Common Ulcerative Colitis Questions Answered
I have had ulcerative colitis for years, and it began when I stopped smoking. I have read that there may be an association. I obviously don't want to smoke again. Can you tell me a little about this?
There most definitely is an association between tobacco smoking and inflammatory bowel disease. Interestingly, the effect on Crohn's Disease and ulcerative colitis are opposite. It appears that smoking cigarettes tends to protect one from ulcerative colitis. In patients predisposed to having ulcerative colitis, stopping smoking can trigger the disease. Ulcerative colitis therefore appears to be a disease of non-smokers. On the other hand, Crohn's disease is typically more common in smokers, and in patients with Crohn's that do smoke, usually have more severe disease manifested by more flares and more of a need for surgery. In patients with Crohn's disease who smoke, it is strongly recommended to quit smoking. While it may be tempting to advise ulcerative colitis patients who had previously smoked to resume smoking when their disease flares, given the serious health complications from tobacco, that is not recommended. However, studies have been done on nicotine patches in patients with Ulcerative colitis. While they were found to induce remissions more than placebo, side effects of nausea, lightheadness and headache were common. Nicotine capsules were tried, but not well tolerated either. While you should check with your doctor about your case, in general, nicotine as a treatment option for ulcerative colitis, while interesting, appears to be a lat resort prior to surgery.
My brother has severe ulcerative colitis that has been refractory to all treatments including Remicade. He is currently hospitalized and his doctors are talking surgery. I read about the use of heparin in severe ulcerative colitis. Is this a viable treatment option?
While it would seem contraindicated, small studies have shown heparin to be more effective than placebo in ulcerative colitis. Interestingly, bleeding was not increased in patients receiving heparin. Further studies need to be done to determine efficacy and safety, but if surgery is the only option remaining, it is worthwhile bringing it up with his physicians.
I have been taking Remicade for my ulcerative colitis and have had decent results. A friend of mine has been using Humira for Crohn's disease. Will Humira work for me?
Humira was approved for use in Crohn's disease in January 2007 but has still not received approval for ulcerative colitis. Like with Remicade, it is most likely just a matter of time before approval is granted. Both drugs are biologics that are very effective in inflammatory bowel disease. An advantage of Humira over Remicade, is that instead of coming to an infusion center once every two months for a two-hour infusion, Humira is self-injected, similar to an insulin injection, every other week. While some patients taking Humira develop mild skin reactions at the injection site, most do very well. While you could check with your doctor about using Humira now, without approval, your insurance company will not pay for it. You should certainly let your doctor know that you are interested in switching to Humira once it gains approval for use in ulcerative colitis patients.
What is toxic megacolon?
Toxic megacolon is a severe dilation of the colon which occurs when inflammation spreads from the mucosa through the remaining layers of the colon. It is seen more commonly in ulcerative colitis, but can be seen in Crohn's disease involving the colon as well. Patients most be carefully following with abdominal xrays and surgical evaluation, as it the colon gets to me a certain size, it can rupture or perforate, which can lead to death. It is felt that the use of anti-diarrheals such as immodium or lomotil, and narcotics, such as Percocet or Darvocet can lead to toxic megacolon by slowing down intestinal contractions. That is why these medications are typically not recommended in patients with colitis.