IBD: Ulcerative Colitis

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.

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.

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