Ulcerative colitis is a type of inflammatory bowel disease (IBD) that causes severe and even bloody diarrhea that can result in abdominal pain and unexpected weight loss. While people have probably heard about Crohn’s disease more often than they have ulcerative colitis, this condition actually affects as many as 907,000 of the 1.6 million Americans living with IBD.
While ulcerative colitis can happen to anyone, a gastroenterologist most often diagnoses it during a person’s later teen years or by early adulthood. While there is no definitive cause of ulcerative colitis, a family history of this condition can certainly increase your chances of developing this chronic GI problem.
Those with ulcerative colitis experience diarrhea, which can be bloody at times. Some patients may experience rectal pain, occasional constipation, abdominal discomfort, fever, or weight loss. In order to diagnose this gastrointestinal issue, a GI specialist will often need to perform imaging tests such as a CT scan or run an endoscopy to check the health of the gastrointestinal tract and to look for signs of ulcerative colitis.
While there is currently no cure for this condition, there are certainly an array of medications and treatment options available to help you keep your symptoms and flare-ups in check. The type of treatment plan that your GI doctor will create for you will depend on the type and severity of your symptoms.
The main goals of treating ulcerative colitis are to reduce inflammation within the colon while also speeding up the remission process and making sure that your symptoms stay in remission for as long as possible. Of course, it is still possible, even with the right medication, to experience symptoms.
Common medications for treating ulcerative colitis include:
- Antibiotics: to target any infections within the GI tract
- Aminosalicylates: to treat mild to moderate inflammation within the colon
- Corticosteroids: for short-term treatment of moderate to severe symptoms
- Biologics: to target a specific protein, which leads to inflammation
Sometimes, over-the-counter medications and supplements may be used in conjunction with prescription medications. These may include vitamins and nutritional supplements, pain medications and antidiarrheal. If your ulcerative colitis doesn’t respond to these medications then you’ll want to discuss the benefits with your gastroenterologist of getting surgery to remove parts of the colon or rectum to alleviate severe or persistent symptoms.
C. difficile (Clostridium difficile) is an infection that should be talked about more often than it is despite the fact that it infects half a million Americans each year. While C. diff bacteria can be found within the gut of healthy individuals the healthy gut bacteria work to keep the potentially harmful bacteria in check. C. diff spores can be found in our environment through the air we breathe, or even the clothes on our back or the foods we consume. This is usually how we end up with C. diff in our guts.
However, sometimes circumstances arise in which C. diff bacteria are able to multiply within the gut. This most often occurs in someone who is taking antibiotics because while antibiotics are being used to fight an infection it can also kill off some of the healthy bacteria in our gut.
Unfortunately, C. diff bacteria are resistant to many kinds of antibiotics, giving it free range to thrive and multiply quickly within the gut. These bacteria, particularly in larger numbers, can also produce toxins. It’s usually the toxins themselves that lead to symptoms such as diarrhea, stomach cramps, nausea, and fever.
C. diff infections can range from mild to severe. In milder cases, patients may liken their symptoms to an infection within the stomach (also known as gastroenteritis). These symptoms may be mild and self-limiting, lasting anywhere from a couple of days to multiple weeks. Usually, medication or treatment isn’t needed in order to treat the infection.
However, those dealing with severe diarrhea, blood in the stool, severe abdominal pain, fever, and dehydration should seek the care of a gastroenterologist as soon as possible. While these symptoms can be indicative of several different gastrointestinal issues, if you suspect that you might have a C. diff infection it’s important that you seek immediate medical treatment.
Since most people have C. diff within their gut, if it isn’t causing any issues then no treatment is necessary. As we mentioned before, those dealing with minor symptoms may be able to let the issue run its course. Those with severe infections may need to be hospitalized. If you are still taking the antibiotics that may have caused this problem then you will most likely need to stop taking it so that the healthy gut bacteria have a chance of returning and making the gut healthier.
Those with severe diarrhea or colitis (inflammation of the colon) may be prescribed very specific antibiotics known to kill the C. diff bacteria. In the meantime, make sure you are drinking enough water and fluids to keep your body hydrated. If diarrhea is severe, your doctor may need to give you fluids and nutrients through an IV.
Luckily, most people dealing with this infection will be able to fully recover, even if they don’t get treatment; however, those who are older or have a weak immune system should seek medical attention as soon as possible if they suspect an infection. While symptoms can be unpleasant, they will usually go away in a few weeks.
Do you find that most mealtimes end up being ruined by gnawing, nagging heartburn? While most people will experience heartburn at some point during their lifetime, if you are someone who suffers from this problem several times a week then you may just have a digestive disorder known as gastroesophageal reflux disease (GERD).
What is GERD?
Whenever you eat food, it travels from the esophagus to the stomach. Once food enters the stomach, the stomach produces acid to break up the food. Of course, in healthy individuals the food travels from the stomach to the intestines; however, if you have GERD then the acid and food contents actually flow back up to the esophagus from the stomach, irritating the lining of the throat and causing a nasty case of heartburn.
What are the symptoms?
Heartburn is a classic symptom of GERD. Heartburn is a burning in the chest that also affects the lining of the throat. Heartburn sometimes produces an acidic or bitter taste in the mouth. Symptoms may get worse if you eat a big meal, consume something spicy or lie down immediately after eating.
How is GERD diagnosed?
In some situations a gastroenterologist may be able to determine that you have GERD based on the symptoms you describe and through a simple physical exam; however, sometimes a diagnostic test is required in order to determine whether your symptoms are truly caused by GERD or something else. An upper endoscopy is one common diagnostic procedure performed to check for signs of inflammation or damage to the lining of the esophagus, which are indicative of GERD.
What are my treatment options?
Your treatment plan will most likely consist of lifestyle modifications and medications.
If you are overweight or obese you may be at a higher risk for developing GERD. It’s important to lose that excess weight and to maintain a healthy weight to reduce your symptoms. Quit smoking if you are currently a smoker. Make sure to eat slowly and eat smaller meals. Don’t lie down immediately after eating and eat about three hours before going to bed.
Also, there are certain foods that can trigger heartburn symptoms including chocolate, caffeine, alcohol, tomato sauce, garlic, or fatty and spicy foods. Limit or avoid any of these foods if they are known to cause you heartburn.
Those with milder symptoms may be able to use an over-the-counter antacid or medication to manage their symptoms; however, if symptoms are moderate-to-severe, or if you have damage to the lining of the esophagus, then you’ll need a stronger medication to reduce or even prevent the production of stomach acid until the damage has healed.
If you deal with heartburn on a regular basis or can’t seem to get heartburn under control it’s important that you turn to a GI doctor who can help you find the proper treatment option to prevent digestive complications and to make mealtimes more enjoyable again.
Hepatitis C is an infectious disease that causes liver inflammation, sometimes leading to serious liver damage. Most people have no symptoms right after they have been infected, and since any symptoms are likely to go away in a few weeks, you may not know you have Hepatitis C for a long time. Here are the most common signs of Hepatitis C.
Jaundice is a yellowish appearance of the whites of the eyes due to high bilirubin levels. Normally bilirubin gets broken down in the liver and released from the body in the stool. But if the liver is damaged, it cannot properly process bilirubin.
2. Dark Urine
Urine naturally has some yellow pigments called urobilin or urochrome. The color of the urine can vary when certain medications are taken and when foods of certain types are consumed. Chronic dark-colored urine can be related to serious liver conditions, including Hepatitis C and cirrhosis.
3. Chronic Fatigue
The severity of this fatigue differs from person to person. Some individuals are able to work, but then feel burned out in the evening. Some people spend a large amount of time sleeping. However, someone people feel very tired after a good night's sleep. The fatigue associated with Hepatitis C often improves with treatment.
4. Aches and Pains
Some people with Hepatitis C experience abdominal pain. Many suffer from aches and pains in their joints. A variety of different joints can be involved but the most common are in the wrists and hands. The pains can range from mild to severe. In such cases, medications can be used to ease the pain.
5. Poor Appetite
Loss of appetite implies that hunger is absent. Your appetite may worsen if you have cirrhosis or liver failure. Loss of appetite can also be caused by other diseases and conditions. Some of the conditions can be temporary, such as appetite loss from the effects of medication.
6. Low-grade Fever
Everyone gets a fever from time to time. Most usually don't indicate anything serious. However, some people with Hepatitis C experience a low-grade fever (fever up to 102°F). You should book an appointment with a doctor if you've had a fever for more than three days.
7. Cognitive Changes
Some people with Hepatitis C experience problems with concentration, short-term memory, and completing complex mental tasks such as mental arithmetic. Studies have shown that about half of those with Hepatitis C experience cognitive disturbances.
Many people are surprised to learn that they have been infected with Hepatitis C. Some people feel overwhelmed by the changes they need to make in their lives. At a time when life feels out of control, remember that you can take an active role in your health- and your life.
Hepatitis C Facts
- ~3.5 million Americans live with HCV infection.
- >15,000 Americans will become infected with HCV every year.
- >15,000 Americans will die every year from complications of HCV.
- 80% of people who get exposed to HCV will develop a chronic infection.
- HCV is acquired through direct exposure to blood of someone who is infected.
- 15-30% of people with chronic HCV will develop cirrhosis or other complications, most after more than 20 years.
- HCV with heavy alcohol use increases the risk of cirrhosis 100-fold
- Currently, no vaccine is available.
A renaissance in the treatment of Hepatitis C Virus (HCV)
Twenty-five years of HCV’s dark ages are over. Plagued by poor understanding of HCV, primitive and barbaric treatments (specifically interferon) with significant toxicity and limited success were all we had to offer—until now. In 2009, scientists discovered how to replicate HCV in mice, opening the doors to a renaissance in HCV drug development.
The new age Hepatitis C treatment
Within the past year, interferon-free drug regimens for every genotype (sub-type of HCV) have come to market. While we are still gaining important experience with these drugs, a few things are clear: The new HCV drugs are very effective with greater than 90% cure, even in those with cirrhosis, and are easy to take with minimal side effects. Better yet, several additional drugs are currently under study with very promising results; the near future will offer even more effective, shorter, easier, and less costly treatment regimens.
Hepatitis C genotype 1 (and 4)
Type 1 HCV accounts for more than 70% of infections in the United States and traditionally was very resistant to treatment. Harvoni© became available October 10th, 2014 representing the first interferon-free regimen consisting of one pill (containing ledipasvir and sofosbuvir) taken once a day for 12-weeks with >94% clearance. Side effects include headaches and fatigue, but not a single study participant stopped the drugs due to side effects—a gigantic leap forward compared to interferon-based treatments. More recently, Viekira© and Olysio-Sovaldi© treatment regimens were approved, with the promise of several more to come in 2015.
Hepatitis C genotype 2 and 3
Approval of Sovaldi© in combination with Ribavirin© has improved cure rates for HCV genotypes 2 and 3 from 70% to greater than 90%. However, this combination eliminates the need for interferon, but still relies on ribavirin—a drug with the potentially serious side effect of anemia (low red blood cell counts.) Better regimens, which avoid both interferon and ribavirin, are just around the corner.
Who should get treated for hepatitis C in this new era?
With such great new medications, it would seem that everyone should get treated, except for one serious problem: cost. The new drug regimens cost in excess of $80,000; it would cost 280 billion dollars (for the drugs alone) to treat every American with Hepatitis C. Obviously, insurance companies have balked at the thought of an $80,000 drug, and perhaps rightfully so. Less than a third of all persons infected with HCV will ever develop cirrhosis or complications—treatments should be offered to patients who are at a high risk of developing cirrhosis. Fortunately, for most it takes 30 years or more to develop cirrhosis. See a Gastroenterologist to determine if, and when, treatment might be needed.
There has been some excitement lately since the FDA recently approved ColoGuard, a genetic test performed as an additional testing option for colon cancer screening. Dr. Kevin Rufner has outlined the benefits and cost comparison for this test. To read his article, click on the document link below.
Welcome to the Blog of Colorado Gastroenterology
Colorado Gastroenterology would like to welcome you to our blog. Here you will find informative and useful postings about gastroenterology and our practice.
At Colorado Gastroenterology we believe that educated patients are better prepared to make decisions regarding the health of their digestive system. Our blog was designed to provide you with the latest gastroenterology developments and valuable health advice from our dedicated team.
Colorado Gastroenterology hopes you find our blog to be a great resource for keeping up to date with proper digestive health care and treatments.
We welcome all comments and questions.
-- Midtown Medical Center
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