IBD: Ulcerative Colitis

IBD: Ulcerative Colitis

What is ulcerative colitis?

Ulcerative colitis is a chronic disorder affecting the large intestine (colon). The digestive system (including the stomach, small and large intestines) converts food into nutrients and absorbs them into the bloodstream to fuel our bodies. The colon’s main role is to absorb water and salts from undigested food waste. This action helps to thicken and solidify the stool, which is then expelled from the body through the anus. 

Ulcerative colitis causes inflammation (redness and swelling) and ulceration (sores) along the lining of the colon which can lead to abdominal pain, cramps, bleeding and diarrhea. The disease usually begins in the rectal area, which holds stool until you go to the bathroom, and may involve the entire colon over time. Ulcerative colitis is classified as an inflammatory bowel disease (IBD), due to the inflammation that occurs in the intestines. Another common form of IBD is called Crohn’s disease. Although the symptoms of ulcerative colitis are similar to Crohn’s disease, the conditions are different in several ways. 

While both ulcerative colitis and Crohn’s disease are types of IBD, they should not be confused with Irritable Bowel Syndrome (IBS), a disorder that affects the muscle contractions and the sensitivity of the colon. Unlike ulcerative colitis and Crohn’s disease, IBS does not cause intestinal inflammation nor damage the bowel.

Can I prevent ulcerative colitis?

There is currently no known way to prevent or cure for ulcerative colitis (IBD) but the proper strategy for managing your disease can help you lead a happier, healthier, fulfilling life.

The exact cause of ulcerative colitis is unknown. However, it is believed to be due to a combination of factors, including a person’s genes (inherited traits) and triggers in the environment. This interaction of genetic and environmental factors activates an abnormal response of the body’s immune system.

Normally, the immune system protects the body from infection. In people with ulcerative colitis, however, the immune system can mistake microbes (such as bacteria that are normally found in the intestines), food, and other material in the intestines, as invading substances.

When this happens, the body launches an attack, sending white blood cells into the lining of the intestines where they cause inflammation and ulcerations.

Living positively

Ulcerative colitis is a chronic (long-term) condition with symptoms that can disappear and then flare up again throughout your life. Living with the unpredictable nature of ulcerative colitis can pose physical and emotional challenges that may seem overwhelming at times. However, there are several things that you can do to contribute to your health and well-being.

Be informed, proactive, and involved in your care. By establishing a solid partnership with your health care team, developing coping skills, and maintaining a positive outlook, it is possible to stay healthy and happy, despite living with ulcerative colitis.

Diet and lifestyle changes

Although diet and stress do not cause ulcerative colitis, there may be times when changes in your lifestyle may help control your symptoms and lengthen the time between flare-ups. The following changes may help to ease your symptoms:

  • Limit milk/dairy products. If you are lactose intolerant (cannot digest the sugar in milk), milk and dairy products can produce symptoms of excess gas and diarrhea.
  • Restrict intake of certain high-fibre foods: such as nuts, seeds, and raw vegetables.
  • Limit intake of caffeine, alcohol, carbonated drinks and fatty foods. .
  • Eat small, frequent meals, rather than large meals..
  • Exercise regularly to promote movement of the colon and reduce stress..
  • Minimize stress. Yoga, meditation and slow, relaxed breathing techniques can help people with ulcerative colitis manage stress..

Ask your doctor or pharmacist if one of these formulations may be right for you. It is important to take the probiotic in the dose and duration recommended by the manufacturer to achieve the best results.

Statistics

  • It is estimated that 104,000 Canadians had ulcerative colitis in 2012, with 4,500 new cases annually. (Crohn’s and Colitis Foundation of Canada 2012)
  • In 2008, physician visits for ulcerative colitis were estimated to cost the Canadian health care system $54 million/year. The total costs of hospitalization have been estimated to be $120 million in 2008. (Canadian Digestive Health Foundation 2009; Fedorak et al. 2010)
  • Total indirect costs for ulcerative colitis were estimated to be $693 million in 2012. (Crohn’s and Colitis Foundation of Canada 2012)
  • People with ulcerative colitis are at increased risk for colorectal cancer, although there is no excess risk of premature mortality.
  • For more information, see Inflammatory Bowel Disease.

Citations: 

Canadian Digestive Health Foundation. 2009. Establishing digestive health as a priority for Canadians. The Canadian Digestive Health Foundation – National Digestive Disorders Prevalence & Impact Study Report.

Crohn’s and Colitis Foundation of Canada. 2012. The impact of inflammatory bowel disease in Canada - 2012 Final report and recommendations.http://crohnsandcolitis.ca/Crohns_and_Colitis/documents/reports/ccfc-ibd-impact-report-2012.pdf?ext=.pdf [accessed 3 September 2018] [accessed 3 September 2018]

Fedorak RN et al. Canadian Digestive Health Foundation Public Impact Series 4: Inflammatory bowel disease in Canada. Incidence, prevalence, and direct and indirect economic impact. Can J Gastroenterol. 2010 Nov;24(11):651-5.

Signs & Symptoms

The most common symptoms of ulcerative colitis are abdominal pain, diarrhea, blood in the stool and false urges to have a bowel movement.

  • Abdominal pain (cramping): Ulcerative colitis pain can be felt anywhere throughout the abdomen, but it is typically located in the lower left side.
  • Diarrhea: Diarrhea (frequent, loose or watery stools) can range from mild to severe and, in some cases, may involve as many as 20 or more trips to the bathroom a day.
  • Blood and/or mucus in the stool: Ulcers may form where inflammation has damaged the intestinal lining. These areas bleed and produce pus and mucus, which may appear in the stool.
  • False urges to have a bowel movement: The urge to have a bowel movement may arise frequently, even though there is little stool to pass. This urge is caused by inflammation of the rectum.

Other symptoms of ulcerative colitis may include:

  • Weight loss
  • Anemia
  • Fatigue
  • Nausea
  • Fever
  • Vomiting

Alarm Symptoms of Ulcerative Colitis:

If you are already diagnosed with ulcerative colitis, there are several alarm symptoms to look out for. A change in your ulcerative colitis symptoms may mean that additional treatment is needed. Talk to your doctor immediately if you experience a new symptom, a change in your current symptoms or any of the following:

  • An unusual amount of cankers or sores in your mouth
  • Unexplained or unintentional weight loss
  • Failure to gain weight (especially in children)
  • Delayed puberty in teens
  • Drainage of pus from, or severe pain near, the anus which is usually caused by an abscess.
  • Anemia – this blood condition results in fatigue and weakness. It is usually caused by heavy blood loss or a lack of dietary iron
  • Rectal bleeding
  • Fever
  • Change in bowel habits
  • Eye redness / pain
  • Severe joint pains
  • Nausea / vomiting - inability to keep food / drink down

Who is at Risk of Ulcerative Colitis?

  • Age: Ulcerative colitis may affect any age group, although there are peaks at ages 15 to 30 years, and again at ages 50 to 70 years.
  • Race/ethnic background: Ulcerative colitis is more common among caucasians and in people of Ashkenazi Jewish descent.
  • Family history: People with a first-degree relative (parent or sibling) with ulcerative colitis are at greater risk of developing the condition.

What Complications are Associated with Ulcerative Colitis?

Yes. There are some complications related to ulcerative colitis. Possible complications include:

  • Severe bleeding
  • Dehydration
  • Perforated colon (a hole in the colon)
  • Kidney stones
  • Osteoporosis (loss of bone strength)
  • Toxic megacolon (severe abdominal swelling accompanied by a fever, rare)
  • Liver disease (rare)

People with ulcerative colitis are also at increased risk of developing colon cancer. The risk of colon cancer is related to the length of time since you were diagnosed and how much of your colon is affected by inflammation. However, a regular examination by your doctor and colorectal cancer screening tests can help to reduce the risk of cancer and detect problems early.

Covid-19 Information

Not showing symptoms for COVID-19? You should still be taking care to practice social distancing!

The fact of the matter is, even if you’re not showing any symptoms, you can pass this virus on to people who ARE at risk. This not only means the elderly in our community, but people who are have compromised immune systems. Many IBD patients, for example, are on medications that suppress the immune system, and it’s times like these that we need to band together and think of our neighbours. People who suffer from a chronic underlying conditions chronic respiratory illnesses, diabetes, cancer, etc are also at risk. We must be proactive now and get in front of this pandemic.

Practicing social distancing is the best way possible to keep this virus from spreading and potentially harming more people in our community. If you are not taking immunosuppressive medications and your condition is currently in remission, you are at the same level of risk as the general public, according to Crohn’s and Colitis Canada. However, if you are taking an immunosuppressive medication, make sure to continue taking your medications and prioritize social distancing as soon as you can. 

If you are not showing any symptoms, please refrain from any in person visits with a doctor. Healthcare professionals will be working day and night to help the infected, and they must prioritize at risk patients. If we all take care and do our best to protect one another by following the advice of the Public Health Agency of Canada, we have to potential to save countless lives while we wait for a viable vaccine.

We know there’s a lot of information being shared online, so we have decided to make a list of relevant links to help you easily find the best resources for you:

CDHF Links:

You can learn more about health and safety recommendations for patients by going to the Crohn’s and Colitis web page here: https://crohnsandcolitis.ca/Living-with-Crohn-s-Colitis/COVID-19-and-IBD

Health Canada also has information and recommendations for the general public on how to safely navigate this pandemic.https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html

For additional information about COVID-19 in your area, please visit the links below:

Federal COVID-19 information
Travel Advice and Advisories
Ontario COVID-19 information
British Columbia COVID-19 information
Quebec COVID-19 information
Alberta COVID-19 information
New Brunswick COVID-19 information
Newfoundland and Labrador COVID-19 information
Nova Scotia COVID-19 information
Prince Edward Island COVID-19 information
Manitoba COVID-19 information
Saskatchewan COVID-19 information
Yukon COVID-19 information
Northwest Territories COVID-19 information
Nunavut COVID-19 information

Tests and Treatment

Testing for Ulcerative Colitis

Often, symptoms alone can provide doctors with the information they need to diagnose ulcerative colitis. Your doctor will perform a physical examination and take a complete medical history that includes a careful review of your symptoms. For this reason, it is important to be candid and specific with your doctor about the problems you are having.

There is no one specific laboratory test, X-ray or scope to diagnose ulcerative colitis, however, to help confirm the condition and rule out other problems, your doctor may send you to have one or more of the following tests:

  • Blood tests: Blood tests can help to identify anemia (low blood count), infection and inflammation.
  • Stool sample tests: A stool analysis can detect blood in the stool and rule out infection, malabsorption, parasites and other digestive problems.
  • Imaging tests: Your doctor may order tests to see your lower digestive organs. These safe tests can help to diagnose ulcerative colitis or Crohn’s disease and identify other problems such as ulcers, polyps (growths on the lining of the intestines) and colon cancer. A sample of the lining of the intestine (biopsy) may be taken to examine under a microscope.
  • Flexible sigmoidoscopy:A slim, flexible tube (sigmoidoscope) equipped with a light and a tiny camera is guided through the rectum into the colon. The sigmoidoscope allows your doctor to examine the lining of the lower part of the colon only.
  • Colonoscopy: In a procedure similar to a flexible sigmoidoscopy, a flexible scope allows your doctor to view the lining of both the upper and lower parts of the colon.
  • Barium enema: A small tube is placed in the rectum and filled with barium liquid and air. Barium coats the lining of the colon and rectum so they can be seen on an X-ray, allowing your doctor to see areas of damage or inflammation.
  • CT (computerized tomography) scan: A CT scan produces cross-sectional X-ray images of the abdomen and pelvis to help diagnose ulcerative colitis and rule out other possible disorders and conditions.
  • MRI (magnetic resonance imaging) scan: An MRI is similar to a CT scan, but it does not use X-rays to capture an image. An MRI uses magnetism, radio waves, and a computer to produce highly-detailed images of the body. It offers an extremely accurate method of detecting inflammation and disease in the colon and throughout the body.

How is ulcerative colitis treated?

There is no cure for ulcerative colitis at the present time, however, there are effective treatments available that may control your disease and even place it into remission. Remission means that your symptoms disappear completely. Your treatment plan will depend upon the types of symptoms you have, their severity and how they affect your daily life.

Medications:

Medications may be needed to control the inflammation in your colon and/or to reduce your body’s immune response. The goals of treatment are to manage your symptoms and prevent them from coming back so that you can live life to its fullest. You and your physician should discuss and carefully consider the risks and benefits associated with any available treatment options. Often, medications are prescribed in a ‘stepped’ approach, beginning with relatively safe medications with few risks or side effects, and progressing to more powerful medications with additional risks and side effects, if your symptoms do not respond. The following list outlines the most common medications used to treat ulcerative colitis.

  • Mesalamine: also referred to as 5-ASAs (5-amino salicylic acid), is often a first treatment option for mild-to-moderate ulcerative colitis. This medication helps reduce inflammation in the colon and control diarrhea. Amino salicylates can be taken as an oral pill, suppository (a capsule you insert into your rectum) or enema. Suppositories and enemas allow us to locally treat inflammation and help with symptoms of urgency.
  • Corticosteroids:(such as prednisone and budesonide) also reduce inflammation by controlling the body’s immune system response. Steroid medications are effective for short-term control of a flare-up, however they are not recommended for long-term use because of their significant side-effects.
  • Immunosuppressants: (such as 6-MP and azathioprine) may be recommended if your condition does not respond to other treatments. These medications suppress (reduce) the activity of the body’s immune system to control inflammation, however, they also weaken the body’s ability to fight infection. Immunosuppressants typically take 2 to 3 months to begin working.
  • Biologics: (such as infliximab, adalimumab and Golimumab) are powerful medications used for people with moderate-to-severe ulcerative colitis when other treatments have been unsuccessful. Biologics target and block the specific protein molecules causing inflammation in ulcerative colitis, yet they still allow the immune system to work and fight infections.
  • Biosimilars:(such as: Infliximab-dyyb (Inflectra®️)) A biosimilar biologic drug, or biosimilar, is a drug demonstrated to be highly similar to a biologic drug that has already authorized for sale (known as the reference biologic drug). Biosimilars were previously known in Canada as Subsequent Entry Biologics (SEBs).Health Canada states that biosimilars are not generic biologics.Health Canada only approves biosimilars for marketing in Canada when the manufacturer demonstrates that their product is of similar quality, safety, and efficacy to the original reference drug. However, long term studies are still required to confirm these attributes.
  • JAK Inhibitors: (Such as XELJANZ® (tofacitinib)) is a new oral treatment option for adult patients with moderate to severe ulcerative colitis (UC) that may help achieve and maintain remission. XELJANZ® (tofacitinib) is a Janus kinase (JAK) inhibitor. JAK inhibitors are small molecules in a pill form that interfere with a number of key pro-inflammatory cytokines involved in the origination and development of inflammatory bowel disease. Treatment of UC in the past 10 to 20 years have been through injectables or intravenous agents, now XELJANZ, the first Janus kinase (JAK) inhibitor approved by Health Canada, provides a new option for individuals with UC. Use of XELJANZ in combination with biological therapies for UC or with potent immunosuppressant’s such as azathioprine and cyclosporine is not recommended.

Surgery:

About 10 to 15% of people with ulcerative colitis may eventually need surgery to treat their condition, if medical therapy is not successful or complications arise. Ulcerative colitis surgery usually involves removing the entire colon and rectum (proctocolectomy).

When the colon is completely removed, a small opening (stoma) is created in the lower abdomen and feces (digestive waste) are collected into a small bag worn on the outside of the body. For some people, a second operation (called a pouch procedure) can be performed. This operation creates a new rectum, which allows feces to collect inside the body and be expelled by normal passage through the anus. People with pouches often still pass 4-6 stools per day, but without blood or pain.

Symptomatic treatment:

The symptoms of ulcerative colitis can be disruptive, debilitating and embarrassing. In addition to medication to control inflammation, your doctor may recommend additional products to help relieve your symptoms, including antibiotics (for fever), pain relievers (for abdominal pain), antidiarrheals (to control diarrhea) and iron supplements (for anemia). Talk to your doctor about which medications are safe for you to take.

Probiotics:

Studies have found that, in some cases, probiotics may help to improve symptoms of ulcerative colitis. Probiotics are live microorganisms that, when taken in adequate amounts over sufficient time, may provide a health benefit. They are natural, ‘healthy’ bacteria that may help with digestion and offer protection from harmful bacteria in the intestines.

Probiotics are not medicine. They are available to purchase as capsules, tablets or powders, and can also be found in some fortified yogurts and fermented milk products. However, not all probiotics are the same. Although many products claim to have benefits, only two probiotics formulations – E. coli Nissle and VSL#3 – have been shown to be effective in ulcerative colitis.

Ask your doctor or pharmacist if one of these formulations may be right for you. It is important to take the probiotic in the dose and duration recommended by the manufacturer to achieve the best results.

FAQs

Am I going to get cancer because I have (Ulcerative Colitis) IBD? 

People with IBD are at an increased risk of developing colon cancer. Having regular endoscopies will help identify polyps that could potentially develop into cancer.

Does diet affect Ulcerative Colitis (IBD)?

Diet alone is not effective in treating Crohn's disease or ulcerative colitis. However, it is important that patients with IBD have a well-balanced diet. Calcium is important to protect bones. Fibre may not be tolerated during flare ups. Certain vitamins (for example, B12) may be required. Selected patients may sometimes be helped by a registered dietician.

How is Ulcerative Colitis (IBD)different than IBS?

Although both illnesses can be seriously debilitating, there are several primary differences between Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS). IBD is an autoimmune disorder that causes swelling and ulcerations (sores) in the bowel. IBS involves problems with motility (how the bowel moves contents through our intestines) and sensitivity (how the brain interprets sensations in the bowel). Symptoms of IBS may wax and wane and possibly disappear altogether whereas IBD is a chronic condition.

How can I tell if my treatment is working?

For some people, ulcerative colitis symptoms will significantly improve within a short time after starting medication or making lifestyle and dietary changes. For others, finding relief from symptoms is a slow process and it may take longer for a definite improvement to be noticed. It is important for you and your doctor to work together to determine what triggers your symptoms and to find the right treatment to manage your symptoms effectively.

How can I prepare for an appointment with my GI to discuss my ulcerative colitis?

Good communication with your doctor is an important part of effective management of a gastrointestinal disorder like ulcerative colitis. Before your appointment, take the time to keep a symptom journal that can help you and your doctor see patterns in your activities and identify specific triggers for your symptoms.Include the following information in your journal:

  • Write down the symptoms that are bothering you and for how long you have had them.
  • Write down key personal and medical information, including any recent changes or stressful events in your life.
  • Make a list of the triggers (food, stress, activity) that seem to make your symptoms worse.
  • Make a list of medications you are taking, including the conditions you take them for. Also note if any of your medications seem to affect your symptoms.
  • Talk to your family members and find out if any relatives have been diagnosed with ulcerative colitis or another digestive disorder.

Also, create a list of questions to ask your doctor during your appointment. Specifically, you may want to ask your doctor questions such as:

  • What do you think is causing my symptoms?
  • Are there other possible causes for my condition?
  • What diagnostic tests do I need?
  • Do these tests require any special preparation?
  • What treatment approach do you recommend trying first?
  • If the first treatment doesn’t work, what will we try next?
  • Are there any side effects associated with these treatments?

Benefit and Risk Assessment Tool for IBD Treatments

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This e-learning tool was made possible due to an unrestricted educational grant from Pfizer Canada

What I Eat in a Day with UC

https://www.youtube.com/watch?v=6_3aIOHBoNI
As Inflammatory Bowel Disease Awareness Month continues.. we hear from Emma on what she eats in a day with UC. 

The Timeline of My UC Diagnosis

https://www.youtube.com/watch?v=891zMRbP8Ig
In the first video of her video series, Emma talks about the timeline of her diagnosis with ulcerative colitis. Stay tuned for more on Emma's experiences! 

IBD Treatment Options Webinar

https://www.youtube.com/watch?v=gPoES4-eisA
In this empowering session reviewed the basics of IBD, outlined the benefits and risks of medications used to treat ulcerative colitis and Crohn’s disease and answered the many questions of attendees. Special thanks to Dr. Talat Bessissow for sharing his insights and expertise and to AbbVie Inc. for sponsoring our IBD Treatment Options WebSeminar.

Let’s #ImagineUC Differently

It’s #IBDAwarenessMonth, and to mark the occasion, Effie, Katie and Emma are sharing their advice for Canadians living with #ulcerativecolitis. Here’s how you can live your best life with #UC.

My Day to Day with UC

https://www.youtube.com/watch?v=vPikHl76hIs
Emma explains what her day to day life with ulcerative colitis looks like as a university student. 

What’s Health Canada Saying about Biosimilars?

https://www.youtube.com/watch?v=1OeDtXWn3_8
A biosimilar biologic drug, or biosimilar, is a drug demonstrated to be highly similar to a biologic drug that was already authorized for sale (known as the reference biologic drug).  Biosimilars are approved based on a thorough comparison to a reference drug and may enter the market after the expiry of reference drug patents and data protection. Watch this video to get more insight into what Health Canada is saying about biosimilars!

Fecal Calprotectin: The Inside Story on Inflammation

[embed]https://www.youtube.com/watch?v=uS0PFfuwMY8[/embed]
​If you have IBD, you know the painful symptoms you suffer from during a flare are caused by inflammation. Wouldn’t it be great to know -- in advance -- if a flare was on its way, so that you could prevent it from happening! Well, a safe, simple, non-invasive test could help you do just that!

My life with Ulcerative Colitis

https://www.youtube.com/watch?time_continue=5&v=vPoGMvLr7R4
NEWLY DIAGNOSED WITH IBD?
Effie Siamalekas was just diagnosed with UC. She wants you to know what she didn't so you can understand what's happening inside your body and take action to live your life your way despite having a chronic, invisible illness. It's honest, interesting and compelling. Have a look at this self-produced video.

Inflammatory Bowel Disease with Dr. Mike Evans

https://www.youtube.com/watch?time_continue=1&v=Keqzt83KMVA
Helping you understand the details of IBD. Dr. Mike Evans is founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael's Hospital.

Inflammatory Bowel Disease with Dr. Mike Evans

https://www.youtube.com/watch?v=Keqzt83KMVA
Helping you understand the details of IBD. Dr. Mike Evans is founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael's Hospital.

What’s Health Canada Saying about Biosimilars Infographic

Learn all about what Health Canada is saying about Biosimilars in this easy to ready Infographic

Living with Ulcerative Colitis Infographic

IBD Treatment Options: Understanding Your Benefits and Risks Animation

https://www.youtube.com/watch?v=evV_Dngm-IQ
Making informed decisions is imperative to your good health but understanding the benefits and risks associated with IBD therapy options can be challenging. CDHF developed the IBD BRAT - a tool to help you learn more about common risks as well as important benefits around the therapy options. Watch this animation for an overview now.

Uncovering Biologics: Your IBD BodyGuard Animation

https://www.youtube.com/watch?v=wUdtfvOkF0s
If you have Inflammatory Bowel Disease (IBD), you know that taking medication to manage your symptoms and prevent flares is imperative. Your doctor may prescribe a biologic if you have moderate to severe Crohn's Disease or Ulceractive Colitis. Watch the CDHF’s latest animation on biologics and learn how they can protect you from the painful and debilitating symptoms of IBD.

Webinar: Understanding the Benefits and Risks of IBD Therapies

https://www.youtube.com/watch?v=gPoES4-eisA This empowering session reviewed the basics of IBD, outlined the benefits and risks of medications used to treat ulcerative colitis and Crohn’s disease and answered the many questions of attendees.

Biosimilars for IBD: Making the Transition Webinar

  [embed]https://www.youtube.com/watch?v=XG3F9LyMS5g&feature=youtu.be[/embed] On May 28th, Dr. McCurdy answered the following questions in a very informative webinar presentation on Biosimilars:
  • What’s the difference between a reference biologic drug and a biosimilar?
  • Biosimilars: What’s Health Canada saying?
  • What is the clinical evidence to date?
  • How do doctors go about transitioning their patients from a reference biologic drug to a biosimilar?
Watch this webinar now!

Living Positively with Ulcerative Colitis Webinar

[embed]https://www.youtube.com/watch?v=uB6e-phIlV8[/embed] On June 26th CDHF sat down with three individuals who have been diagnosed with ulcerative colitis (UC) to learn all about what it is like to live with this chronic condition. Effie, Emma and Katie chatted all about their experiences with getting diagnosed, current medications, and helpful tips they use to manage their ulcerative colitis every day. They want you to know what they didn’t so you can understand what’s happening inside your body and take action to live your life your way despite having a chronic, invisible illness. Watch the recorded version of this patient focused webinar now.

Hot off the Presses: The Latest IBD Information from Scientific Meetings Webinar

[embed]https://www.youtube.com/watch?v=HAG6qYhkyv4[/embed] In this educational webinar, Dr. Silverberg reviewed the most recent scientific findings in Inflammatory Bowel Disease (IBD) and discussed the role of diet and gut bacteria in IBD. Watch the recording of this webinar now.

IBD: Switching from a Biologic to a Biosimilar

Having to change any kind of medication can be very stressful. While CDHF believes in patient-physician choice, we acknowledge political policy decisions and our organization is committed to providing clear and unbiased information and resources for patients. Both biologics and biosimilars have gone through rigorous standards for authorization by Health Canada, to which both have been found safe and effective for use in Inflammatory Bowel Disease (IBD). Watch this video to learn more about switching from a biologic to a biosimilar.

IBD Treatment Options: Understanding Your Benefits and Risks (Ulcerative Colitis)

Making informed decisions is imperative to your good health but understanding the benefits and risks associated with Ulcerative Colitis (UC) treatment options can be challenging. CDHF developed the IBD BRAT - a tool to help you learn more about common risks as well as important benefits around the therapy options. Check out our detailed online version by clicking here, or download the coles notes version below!

Infographic that explains: What is IBD? Inflammatory bowel disease (IBD) is a chronic disease for which there is currently no cure. It is a group of disorders that involve chronic inflammation of all or part of the digestive tract. Like many chronic diseases, IBD can alternate between severe episodes (flare-ups) and stretches of time with milder symptoms or no symptoms at all (disease remission). It can be painful, affect growth in children, and sometimes lead to serious complications. The disease has two main forms: ulcerative colitis (UC) and Crohn’s disease (CD)
Infographic that explains: Understanding the benefits and risks of IBD treatment options Ongoing treatment of any chronic disease is imperative. IBD is typically treated with a series of medications. Your treatment plan will likely revolve around medications designed to reduce intestinal inflammation, control your symptoms and even prevent long-term damage from inflammation. When you have the proper treatment, you can expect to enjoy improved physical health, greater quality of life, less abdominal pain, less fatigue and significantly less depression. There is no clear roadmap of how your IBD will progress over time. Everyone is different. You will experience peaks and valleys of symptoms over the years. To make the right decision about your IBD treatment, you need to balance the benefits and risks of treatment against the risks of no treatment. All medications have benefits, risks, and side effects. However, it is vital for you to understand that not treating the disease can be even more dangerous. When you get the right treatment for your stage of disease, situation and lifestyle, the benefits of treatment far outweigh the risks. Most people living with IBD go on to lead fulfilling lives despite the challenges of the illness. Treatment can help you maximize your health. With the proper treatment, you can: • Reduce complications • Reduce the number and frequency of flares • Minimize hospital stays and surgery • Improve healing • Enjoy longer periods of remission • Experience a better quality of life IBD can be frustrating and debilitating. Finding the best medicine and consistently following the recommended treatment can help you control your disease. When you achieve your best health, you multiply your opportunities to develop physically, intellectually, emotionally and socially. A standard of health that allows you to enjoy and fully participate in work, school and social situations should be your goal.
Infographic that explains: 5-amino salicylic acid (5-ASAs), also known as mesalamine, reduces inflammation in the intestine, controls diarrhea and helps maintain remission (freedom from symptoms). 5-ASAs can be used at the same time as other medications, such as immunosuppressants and steroids. The goal of 5-ASA therapy is to help you achieve and maintain remission if you have mild to moderate ulcerative colitis and colonic Crohn’s disease. Some formulations also help induce and maintain remission of mild, small intestinal Crohn’s disease. Also: Steroids Steroids rapidly reduce inflammation by suppressing the activity of immune cells. The most common steroids used to treat IBD (prednisone, methyprednisone, and hydrocortisone) circulate throughout the whole body. Some newer steroids (e.g., budesonide) target specific areas of the intestine, and tend to have fewer side effects and less toxicity. Steroids are a short-term therapy to control acute flares and achieve remission. They are not used as maintenance therapy. Steroids can be taken with maintenance medications such as 5-ASAs, immunosuppressants, and biologics. This means you can begin treatment with a maintenance drug while still on steroids. symptoms improve, your doctor will carefully and gradually wean you off the steroid. Depending on the severity and location of the disease, steroids can be delivered orally, rectally, or intravenously. Do not stop taking steroids on your own! It is very important to slowly wean your body from these drugs under the direction of your physician.
Infographic that explains: Immunosuppressants Immunosuppressants are drugs that suppress the immune system, thus reducing inflammation and preventing the body from mistakenly attacking its own digestive system (a feature of IBD). Immunosuppressants aims to decrease the use of steroids, bring about remission, and maintain remission for patients with moderate to severe disease. Immunosuppressants have fewer and less severe side effects than steroids, so you can use them for longer periods of time. It can take several months for oral immunosuppressants to achieve their full effect but they can be combined with steroids until that time. You can also use them with other medications – for example, to prevent your disease from flaring while you are tapering off steroids. Commonly used immunosuppressants are azathioprine (Imuran), 6-mercatopurine (Purinethol), and methotrexate. Immunosuppressants can be taken orally and Methotrexate can be taken orally or by injection. Also explains: Biologics Biologics are proteins specifically engineered to block one or more inflammatory pathways in your body and thus reduce the inflammation that causes your IBD. One class of biologics blocks the action of a protein called tumor necrosis factor (TNF-α), which your body makes naturally. If you have IBD, you produce more of this protein than normal, which causes inflammation and damage to healthy tissue. By suppressing TNF-α production, anti-TNF biologics reduce inflammation and damage. Biologic therapy aims to induce and maintain remission for patients with moderate to severe disease. Sometimes, biologics are used in combination with other IBD medicines to achieve a better treatment effect and/ or reduce the risk of developing antibodies against the biologic. Biologics are delivered in one of two ways: • through intravenous (IV) infusion by a healthcare provider at a clinic • by subcutaneous injection which you can do yourself or have done by a trained nurse at home or in a clinic.
Infographic that explains: A biosimilar drug has demonstrated to be highly similar to a biologic drug that has already been authorized for sale (known as the reference biologic drug).Biosimilars were previously known in Canada as Subsequent Entry Biologics (SEBs). Health Canada states that biosimilars are not generic biologics. Health Canada only approves biosimilars for marketing in Canada when the manufacturer demonstrates that their product is of similar quality, safety, and efficacy to the original reference drug. Also explains: JAK Inhibitors, New ORAL treatment for ulcerative colitis can be done at home, XELJANZ® (tofacitinib) is a new oral treatment option for adult patients with moderate to severe ulcerative colitis (UC) that may help achieve and maintain remission. XELJANZ® (tofacitinib) is a janus kinase (JAK) inhibitor. JAK inhibitors are small molecules in a pill form that interfere with a number of key proinflammatory cytokines involved in the origination and development of inflammatory bowel disease. Treatment of UC in the past 10 to 20 years have been through injectables or intravenous agents. Now XELJANZ, the first Janus kinase (JAK) inhibitor approved by Health Canada, provides a new option for individuals with UC and helps promote mucosal healing in the gastrointestinal tract. When you have IBD, the interior layer of tissue lining your intestine (called the mucosa) gets damaged. Mucosal healing is the restoration of a healthy mucosa. JAK Inhibitors help to promote mucosal healing in the gastrointestinal tract. Use of XELJANZ in combination with biological therapies for UC or with potent immunosuppressant’s such as azathioprine and cyclosporine is not recommended.
Infographic that summarizes: While you can expect to have IBD for the rest of your life, current treatment options can help control the disease and minimize symptoms so you can enjoy a healthy, fulfilling life. Understanding your options and their associated benefits and risks can help you make the best decisions about your health. To get the most out of your treatment, follow the plan you and your doctor have discussed and agreed upon as being best for you, your body, situation and lifestyle. It is important that you be involved in decisions about your treatment. If you don’t understand something your doctor tells you, don’t be afraid to ask questions. If you find your drug regimen difficult to follow or wish to try out a different type of treatment, tell your doctor. If cost is a barrier, discuss this with your doctor: there may be a solution you didn’t know about. To get the most out of your treatment, become a partner with your doctor: deciding on a treatment plan together, asking questions or for more information, and letting your doctor know how things are going at every step of the way. Donate: CDHF relies on the generosity of our supporters to run our foundation and achieve our goals. Your gift will support initiatives that help reduce the incidence of digestive disorders, improve quality of life, support those living with digestive diseases and disorders and the professionals who care for them and, enhance education and research. https://cdhf.ca/donation/
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