Ulcerative Colitis and Chronic Diarrhea

Aloe Vera Helps Ulcerative Colitis: 44 ulcerative colitis patients were given 100 cc aloe vera gel or placebo twice a day for four weeks. Clinical remission, improvement and response occurred in 30%, 37% and 47%, respectively with aloe vera vs. 7%, 7%, and 14% with placebo. Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Langmead L, Feakins RM, et al. Aliment Pharmacol Ther. 2004 Apr;19(7):739-47. Ed: This would cost about $20 per month for the aloe vera gel. 

Azathioprine No Better Than Sulfasalazine in Small Study of UC: In a randomized, open-label study of 25 patients with severe ulcerative colitis using azathioprine (2.5 mg/Kg/day) vs. sulfasalazine (6 g/day), 2 patients in Group A had to stop azathioprine because of adverse effects (bone marrow suppression and acute pancreatitis). The relapse rate of ulcerative colitis on maintenance therapy with azathioprine or sulfasalazine was comparable; there was a trend towards earlier treatment failure with azathioprine. Azathioprine versus sulfasalazine in maintenance of remission in severe ulcerative colitis. Sood A, Midha V, et al. Dayanand Medical College, Punjab, India. Indian J Gastroenterol. 2003 May-Jun;22(3):79-81.

Bile Acid Malabsorption (BAM), a Cause of Chronic Diarrhea, can be diagnosed by the SeHCAT test. The SeHCAT test was performed in 135 patients with chronic diarrhea and no cause found. In 44%, bile acid absorption was normal with SeHCAT retention > or = 15%. Impaired SeHCAT was found in 56%. All patients with ileocaecal resections had retention values < 10%. Patients with microscopic colitis presented with BAM in 39%. Patients with idiopathic BAM and/or SeHCAT retention values < 5% had the best response to treatment with cholestyramine. Bile acid malabsorption in patients with chronic diarrhoea: clinical value of SeHCAT test. Wildt S, et al. University Hospital of Copenhagen, Denmark. . Scand J Gastroenterol 2003 Aug;38(8):826-30

Bile Acid Malabsorption in Microscopic Colitis and in Unexplained Functional Chronic Diarrhea: A [75Se]HCAT abdominal retention test was performed in 26 patients with collagenous colitis, 25 with lymphocytic colitis, and 32 with previously unexplained functional chronic diarrhea. 43% patients with microscopic colitis and 75% patients with previously unexplained functional chronic diarrhea presented with BAM. The frequency of BAM was higher in lymphocytic colitis than in collagenous colitis (60% vs 27%; P = 0.025). Cholestyramine induced clinical remission in 19 of 22 patients with microscopic colitis and BAM, none of eight patients treated with collagenous colitis without BAM, and all patients with previously unexplained chronic diarrhea and BAM. Fernandez-Banares F, et al. Spain. Dig Dis Sci 2001 Oct;46(10):2231-8.

Boswellia Helped Chronic Colitis: In a 6-week DB study, twenty patients were given a preparation of the gum resin of Boswellia serrata (300 mg 3 times a day) and ten patients were given sulfasalazine (1 gm 3 times a day). Out of 20 patients treated with Boswellia gum resin 18 patients showed an improvement in one or more of the parameters: including stool properties, histopathology as well as scanning electron microscopy, besides hemoglobin, serum iron, calcium, phosphorus, proteins, total leukocytes and eosinophils. In the control group 6 out of 10 patients showed similar results. Out of 20 patients treated with Boswellia gum resin 14 went into remission while in case of sulfasalazine remission rate was 4 out of 10. Boswellia has minimal side effects. Effects of gum resin of Boswellia serrata in patients with chronic colitis. Gupta I, Parihar A, et al. Medical College Jammu, India. Planta Med. 2001 Jul;67(5):391-5

Boswellia Helped Ulcerative Colitis as Well as Sulfasalazine: Boswellic acids are specific, nonredox and noncompetitive inhibitors of 5-lipoxygenase, the key enzyme of leukotriene biosynthesis. In patients suffering from ulcerative colitis grade II and III the effect of Boswellia serrata gum resin preparation (350 mg thrice daily for 6 weeks) on stool properties, histolopathology and scan microscopy of rectal biopsies, blood parameters including Hb, serum iron, calcium, phosphorus, proteins, total leukocytes and eosinophils was studied. Patients receiving sulfasalazine (1 g thrice daily) served as controls. Of boswellia patients, 82% went into remission vs. sulfasalazine 75%. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Gupta I, Parihar A, et al. Jammu, India. Eur J Med Res. 1997 Jan;2(1):37-43.

Clonidine Helped Reduce Sympathetic Overactivity and Disease: In an 8-week DB PC study of 23 patients with UC and 20 controls, researchers documented an overall increase of sympathetic activity characterized active UC. Normalization of the autonomic profile by clonidine was accompanied by an improvement of the disease. Sympathetic Overactivity in Active Ulcerative Colitis: Effects of Clonidine. Furlan R, et al. University of Milan, Italy. Am J Physiol Regul Integr Comp Physiol. 2005 Aug 25

Fish Oil Supplement May Have Helped a Little: In a DB PC 6-month study of 121 UC patients, those on an 18 oz oral daily supplement enriched with fish oil, fructooligosaccharides, gum arabic, vitamin E, vitamin C, and selenium showed a significant and similar degree of improvement in disease activity (-2.5 vs. -2.8 for placebo) and histologic index (-1.9 vs. -2.0 for placebo). However, those on the supplement had a greater rate of decrease in the dose of prednisone required to control clinical symptoms over 6 months as compared with the placebo group ( P < .001). An oral supplement enriched with fish oil, soluble fiber, and antioxidants for corticosteroid sparing in ulcerative colitis: a randomized, controlled trial. Seidner DL, Lashner BA, et al. Cleveland Clinic. Clin Gastroenterol Hepatol. 2005 Apr;3(4):358-69

Infliximab Helped Severe UC: Despite treatment with corticosteroids, severe to moderately severe attacks of ulcerative colitis have a high colectomy rate. Cyclosporin A causes a high risk of side effects and cyclosporine-related mortality. In a 3-month DB PC study of 45 severe to moderately severe ulcerative colitis patients not responding to conventional treatment, patients were randomized to infliximab/placebo either on day 4 after the initiation of corticosteroid treatment if they fulfilled the index criteria for fulminant ulcerative colitis on day 3 or on day 6-8 if they fulfilled index criteria on day 5-7 for a severe or moderately severe acute attack of ulcerative colitis. Seven patients in the infliximab group and 14 in the placebo group had a colectomy ( P = .017; odds ratio, 4.9) within 3 months. No serious side effects occurred. Three patients in the placebo group required operation for septic complications. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Jarnerot G, Hertervig E, et al. Gastroenterology. 2005 Jun;128(7):1805-11.

Meat, Mammal Meat, Eggs, Alcohol Bad for Ulcerative Colitis: 183 adults with stable ulcerative colitis were followed for one year during which 52% relapsed. Those who ate the most meat (4 oz. or more a day) were three times as likely to relapse as those who ate the least (less than 2 oz.). If this was mammal meat and/or processed meat,  patients were five times more likely to relapse. A high intake of animal protein in general, fish, and eggs tripled the risk. Those who drank the most alcohol (more than 2 units a day) were also almost three times as likely to relapse compared with those who drank the least (less than 1 unit a day). Surprisingly, the risk of relapse was not associated with high intake of milk and dairy products, and high levels of dietary fiber did not seem to ward off the risk of relapse either. When the food constituents were assessed, high intakes of sulphur and sulphate were associated with relapse, which could explain the link with red meat and alcohol. The main sources of dietary sulphur are the sulphur amino acids, found in high protein foods, such as mammal meat, cheese, milk, nuts and eggs, and sulphate. Sulphate is found in brassica vegetables, such as broccoli, and is used as a preservative in processed foods, especially bread, beer, sausages, and dried fruit. Many alcoholic drinks also contain sulphate. A high sulphur diet produces hydrogen sulphide, which damages the inner lining of the bowel, making it more 'leaky' and increasing cell turnover, say the authors. Newcastle University, Gut 9/2004.

Microscopic Colitis: Collagenous or Lymphocytic: is a common autoimmune-type disorder that is a cause of chronic, non-bloody diarrhea (90%) with pain (40%), Weight loss (40%), urgency (30%) and nocturnal stools (20%) with normal endoscopic and radiological findings and diagnosis by biopsy of collagenous or lymphocytic infiltration. There is no fat malabsorption. It is sometimes induced by NSAIDs or other drugs. Average age of onset is 64 for collagenous and 59 for lymphocytic with 5:1 females for collagenous and 2.4:1 for lymphocytic. In can be associated with celiac disease.  Six randomized trials were identified. One trial studied bismuth subsalicylate (published in abstract form only) was of 9 patients given nine 262 mg tablets daily for 8 weeks with clinical (p = 0.003) and histological (p = 0.003) improvement favoring bismuth. One trial with Boswellia of 31 patients (abstract form only) found only a weak trend towards benefit (44% vs. 27%). Three studies with budesonide of 94 patients found 9 mg daily (Entocort $360/month) or in a tapering schedule for 6 to 8 weeks had a very good pooled odds ratio for clinical response of 12.32, with a number needed to treat of 2 patients. The effectiveness of prednisolone and Boswellia serrata extract and other therapies for induction or maintenance of remission of collagenous colitis is unknown and requires further study. Interventions for treating collagenous colitis. Chande N, et al. Cochrane Database Syst Rev 2005 Oct 19;(4):CD003575. The long-term prognosis of microscopic colitis is good, serious complications are rare and there is no increased mortality. 

Microscopic Treated with Cholestyramine: In 13 lymphocytic colitis (LC), and 7 with not otherwise specified (NOS) microscopic colitis, cholestyramine achieved remission in 75 % with no therapeutic effect in 15 %. In general, the anti-diarrhoeal effect appeared within one week. Chronic diarrhoea in non collagenous microscopic colitis: therapeutic effect of cholestyramine. Baert D, et al. Ghent, Belgium. . Acta Clin Belg 2004 Sep-Oct;59(5):258-62. 

Microscopic Collagenous Colitis: Retrospective Study of 163 Patients: In 163 histopathologically verified cases from 25 hospitals, collagenous colitis followed a chronic intermittent course in most cases (85%) with a sudden onset in 42%. Symptoms were chronic watery diarrhea, often nocturnal (27%), abdominal pain (41%), and weight loss (42%). 40% had one or more associated diseases. The median age at diagnosis was 55 (range 16-86), but 25% of the patients were younger than 45. The response rate for sulphasalazine was 59%, and 50% and 40% for mesalazine and olsalazine. Prednisolone was most effective with a response rate of 82%, but the required dose was often high and the effect was not sustained after withdrawal. Antibiotics (e.g. metronidazole? which helps C. dificile, and others) were efficient in 63%. Cholestyramine and loperamide had response rates of 59% and 71% respectively. A plan for the treatment of a newly diagnosed patient with collagenous colitis is proposed. Bohr J, et al, Sweden. Gut 1996 Dec;39(96):846-51.

Microscopic Colitis Series: In 81 patients with microscopic colitis studied prospectively, 37 with CC and 44 LC, those with CC had a longer duration of diarrhea before diagnosis. Drug-induced disease was suspected for ticlopidine, flutamide, gold salts, and bentazepam in LC. Complete resolution of diarrhea was achieved in all patients, spontaneously occurring in nearly 20% of them. Response to salicylates (mainly mesalazine) was better in LC than in CC (86% vs 42%, p = 0.005). Cholestyramine was highly effective in patients of both groups with concomitant bile acid malabsorption. Patients with CC required prednisone more often (30% vs 4.5%, p = 0.005). Both prednisone and budesonide controlled ileal release were highly effective in patients with CC (82% and 89% efficacy). After cessation of diarrhea, 25% of patients with LC and 30% of those with CC relapsed after a mean follow-up of around 3 yr. Collagenous and lymphocytic colitis. evaluation of clinical and histological features, response to treatment, and long-term follow-up. Fernandaz-Banares F, et al. Barcelona, Spain. Am J Gastroenterol 2003 Feb;98(2):340-7.

Trichuris Suis Worm Eggs Help in DB: Ulcerative colitis is most common in Western industrialized countries, but uncommon in developing countries where helminths are frequent. People with helminths have an altered immunological response to antigens. In animal models, helminths prevent or improve colitis by the induction of regulatory T cells and modulatory cytokines. In a DB PC study of 54 ulcerative colitis patients, trichuris suis ova orally at 2-week intervals for 12 weeks resulted in 43% improving vs. 17% with placebo.  Treatment induced no side effects. The worms die harmlessly. Trichuris suis therapy for active ulcerative colitis: a randomized controlled trial. Summers RW, Elliott DE, et al. University of Iowa. Gastroenterology. 2005 Apr;128(4):825-32. Ed: The treatment is not yet available.

Yogurt: Pouchitis Markedly Improved by Yogurt Bacteria: In a 9-month, University of Bologna DB PC study of 40 pouchitis patients, the 20 given 6 g packets of yogurt bacilli (lacto-, and bifidobacilli, and S. thermophilus) had only 3 relapses (15%) vs. 20 relapses (100%) for the placebo group. Pouchitis is the major long-term complication after ileal pouch-anal anastomosis for ulcerative colitis. Most patients have relapsing disease. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gionchetti P, Rizzello F, Venturi A, Brigidi P, Matteuzzi D, Bazzocchi G, Poggioli G, Miglioli M, Campieri M. Gastroenterology. 2000 Aug;119(2):305-9 

Yogurt: Ulcerative Colitis Markedly Improved with Bifido Yogurt: In a Japanese DB PC 1-year study of 21 UC patients, only 3 of 11 of those on one cup per day of bifidobacterium fermented milk had endoscopically confirmed relapses vs. 9 of 10 on placebo. Randomized controlled trial of the effect of bifidobacteria-fermented milk on ulcerative colitis. Ishikawa H, Akedo I, Umesaki Y, Tanaka R, Imaoka A, Otani T. J Am Coll Nutr. 2003 Feb;22(1):56-63

Yogurt Bacteria: Ulcerative Colitis Helped by Bifidobacterium Capsules: In an 8-week, 30-patient Chinese DB PC study of UC patients in remission with the help of steroids and sulfa, patients on the probiotic capsules had many fewer endoscopically confirmed relapses, 3 vs. 14. The effects of bifidobacterium on the intestinal mucosa of the patients with ulcerative colitis Cui HH, Chen CL, Wang JD, Yang YJ, Sun Y, Wang YD, Lai ZS. Zhonghua Nei Ke Za Zhi. 2003 Aug;42(8):554-7; The yogurt bacteria has also been effective in mice for ulcerative colitis (Digestion. 2003;67(1-2):90-5) and enterocolitis. 

Yogurt: Ulcerative Colitis Patients Appear Helped Without Meds: In 20 UC patients either allergic to or intolerant of 5-ASA, the standard UC treatment, a one year trial of yogurt bacteria in a commercial preparation resulted in 80% being relapse free. Impact on the composition of the faecal flora by a new probiotic preparation: preliminary data on maintenance treatment of patients with ulcerative colitis. Venturi A, Gionchetti P, Rizzello F, Johansson R, Zucconi E, Brigidi P, Matteuzzi D, Campieri M. Aliment Pharmacol Ther. 1999 Aug;13(8):1103-8