearance of this form of colitis is a genetic predisposition.
• Recurrent form. Chronic colitis, which, under certain conditions, turns into acute, and when the provoking effect disappears, it returns to the chronic stage.

The most difficult to treat is recurrent and chronic colitis. This is due to the defeat of a sufficiently large area of ​​the mucous membrane and possible penetration into the deep layers.If treatment does not work for a long time, the patient is likely to need surgery.

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Symptoms

The manifestations of colitis depend on the severity of the disease. With a latent course, there may be a complete absence of noticeable symptoms or changes in the patient’s well-being.Minor symptoms are often overlooked while the disease progresses to a more serious stage.

All symptoms of ulcerative colitis are conventionally divided into intestinal and non-intestinal. The main intestinal symptoms include:

• Mucus and blood in the stool, diarrhea.
• Decreased appetite, weight loss.
• Cutting pains in the abdomen, often localized in the left side.
• Increased temperature, chills.
• Disorder of the kidneys, edema associated with a malfunction of the water and electrolyte balance.

Colitis can be confused with symptoms of other intestinal disorders, such as Crohn’s disease or irritable bowel syndrome. Others, that is, extraintestinal symptoms, help to clarify the diagnosis. These include:

• Inflammation of the mucous membrane in the mouth.
• Vision pathologies – iritis, conjunctivitis and accompanying visual acuity disorders.
• Arthritis.
• Cutaneous manifestations.
• Thromboembolism, thrombophlebitis.

Evaluation of all the symptoms of the disease allows us to make a preliminary diagnosis and move on to further diagnostics, identifying the causes of ulcerative colitis.

Diagnostic features

The first stage of diagnosis after examination and questioning are diagnostic tests. The main ones are microbiological analyzes, pathomorphological and X-ray studies.An integrated approach to diagnosis allows you to form an accurate picture of the disease and determine an effective treatment tactics.

1. Microbiological research. Basically, these are crops of material, allowing to confirm or exclude the infectious nature of the disease. Often, with ulcerative colitis, the indicators of pathogenic flora greatly increase, the content of staphylococci increases, the number of lactobacilli decreases, and a specific microflora appears that is not observed in a healthy intestine.Blood and urine are examined, including detailed analyzes, and feces are also examined.
2. X-ray examinations. The procedure allows you to identify inflammatory foci in the intestines. Often in the picture there is a narrowing of the intestinal lumen in one or several places, as well as irregularities in the walls, especially large ulcerative lesions can be seen. If, with the characteristic symptoms of colitis, its manifestations are not on the X-ray, the patient is referred for a consultation with an oncologist.If there is a suspicion of chronic nonspecific colitis, in the presence of narrowing of the lumen of the intestine, there may also be stiffness, lack of peristalsis, or shortening of the intestine due to spasm.
3. Pathological studies. Often, in the presence of ulcerative colitis, the mucous membrane is affected not only in the upper layer, but also deep into the intestine (the submucosa and even muscles are affected). Ulcerative perforations have smooth edges, glandular epithelium can grow. This is clearly visible on the roentgenogram.To clarify the diagnosis, additional blood tests may be carried out, including special markers, according to the indicators of which it is possible to judge the development of the disease.

A biopsy is done if necessary.

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Possible complications of ulcerative colitis

Like any disease, colitis can be complicated.There is a high probability of developing pathological consequences in the absence of treatment or severe tissue damage. The most common complications of the disease are:

• Bowel perforation resulting in bleeding, mucosal infection, severe inflammation. If it is not eliminated in time, a very serious condition and death occurs.
• Toxic megacolon – a strong thickening of the wall of the intestine affected by inflammation with a narrowing of the lumen. The body becomes dehydrated, depleted, all this leads to death.
• Acute bowel perforation. It is highly likely to result in death if not provided with assistance. Perforation occurs in several areas, severe bleeding, acute pain develops.
• Colon cancer. Untreated colitis can cause cancer. More often cancer is observed in patients suffering from total defeat. If this form of colitis is left untreated, the likelihood of developing cancer increases within ten years.

Treatment of ulcerative colitis

Depending on the severity of the lesion, the patient is shown drug or surgical treatment.In general, a blood transfusion is required, elimination of dehydration, and restoration of electrolyte balance. At first, the patient is transferred to parenteral nutrition, that is, nutrients are introduced artificially. This helps to reduce the stress on the affected intestine.

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Drug therapy consists of several main points:

• Stabilization of the balance of water and salt with the use of infusion drugs that stop diarrhea.
• Stopping internal bleeding.
• Minimization of traumatic and irritating effects on the intestinal mucosa in order to allow the formation of the epithelial layer.
• Pain relievers, antimicrobials as needed.

All drugs are selected individually, depending on the clinical picture. If medical therapy and diet do not help to cope with the acute condition, surgery is prescribed.There are several types of surgery used for ulcerative colitis:

• Radical interventions. They are performed in cases of significant tissue damage, when it is impossible to restore some areas. The operation is performed with resection of individual areas and subsequent reconstruction of its integrity.
• Palliative operations. Complete removal of mucosal areas is not expected, the operation is indicated in cases where the lesion affects less than 60% of the intestine with scattered localization.
• Operations with complete reconstruction – complete removal of the intestine and its restoration with the help of prostheses.

The operation is not the last stage of treatment. After eliminating the inflammation, there are several more important points that must be observed:

• Dietetic food.
• Taking medications, including antibiotics.
• Infusion therapy.
• Preparations for stool correction.

An early visit to a doctor will help eliminate the disease and avoid complications. We invite patients from Moscow and the Moscow region to the Multidisciplinary Medical Center “Clinic No. 1”.

90,000 Ulcerative colitis (NUC) and Crohn’s disease (CD)

Terminology

Inflammatory diseases of the large intestine are collectively referred to as colitis.Depending on the type of course, localization, clinic, etiology, there are many variants of colitis: acute and chronic; infectious, radiation, ischemic, medicinal, toxic; catarrhal, erosive, ulcerative, atrophic, spastic; sigmoiditis, proctitis, transverse, typhlitis, pancolitis, as well as gastroenterocolitis widespread on the stomach and small intestine.

Ulcerative colitis (UC) and Crohn’s disease (CD) are different diseases, and the differences between them are fundamental.For example, Crohn’s disease cannot rightfully be called colitis, since it does not fit into the framework of this diagnosis according to the criterion of localization. However, today NNC and BC are increasingly considered in a pair, since not only the differences, but also their common features are quite significant and obvious.

Both diseases are inflammatory and affect the gastrointestinal tract. Both show similar or similar symptoms. Both are still etiologically unclear. Both are somehow related to anthropogenic factors (technogenic, environmental, alimentary, etc.)etc.). And both literally in a few decades from the category of rare diseases known mainly to academic medicine have moved into the category of “problems of humanity”, and these problems continue to worsen in the epidemiological aspect and “get younger” in terms of the average age of manifestation. To some extent – far from decisive – this is due to the fact that modern coloproctologists and gastroenterologists are much better prepared for the recognition and evidence-based diagnosis of UC and CD (both nosological and differential) than it was, say, another fifty years back, and have qualitatively different diagnostic tools.In other words, it is legitimate to assume that today these diseases are simply diagnosed more often. However, both the annual incidence and, accordingly, the prevalence in the general population are indeed growing at a rapid pace.

Taken together, all this attracts close attention to the problem of both specialists and all those who are interested in the issues of modern medicine.

Causes

As indicated above, the causes of both inflammatory processes are the subject of ongoing research and heated debate.It is known that Caucasians suffer from NUC and CD more often than representatives of other races, and that this is especially true of Jews: compared with other nations, the incidence among Semitic tribes is up to six times higher (which would give reason to assume the influence of, say, national cuisine, don’t be Jewish cuisine one of the most dietary in the world). The regions of the highest prevalence are large cities in North America, Western and Northern Europe: 70-150 patients per 100 thousand population. Many? Few? If you imagine a large square courtyard, bordered by large multi-storey residential buildings around the perimeter, then at least one person in each of these houses suffers from ulcerative colitis or Crohn’s disease.Diseases are severe, they significantly reduce the average life expectancy of patients. In other words, even one case in a thousand, or four cases in a similar Petersburg courtyard, is very, very large …

In per capita terms, NUC is still more widespread, but the increase in incidence is several times higher in CD.

Among the alleged causes of both diseases, infectious (bacterial and viral), hereditary, autoimmune, psychoemotional, toxic factors are considered; the polyetiological hypothesis is also discussed.All of them find their confirmation, and none of the confirmation is sufficient.

Ulcerative colitis is more often associated with the harmful influence of the external environment, alimentary factor (nutrition), long-term medication and self-destructive habits.

Crohn’s disease is more “suspicious” in the autoimmune plan: a number of signs indicate that the aggressor in relation to the gastrointestinal tract is the patient’s own immune system.

Symptoms

The clinical picture of both diseases is extremely variable and polymorphic.The most common and common symptoms include frequent diarrhea and other dyspeptic symptoms, emaciation, asthenic syndrome, abdominal pain, appetite disorders, and fever-like malaise. Loose stools and / or blood in the stool are more common in NUC; constipation, belching, heartburn, and extraintestinal manifestations (for example, arthritis, osteoporosis, various eye inflammations, urolithiasis, etc.) are more often found in the CD clinic, which is one of the main arguments in favor of the autoimmune hypothesis.

It should, however, be understood that both the listed and many other symptoms occur both in ulcerative colitis and Crohn’s disease, and in very different combinations. In addition, each disease significantly increases the risk of cancer and leads to severe complications (eg, intestinal fistulas and perforations, peritonitis, obstruction, paraproctitis, etc.).

Differential Diagnostics

The main differences between NNC and BC are as follows.By definition, ulceration of the intestinal mucosa is inherent in ulcerative colitis (recall that an ulcer is a long-term non-healing inflamed wound site that penetrates into the underlying layers, in contrast to superficial erosion, and causes the irreversible loss of one or another volume of tissues “corroded” by the ulcer. Unlike, again, from erosion, an ulcer cannot heal without a trace, it always leaves a fibrous defect). Crohn’s disease is pathomorphologically manifested by granulomas – concentrated foci of inflamed connective tissue.

An important differential diagnostic point is that granulomatosis never occurs in ulcerative colitis, while ulcers and granulomas are often found in Crohn’s disease. In other words, the presence of transmural (to the entire depth of the intestinal wall) granulomas is an evidence in favor of CD, and the presence of ulcers, etc. crypt abscesses as a differential diagnostic sign in favor of NUC can only partially serve.

Further, the most important criterion is localization.If inflammation of the intestine is limited to its thick section, it can be both NUC and CD, and ulcerative colitis is much more likely. If the inflammation spreads and / or is predominantly localized in other parts, this is definitely Crohn’s disease, which can affect absolutely any part of the gastrointestinal tract, from the oral cavity and inner surfaces of the cheeks to the anus.

Rectal bleeding is twice as common in NUC as in CD. Weight loss is more inherent in Crohn’s disease in its small intestinal localization.Malignancy (malignancy), on the contrary, is more common in ulcerative colitis, and in this case, the start of the tumor process occurs, as a rule, with a shorter course than in the case of Crohn’s disease.

Fibrous processes, thickening of the intestinal walls due to the growth of scar tissue are always found in Crohn’s disease, and rarely in ulcerative colitis.

The final diagnosis is established by a thorough clinical, anamnestic, medico-genetic, laboratory and instrumental examination.The most informative in this case are endoscopic methods (colonoscopy, FGDS, diagnostic laparoscopy), contrast-enhanced radiography, biopsy (histological analysis). Sometimes an ultrasound scan with rectal access, MRI or other studies is additionally prescribed.

Treatment

Therapy of both inflammatory processes necessarily includes a special diet and giving up bad habits, primarily smoking. In both cases, hormonal corticosteroids are used.In a number of patients (more often with Crohn’s disease), the beneficial effect is caused by the appointment of immunosuppressants, which would be an important argument in favor of an autoimmune etiology, if not for the numerous other cases when immunotherapy does not bring results.