Talk:Ulcerative colitis

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 26 August 2019 and 15 November 2019. Further details are available on the course page. Student editor(s): ML6484, Vsiemion, Gaffneybrennan9, Tdownie53.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 11:55, 17 January 2022 (UTC)

Folic Acid deficiency

Is there a source for the need for a folic acid supplement with sulfasalazine? M dorothy

sulfate reducing bacteria in the gut?

naturally! people take sulfasalazine tablets don't they 1.155.227.101 (talk) 00:42, 30 September 2011 (UTC)

It's a while since i used a Wiki: when i had UC more than 20 years ago as part of my cure i was advised to avoid abrasive foods such as 'grain' breads; oats; siliceous greens, etc. My gut took around 9 months to recover to good as new when i followed this advice (in addition to having neutralised repressed anger and grief plus removed a specific and associated unconscious belief from childhood). I had UC for 20 years; there was an approx. 18 year delay between the psychological conditioning in primary school and the physical sequel of UC. I shall not repeat myself if this is deleted: the answer is in psychoneuroimmunology. I am now 66 y.o.

I am well aware of the personal challenge in facing oneself and what is in the so-called unconscious mind (refer Greek myths and in particular Joseph Campbell's the hero with a thousand faces), but if i can do it so can others.

Regads 123.208.107.182 (talk) 06:25, 6 October 2011 (UTC)

UC is not caused by psychiatric factors - stress can IRRITATE it, but it is not the cause. UC can spontaneously just go away in about a quarter of the cases. Many people follow all dietary restrictions and continue to go downhill and need surgery eventually.HammerFilmFan (talk) 16:54, 3 June 2015 (UTC)

Someone entirely different here, but thanks for the above, 123.208.107.182. I was recently diagnosed with it at 21 and it's kind of annoying it fades in and out of remission. I had a strong thought it might very well be dietary, but interestingly, it only first happened once I drank in excess of 2L of diet pepsi a day over a summer. Obviously I don't touch colas nearly as much now (maybe twice a week), but I can't help but think the aspartame or some other ingredient in high doses at least contributed to it. 184.151.63.189 (talk) 20:14, 13 September 2012 (UTC)

Nah. While the cause of UC is not known, there is an undeniable genetic portion to the disease. Why it happens or triggers the first flare-up is unknown, but drinking a Pepsi didn't do this to you - it would have happened anyway. Most often, the disease seems to trigger after a mild infection of some type (such as a headcold) and the body's immune system fails to "turn off" and begins attacking healthy tissue. That's why the Talk Pages need to be restricted to the discussion of Reliable Sources, rather than a forum for the discussion of the general subject, because it is unproductive for the project. HammerFilmFan (talk) 16:58, 3 June 2015 (UTC)

2011 review in NEJM

[1] --Doc James (talk · contribs · email) 05:46, 14 November 2011 (UTC)

Steroids increase risk of bowel perforation!

There is mentioned that particularly in elderly patients there is an increased risk of bowel perforation after steroid intake[ref: http://emedicine.medscape.com/article/195537-overview#showall ]. And, of course, steroids mask simptoms of acute abdomen, so it could be deleterious to use steroids in patients with risk of perforation because of missing the perforation.

But i couldn't find anything worth that would explain the mechanism how steroids induce bowel perforation in ulcerative colitis. Please help! — Preceding unsigned comment added by Vldscore (talk • contribs) 18:44, 29 February 2012 (UTC)

Research

The section had a citation required since Jan 2012. I have removed the citation required tag after providing appropriate reference. Diptanshu^Talk 15:50, 22 December 2012 (UTC)

Added citation for "Sulfasalazine has been a major agent in the therapy of mild to moderate UC for over 50 years. In 1977, Mastan S. Kalsi et al. determined that 5-aminosalicylic acid (5-ASA and mesalazine) was the therapeutically active in sulfasalazine." George Bounacos (talk) 23:36, 30 August 2014 (UTC)

New reviews

2013 BMJ "Ulcerative colitis". BMJ (Clinical research ed.). 346: f432. 2013-02-05. PMID 23386404. {{cite journal}}: Unknown parameter |authors= ignored (help)

2012 BMJ Kelly, S (2012-05-10). "Ulcerative colitis". BMJ (Clinical research ed.). 344: e2947. PMID 22577187.

Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:25, 27 February 2013 (UTC)

Take a deep breath - smoking helps with colitis, and so does hydrocodene!

I have suffered off and on with UC for more than 30 years. Numerous colonoscopies, every test available to determine whether it was UC or Crohn's. All tests came back non specific Crohn's-colitis. The only determining factor that identified it as UC is that over the years I have found that smoking cigarrettes tends to bring the disease into remission, and when I have told my doctors that, they at first have asked me not to quote them, lol, but history has shown that smoking will help with UC and yet with Crohn's it actually worsens the condition. I have tried every drug available to man, sulphur drugs, prednisone, imuran, remicaid (I think that is what it was called - $10k a dose if I recall! None had any effect in bringing the condition into remission. Three times I have been hospitalized because the condition was so bad, one time for 30 days - after which I was no closer to remission than on day one, but without real food for a month, considerably lighter. My wife noticed a common denominator prior to my hospitalization - I had quit smoking. I read another post that UC is in many cases caused by something in the mind. I believe that to be true in my case. Although I may not appear anxious, nervous or depressed, I have always been what my parents called "a worrier". I do give a lot of thought to how I perform my job and I have held some very stressful positions, and I suppose I do overthink the future, detail etc. don't think I can change my make up though, it's the way I am, and I suppose it must be a great contributing factor as to why I suffer with UC. I am intrigued though with how smoking helps and why a healthy substitute cannot be developed based on that fact? Gum, nicorette, fake cigs, even pot do not help at all. I even tried writing to Phillip Morris to see if they would study it! but never got a reply - you would think they would jump at the chance to put a positive spin on such a killer habit. In the past 4 months, I once again quit smoking, having been free from any symptoms for close to 2 years (smoking during that time since the day I left the hospital - which by the way was the day my symptoms started to go away). In the past when I quit, I jotted down the worsening of my symptoms, little worsening the first week, gradually progressing to full blown at around 6 weeks. I would then normally pick up a cigarette and within hours feel better and within days the symptoms would be pretty much gone. This last time though, my doctor had me on a tapering dose of prednisone, from 40mg all the way down to 5mg. Although symptoms had improved, I still had active UC even though I had started smoking again. Here is the kicker - I had some foot pain last week and have been taking Hydrocodene otherwise know as Lortabs I think. It is like a miracle cure! All symptoms have completely disappeared. Foot is still aching, but heh, I'll take what relief I can get. I actually ran out of the pills and will not be taking anymore due to the addictive nature of the drug, but I felt compelled to share this story in hopes that others out there may know the answers as to why they help me, others still may find that these products may help them also. I know how desperate one becomes when UC is active, the panic to get to a bathroom, the panic never to be far from a bathroom, the need to know where every bathroom in a city is located etc. I also know the embarrassment of having to take relief when no bathroom is available, not pleasant. Please reply to this post if any of it rings true to your situation. Good luck. Atkinsx (talk) 00:14, 4 December 2013 (UTC)

The Wike TP's are not for the discussion of a personal experience or a forum. Please only post if you have a Reliable Source to improve the quality of the article. I am asking an Administrator to "hat" this post, please? HammerFilmFan (talk) 16:49, 3 June 2015 (UTC)

Under "Alternative Medicine" I think SAMe was intended in place of S-Methyl Methionine

S-Adenosyl methionine notes "SAMe has been studied in the treatment of osteoarthritis. SAMe reduces the pain associated with osteoarthritis. Although an optimal dose has yet to be determined, SAMe appears as effective as the non-steroidal anti-inflammatory drugs". Shjacks45 (talk) 10:26, 1 May 2014 (UTC)

Under "Alternative Medicine" and Causes

Omega-3 fatty acids contribute to digestive system health. You haven't figured out why 5-ASA are, but NSAIDs are not, used therapeutically (yet the target inflamation)? Same reason NSAIDs promote stomach ulcers, they inhibit prostaglandins that are protective of the stomach lining as well as the rest of digestive system lining. Long term high dose use has been implicated in promoting IBD. Shjacks45 (talk) 10:56, 1 May 2014 (UTC)

And your reference for your statement (title and page number) is what, exactly? HammerFilmFan (talk) 16:50, 3 June 2015 (UTC)

×==Bacterial recolonisation part==

This part has problems, the fecal recolonisation part. I removed sentence, as it is PPOV and suggesting self medication "In the United States it can be difficult to find doctors who perform this procedure so some patients have performed the procedure at home using a protocol outlined in a published study." And the protocol is included, so, we have here "try it at home situation." First, doctors don't perform it as is it not approved treatment, not even far in development. Second, there were only tiny samples in experiments: 6 people, 10 children, and results were mixed. Third; so far results are mixed.In one study there was 67% remission, in other one was only 32% response (a little bit bellow placebo effect). Fourth: There are not even larger double blind studies,so, it can't be said it is even a method in development, more like case studies than a full blown research. Fecal recolonisation was tried in small samples on patients with various illnesses, among them patients autoimmune diseases, including UC andCrohn's dissease..Even autism was included in trials, and so far doesn't look that his method is very promising, according to paper from 2014, about this treatment and UC.I don't even know why this part (fecal recolonisation) is included in the body of the article, as there are not numerous studies like is the case with probiotics, but only so few with so tiny samples. Case studies abound in medicine, and if we were to include them in wikipedia articles, we could have very long articles.Why not to focus on larger, double blind studies, they are more advanced. I would say this part fits more into diarrhea section, as three are more studies regarding this treatment in various types of diarrhea, and those were very succesful. As you see from this source, fecal bacterial transplant was used as support in probiotic recolonisation, quoting the article "The intestinal ecosystem of each individual patient reacted very differently to the fecal transplantation. Intestinal bacteria of the donors were detected in the patients, but at different times and in different frequencies." Bialosz (talk) 11:32, 31 January 2016 (UTC)

References

Pathophysiology - hydrogen sulfide not detrimental -> section needs revision

The upshot of the current text is that hydrogen sulfide is detrimental. Both articles cited are over 15 years old. Newer references exist that reverse the detrimental view of H2S. Furthermore, a role in future therapeutics is being investigated. I propose updating this section. Any thoughts among the watchers of UC? Thanks in advance for your input.

McortNGHH (talk) 20:27, 15 April 2016 (UTC)

References

The cause of Ulcerative Colitis

19:41, 24 June 2016 (UTC)Jay Pravda MD MPH (talk)The evidence suggests that colonic inflammation in ulcerative colitis develops as a result of excess colonic epithelial hydrogen peroxide that diffuses (leaks) out of epithelial cells and oxidizes (damages) tight junctional proteins. This increases mucosal permeability to luminal bacterial antigens that gain access to the normally sterile submucosal tissues, which initiates a neutrophilic inflammation characteristic of this disease (1).

There is sufficient experimental data to substantiate further studies to verify if this mechanism of disease is indeed operative in ulcerative colitis (2, 3). I strongly encourage research institutions that have an interest in curing ulcerative colitis to fund the necessary studies in order to determine if this mechanism of disease is indeed the cause of ulcerative colitis.

The sooner we know the truth, the closer we get to the cure.

1. Radical induction theory of ulcerative colitis http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4305621/

2. Impairment of mitochondrial acetoacetyl CoA thiolase activity in the colonic mucosa of patients with ulcerative colitis http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095666/

3. Differential immune and genetic responses in rat models of Crohn's colitis and ulcerative colitis http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025515/

Jay Pravda MD MPH

Lancet

doi:10.1016/S0140-6736(16)32126-2 JFW | T@lk 09:29, 2 December 2016 (UTC)

Frequency and deaths

This edit from an ip (Removed frequency and deaths as they give info for Chron's disease which is NOT ulcerative colitis - therefore irrelevant) was reverted [2]. I agree with the ip.

The same has happened with the Crohn's disease page [3].

In my opinion, it is very confusing. Keep in mind that it is intended for the general public, of all intellectual levels. What does the reader have to understand? That these are deaths and frequency of people who have both ulcerative colitis and Crohn's disease? Or that are people who only have Crohn's disease? And where...?

I would leave these figures only on the IBD page. Here it is not informative, just the opposite. If we do not have specific figures, we do not have specific figures.

As I have said more times, attempts to simplify sometimes confuse rather than help. And that is worrisome. --BallenaBlanca 🐳 ♂ (Talk) 10:06, 4 April 2018 (UTC)

This is not data just for Crohn's disease but data for CD and UC together. IMO they are useful both here and the IBD page. If we have data for just CD by itself than sure. Doc James (talk · contribs · email) 19:24, 4 April 2018 (UTC)

Do we apply the same criteria here as in Crohn's disease? [4] [5] --BallenaBlanca 🐳 ♂ (Talk) 23:13, 5 April 2018 (UTC)

In addition, the figure is wrong, not 112 million but 11.2 million (see table 2 "11 223·5 thousands". --BallenaBlanca 🐳 ♂ (Talk) 23:27, 5 April 2018 (UTC)

Yes agree the figure is wrong and fixed it. Do you have figures for just UC? Doc James (talk · contribs · email) 16:31, 7 April 2018 (UTC)

Can someone give a precise citation for this figure (page or table number)? SarahSV ^(talk) 17:49, 7 April 2018 (UTC)

@Doc James: I do not understand why you have reinserted this data [6]. It is very confusing and readers do not understand it. I will not repeat what I said above [7], but please, can you re-evaluate it putting yourself in the mind of a lay person who does not know what inflammatory bowel disease is, or what diseases it covers, why is Crohn's disease mentioned here ...?

I already added the data in inflammatory bowel disease and fixed the incorrect figure [8] and IMO that is enough. --BallenaBlanca 🐳 ♂ (Talk) 18:20, 7 April 2018 (UTC)

Because this is the data we have. If you have data for UC by itself we can use it. Doc James (talk · contribs · email) 18:23, 7 April 2018 (UTC)

This Lancet paper PMID:22001864, page 1488, is unclear and needs explanation -- not easy in the Infobox. I suggest we drop the global combined IBD figure (very much an estimate) from the UC article and see if we can find another ref.Jrfw51 (talk) 18:28, 7 April 2018 (UTC)

This one PMID 29050646 "Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies" (Lancet, December 2018) contains separate data with graphics and tables. I can send you the pdf --BallenaBlanca 🐳 ♂ (Talk) 18:40, 7 April 2018 (UTC)

That looks to be good for prevalence but global mortality data are not very relevant as SMR are only slightly increased and variable. PMID:25185685 Overall UC Highest risk estimate. HR, 1.25 (95% CI, 1.22–1.28); Lowest estimate, Pooled SMR, 1.1 (95% CI, 0.9–1.2). Jrfw51 (talk) 18:55, 7 April 2018 (UTC)

Which details about UC are you thinking we should use? Doc James (talk · contribs · email) 09:08, 8 April 2018 (UTC)

I would drop the Deaths data from the Infobox. Jrfw51 (talk) 10:17, 8 April 2018 (UTC)

Do we have details on the death rate for UC alone? Doc James (talk · contribs · email) 06:36, 9 April 2018 (UTC)

Can this be useful? PMID 25071340 Epidemiology, demographic characteristics and prognostic predictors of ulcerative colitis: "In meta-analyses of population-based cohort studies reported by Jess et al, five of 10 studies reported on UC-related mortality. The authors reported that among patients with UC, the mean percentage of deaths ascribed to UC itself was 17% (range 11% to 30%)." --BallenaBlanca 🐳 ♂ (Talk) 22:50, 10 April 2018 (UTC)

Lectin

Can have an ulcerative affect on the colon wall according to some sources Wikipietime (talk) 18:05, 17 June 2018 (UTC)

Having an ulcerative effect on the colonic mucosa is very different than ulcerative colitis. Many factors can lead to ulcers in the colon (lack of blood flow, constipation, etc), which have nothing to do with ulcerative colitis. However, if there is good quality evidence that lectin may contribute to the development of ulcerative colitis, I encourage you to add this content to the article, with references. Rytyho usa (talk) 01:49, 23 October 2020 (UTC)

"maintaining a high-calorie diet"

The article says "Dietary changes, such as maintaining a high-calorie diet or lactose-free diet, may improve symptoms.", but the reference doesn't seem to support this. Rather a linked page from the reference says "Ulcerative colitis symptoms may cause some people to lose their appetite and eat less, and they may not get enough nutrients.". While it may be true that a lactose-free diet (with appropriate supplementation) may reduce symptoms, aggravation, or onset of the condition (probably through microbiome related complex dynamics), it seems that the claim of a high calorie diet being helpful isn't backed obviously by the reference. The claim about dairy should probably be refined, but right now I suggest that the claim about high-calorie diet be dropped or be refined or qualified with peer reviewed research / a more obvious reliable source. — Preceding unsigned comment added by Thefreeencyclopedia1 (talk • contribs) 15:57, 12 February 2021 (UTC)

I just read the source and couldn’t find a reference to either the dairy part or the high calories. 78.152.205.15 (talk) 07:28, 23 July 2023 (UTC)

Wiki Education assignment: WikiProject Medicine Fall 2022 UCF COM

This article was the subject of a Wiki Education Foundation-supported course assignment, between 24 October 2022 and 18 November 2022. Further details are available on the course page. Student editor(s): Rasika ucf (article contribs). Peer reviewers: Medabloom.

— Assignment last updated by DrDexterN (talk) 20:17, 14 November 2022 (UTC)

Work Plan

Hello, I am a fourth-year medical student from the University of Central Florida, and I am enrolled in a WikiProject course. I have chosen this article and plan to edit it by changing wording and structure of some sentences that may be misleading or may use medical jargon. I plan to explain the meaning of various terms that would not be well known to most viewers (ex. Skip lesions, ileus, biologics etc.). The article seems to have most citations in place, but there are a few areas that indicate a need for citations. I hope to add references for those areas.

I also hope to add more information in the “Differential diagnosis” section of the article, as many of the diagnoses listed include vague descriptions. Additionally, I will update the information regarding medications and their side effects.

I would be happy to take any suggestions for changes as well! Rasika ucf (talk) 00:01, 8 November 2022 (UTC)

WikiProject Medicine Fall 2022 UCF COM, Peer Review

I learned so much from reading this article, especially from your contributions. Overall, I think your contributions were relevant, concise (which is not easy to do), important, and necessary additions to the article. From reading through your work plan, you achieved everything you hoped to accomplish. The information added is also understandable to the intended WP audience.

Great job editing and changing the wording and structure of sentences that were misleading or used medical jargon. A specific example of this was when you concisely defined “systemic signs of toxicity,” as “fever, chills, weight changes.” Contributions such as these are important for the understanding of the average reader.

I found it helpful that you explained the meaning of various terms that would not be well-known to most viewers, such as toxic megacolon.  

I appreciate how many references you contributed to the article (13!). I think your inclusion of quality secondary sources really takes this article to the next level, especially for viewers who may be interested in further reading on the topic.

I enjoyed reading and learning from your additions on primary sclerosing cholangitis, pyoderma gangrenosum, anemia, and hidradenitis suppurativa - it was well-done, concise, and packed with an informative punch accessible to the layperson! Your large addition to the imaging section really improved that portion of the article, which was very trim before.

You went above and beyond to meet your goal of expanding the differential diagnoses section. Thank you for explaining how to distinguish Crohn's disease, infectious colitis, other forms of colitis, and graft versus host disease from ulcerative colitis.

I spot-checked the links and they are all working! The article flows understandably and meets readability guidelines (no sentences longer than 26 words). You made use of periods and few commas or semicolons.

A suggestion for improvement could include adding more of the wiki links to different terms in the article such as: anal fissures, abscess, and infectious colitis.

Medabloom (talk) 18:59, 17 November 2022 (UTC)

Thank you so much for your feedback! I really appreciate your help and will definitely try to incorporate some more wikilinks! Rasika ucf (talk) 14:03, 18 November 2022 (UTC)

The Mayo Endoscopic Score should be mentioned somewhere in the article

As the title states, the Mayo Endoscopic Score should be mentioned somewhere in the article. Either under the Endoscopic subheading under the Diagnosis section and/or under the Progression/Remission subheading under the Prognosis section. After all MES is the common endoscopic index recommended in guidelines and considered a quality indicator, and widely used in clinical trials and clinical practice. Instantwatym (talk) 18:26, 10 September 2023 (UTC)