Understanding the Role of Inflammation in Ulcerative Colitis
What does inflammation have to do with ulcerative colitis?
Dr. Carmen Cuffari is a leading gastroenterologist at the Johns Hopkins University School of Medicine, Division of Pediatric Gastroenterology and Nutrition. To meet Dr. Cuffari, click here.
“Inflammation plays a big role in ulcerative colitis. Recognizing what inflammation does and how it can be controlled is crucial to reducing your symptoms and getting your UC into remission.”—Carmen Cuffari, MD
Dr. Cuffari believes that understanding inflammation and getting it under control is key to managing your ulcerative colitis (UC). To do this, it's important to understand the role of inflammation in this condition, as Dr. Cuffari points out.
Most gastroenterologists define remission as having normal bowel movements without blood and abdominal pain. If you feel your medicine is not providing complete relief of your symptoms, it's time to talk to your doctor. Here are some of the things you should know about inflammation and UC.
First, understand that inflammation can be good and bad. Inflammation is an automatic and normal response from our immune system to defend and protect. When we get an infection or have an injury, our immune system pulls out all the stops to protect our body from harmful invaders—inflammation is one of many defense moves. In this situation, inflammation is good because it essentially walls off the injured or infected area and allows an increased blood supply to come in to help heal. When this happens, the area of harm gets "warm" (with new blood) and the surrounding tissue swells.
Some chronic diseases, like ulcerative colitis, also cause inflammation. We don't completely understand why this happens, but, unfortunately, this kind of inflammation is bad and chronic, meaning it occurs constantly. In this situation, the body's defense system has a glitch—the inflammation is "on" all the time, and it does not know when to turn off.
Chronic inflammation is a factor in ulcerative colitis. In UC, inflammation takes place in the mucosal (or mucus) lining of the colon—a layer that would normally protect the colon from damage. The presence of chronic inflammation eventually damages this lining, producing symptoms like diarrhea, rectal bleeding, urgency, and abdominal pain. As the inflammation gets worse, ulcers (or sores) develop.
To treat UC, we need to reduce the inflammation to heal the colon. Doctors now realize that controlling UC symptoms is not enough. If inflammation is ongoing, symptoms may return. But when inflammation is reduced, you may see a reduction in symptoms.
How do we know this approach works? A study conducted in people with ulcerative colitis looked at whether or not healing the lining of the colon was effective in long-term treatment. After 1 year of follow-up, the study concluded that healing does reduce future UC relapses and decreases the need for a colectomy.
Uncontrolled inflammation can also increase the risk for colon cancer. Several other studies have suggested that the risk for developing colorectal cancer increases as the severity of inflammation in the colon increases. In these studies, inflammation was found on colonoscopy and in biopsies of colon mucosa taken during colonoscopy and viewed by microscope.
Talk to your doctor about your UC treatment. Hopefully you now understand that the goal of your treatment should be to return to a normal number of bowel movements without blood and to reduce the inflammation in your colon so that you can maintain disease remission as long as possible.
Unfortunately, many patients mistakenly believe that flare-ups are just something they have to live with. In fact, a recent survey showed that most patients accept having up to 6 flares per year as "normal" and the best they can ever hope to expect from their treatment. Furthermore, the study also showed that their physicians are unaware of the true number of "flare-ups" these patients are experiencing on a yearly basis. If you think you should be feeling better with fewer "flare-ups" per year, be sure to bring it up at your next visit with your gastroenterologist.
Want to understand why it's so important to talk to your doctor? Click here to find out why patients may feel worse than their physicians perceive, based on the results of the UC: NORMAL survey.
