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Blood in stool
Bleeding from anus
Stomachache
Diarrhea
Stomach pain with diarrhea
Abdominal discomfort
Frequent bowel movements with stomach ache
Not seeing your symptoms? No worries!
What is Ulcerative Colitis?
An inflammatory condition of the large intestine that damages the gut wall. The exact cause is not well known.
Typical Symptoms of Ulcerative Colitis
- Blood in stool
- Abnormal stool color
- Constipation with urge to go but unable to pass stool
- Bleeding from the anus
- Diagnosed with Primary Sclerosing Cholangitis
- Abnormal stool shape
- Diagnosed with Erythema nodosum in the past
- Stomach or abdominal pain in a specific area
Diagnostic Questions for Ulcerative Colitis
Your doctor may ask these questions to check for this disease:
- Have you noticed any blood in your stool?
- Have you noticed any changes in your stool color?
- Do you have constipation where you feel the urge to go but can't pass stool?
- Are you experiencing anal bleeding?
- Have you been diagnosed with Primary Sclerosing Cholangitis?
Treatment of Ulcerative Colitis
Treatment includes medications to reduce inflammation and suppress the immune system. Lifestyle changes like a modified diet and stress reduction may be helpful. In severe cases, hospitalization for intravenous hydration, and surgery to remove part of the large intestine may be needed.
Reviewed By:
Samantha Nazareth, MD (Gastroenterology)
Board-certified gastroenterologist. Experience managing gastrointestinal conditions (GERD, IBS, ulcerative colitis, Crohn’s, celiac disease, NASH) within healthcare organizations (three ambulatory surgical centers, single-specialty practice, multi-specialty practice and solo practice).
Aiko Yoshioka, MD (Gastroenterology)
Dr. Yoshioka graduated from the Niigata University School of Medicine. He worked as a gastroenterologist at Saiseikai Niigata Hospital and Niigata University Medical & Dental Hospital before serving as the Deputy Chief of Gastroenterology at Tsubame Rosai Hospital and Nagaoka Red Cross Hospital. Dr. Yoshioka joined Saitama Saiseikai Kawaguchi General Hospital as Chief of Gastroenterology in April 2018.
Content updated on Mar 31, 2024
Following the Medical Content Editorial Policy
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- Green poop
- Stools looks like strawberry jam
- Stool looks like raspberry jelly
- Pale stools
- Poop looks like strawberry jam
- Poo looks like currant jelly
- Clay like stool
- Blood and mucus in stool
- Stool looks like jelly
- Fresh blood from anus
- Hard pebble like stool
- Bloody diarrhea
- Red sticky poo
- White pellet like stool
- White stools after 1 month after birth
See full list
Symptoms Related to Ulcerative Colitis
Diseases Related to Ulcerative Colitis
FAQs
Q.
Biologic Failure IBD? Why Your Gut Won’t Heal & New Medical Next Steps
A.
There are several factors to consider with biologic failure in IBD: a drug may never work or stop working due to antibodies, low levels, shifting inflammation pathways, non-IBD causes, or structural damage, leading to persistent symptoms and abnormal inflammatory markers. Next steps usually include therapeutic drug monitoring, dose optimization, switching drug classes, possible combination therapy, or surgery, plus checking for infections or IBS mimics and knowing when urgent care is needed. See the complete guidance below, since key details and risks can change which path is right for you.
References:
* Papamichael K, et al. Management of inflammatory bowel disease patients with loss of response to biologics: an updated practical guide. J Crohns Colitis. 2022 Jul 23;16(7):1037-1052. doi: 10.1093/ecco-jcc/jjac011. PMID: 35741006.
* Chapin A, et al. Treatment Algorithms for Patients with Biologic Failure in Inflammatory Bowel Disease. Clin Transl Gastroenterol. 2020 May;11(5):e00174. doi: 10.14309/ctg.0000000000000174. PMID: 32414167.
* Gisbert JP, et al. Loss of Response to Biologic Therapies in Inflammatory Bowel Disease. Drugs. 2020 Aug;80(12):1179-1193. doi: 10.1007/s40265-020-01362-x. PMID: 32675005.
* Riaz M, et al. Novel Therapeutic Options for Refractory Inflammatory Bowel Disease. J Clin Med. 2020 Sep 5;9(9):2851. doi: 10.3390/jcm9092851. PMID: 32900222.
* Sandborn WJ, et al. Biologics, Small Molecules, and Combination Therapy for Inflammatory Bowel Disease. N Engl J Med. 2023 Feb 23;388(8):721-738. doi: 10.1056/NEJMra2202720. PMID: 36830727.
Q.
Biologics Failing? Why Your UC Resists & New Medical Next Steps
A.
There are several factors to consider; see below to understand more. Biologic therapies can fail due to primary non-response, antibody-related loss of response, low drug levels, or misdiagnosis, so re-evaluation with infection checks and drug-level testing is the first step. Next options include switching to a different class, using small molecule oral therapies, optimizing or combining treatments, exploring clinical trials, or considering curative surgery; see below for key risks, monitoring targets like mucosal healing, and urgent symptoms that could change the best next step.
References:
* Atallah, H., Singh, A., Patel, H., & Khan, N. (2023). Novel and emerging therapeutic strategies for ulcerative colitis refractory to biologics. *Expert Review of Clinical Immunology*, *19*(1), 79–88.
* Jharap, B., Dulai, P. S., & Sandborn, W. J. (2022). Treatment of Ulcerative Colitis Refractory to Biologic Agents. *Digestive Diseases and Sciences*, *67*(11), 5076–5085.
* Hagey, D. B., & Click, B. (2021). Management of Ulcerative Colitis Refractory to Biologics. *Gastroenterology Clinics of North America*, *50*(1), 145–156.
* Panchoo, K., Dassanayake, A., & Bressler, B. (2020). Advances in the Management of Biologic-Refractory Ulcerative Colitis. *Clinical and Translational Gastroenterology*, *11*(11), e00263.
* Afzali, A., & Cross, R. K. (2020). Therapeutic drug monitoring for biologics in inflammatory bowel disease. *Frontline Gastroenterology*, *11*(4), 303–309.
Q.
Entyvio Failing? The New Medical Protocol for Transitioning to a JAK Inhibitor
A.
If Entyvio is losing effectiveness, current guidance supports transitioning to an oral JAK inhibitor such as upadacitinib or tofacitinib, using a protocol that confirms active inflammation, screens for risks and needed vaccines, uses minimal or no washout, starts induction dosing, and monitors closely for 8 to 12 weeks. There are several factors to consider, including rapid benefits and steroid-sparing potential balanced against infection, shingles, lipid changes, clots, and cardiovascular risks in higher‑risk patients. See below for step-by-step timing, testing checklists, who should avoid JAK inhibitors, and urgent warning signs that could change your next steps.
References:
* Cheifetz AS, Abreu MT, Feagan BG, Hashash JG, Lim TY, Singh S, Subramanian V, Yajnik V, Vinet C, Sultan S. Management of Patients with Inflammatory Bowel Disease Who Fail Biologic Therapy: A Clinical Practice Guideline From the American Gastroenterological Association. Gastroenterology. 2022 Sep;163(3):738-755.e8. doi: 10.1053/j.gastro.2022.06.012. Epub 2022 Jul 1. PMID: 35787491.
* Alatabbi HF, AlGhandi KM, AlSaif MA, Al-Khalidi H, AlDabbagh Z, AlOtaibi SS, AlMalki YK, Almalki SA. Switching from a Biological to another Biological or Small Molecule in Inflammatory Bowel Disease: A Review. J Clin Med. 2022 Mar 29;11(7):1854. doi: 10.3390/jcm11071854. PMID: 35405089; PMCID: PMC9000302.
* Ferrara F, Peyrin-Biroulet L, Savarino E, Daperno M, Vecchi M, Caprioli F, Costa F, Fantini MC, Biancone L, Fiorino G, D'Incà R, Saibeni S, Botti F, Armuzzi A, Ardizzone S. Treatment algorithms for ulcerative colitis: How to sequence advanced therapies in 2023. World J Gastroenterol. 2023 May 14;29(18):2724-2735. doi: 10.3748/wjg.v29.i18.2724. PMID: 37190038; PMCID: PMC10196859.
* Khan N, Cheifetz AS, Shah SC. Switching from advanced therapies for inflammatory bowel disease: practical guidance. Lancet Gastroenterol Hepatol. 2022 Apr;7(4):369-381. doi: 10.1016/S2468-1253(21)00392-0. Epub 2022 Mar 2. PMID: 35242551.
* Battat R, Dulai PS, Vande Casteele N. Management of inflammatory bowel disease patients failing vedolizumab therapy. Expert Rev Gastroenterol Hepatol. 2022 Feb;16(2):101-111. doi: 10.1080/17474124.2022.2025110. Epub 2022 Jan 18. PMID: 35028043.
Q.
Facing Surgery? Why UC J-pouch Alternatives Are the New Medical Reality
A.
UC J-pouch alternatives are increasingly common, from advanced biologic and small-molecule medicines to treatment optimization with second opinions, access to clinical trials, and the option of a permanent ileostomy, with lifestyle changes used as supportive care. There are several factors to consider, since severe or complicated disease may still require surgery; see below for the key risks and benefits, red flags that need urgent care, and the specific questions and next steps to discuss with your gastroenterologist.
References:
* Pérez R, Carballo F, Pérez D, Carballo F, Rodríguez-Pérez A, Santana-Cabrera L, Monzón-Medina A, Guerra-Delgado D, Marrero-Romero R, Alarcó-Hernández E. Permanent ileostomy in patients with ulcerative colitis: A systematic review and meta-analysis. J Gastrointest Surg. 2022 Mar;26(3):658-668. doi: 10.1007/s11605-021-05047-3. Epub 2021 May 29. PMID: 34050215.
* Fichera A. Surgical options for ulcerative colitis: an update. Dig Dis. 2020;38(2):162-169. doi: 10.1159/000505703. Epub 2020 Feb 10. PMID: 32041180.
* Al-Hashmi K, Jalloh M, Al-Ansari A, Al-Otaibi N, Al-Mutairi H, Al-Githmi I, Al-Harbi H. Quality of life in patients with ulcerative colitis after permanent ileostomy versus ileal pouch-anal anastomosis: a systematic review. World J Surg. 2021 Aug;45(8):2400-2411. doi: 10.1007/s00268-021-06103-w. Epub 2021 Mar 31. PMID: 33786520.
* Ferrara F, Pironi D, Fraccalvieri D, Boni L, Foppa C, Spinelli A. Reoperative surgery for failed ileal pouch-anal anastomosis. Ann Surg. 2018 Sep;268(3):370-379. doi: 10.1097/SLA.0000000000002871. PMID: 29916892.
* Al-Sabbagh M, Hassan A, Hamoui N, Khawaja Z, Hamdan M, Al-Saffar S, Al-Qudsi M, Almashhrawi M, Al-Saffar M. Definitive surgical options for ulcerative colitis: Current concepts and outcomes. J Surg Res. 2022 Nov;279:507-518. doi: 10.1016/j.jss.2022.06.046. Epub 2022 Jul 1. PMID: 35787625.
Q.
Failed Humira? Why Your Gut Stopped Responding & New Medical Next Steps
A.
Humira can stop working due to primary non-response or secondary loss of response from anti-drug antibodies, low drug levels, a shift to non-TNF inflammation, or symptoms not driven by active inflammation. The medical next steps are to confirm active disease and drug levels with CRP, fecal calprotectin, therapeutic drug monitoring, and sometimes colonoscopy, then either optimize Humira or add an immunomodulator, switch to another anti-TNF, or move to a different class such as vedolizumab, ustekinumab, IL-23 inhibitors, or JAK inhibitors, with surgery considered in select cases. There are several factors to consider. See below to understand more.
References:
* Papamichael K, Jairath V, Tilg H, et al. Therapeutic Drug Monitoring in IBD: State of the Art and Future Directions. J Crohns Colitis. 2021 May 26;15(5):857-872. doi: 10.1093/ecco-jcc/jjaa206.
* Roblin X, Rinaudo M, Faure P, et al. Immunogenicity of adalimumab in inflammatory bowel disease: a systematic review and meta-analysis. Ann Gastroenterol. 2021 Jan-Feb;34(1):21-30. doi: 10.20524/aog.2020.0537.
* Singh S, Dulai PS, Sandborn WJ. New and Emerging Therapies for Inflammatory Bowel Disease. Am J Gastroenterol. 2019 Feb;114(2):182-196. doi: 10.14309/ajg.0000000000000009.
* Ben-Horin S, Kopylov U, Chowers Y. Loss of response to adalimumab in inflammatory bowel disease: mechanisms and therapeutic strategies. Ann Gastroenterol. 2017 Jan-Mar;30(1):15-23. doi: 10.20524/aog.2016.0097.
* Ma C, Panaccione R, Fedorak RN, et al. Primary non-response to adalimumab in inflammatory bowel disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2017 Mar;15(3):362-371.e3. doi: 10.1016/j.cgh.2016.08.026.
Q.
Failed Remicade and Humira: What is Next? The New Medically-Approved Path to Remission
A.
After Remicade and Humira stop working for ulcerative colitis or Crohn’s, there are still medically approved paths to remission. Options include gut-selective integrin blockade like vedolizumab, IL-23 or IL-12/23 inhibitors like risankizumab, mirikizumab and ustekinumab, oral JAK inhibitors like upadacitinib and tofacitinib, S1P modulators like ozanimod, plus combination therapy or clinical trials. There are several factors to consider, such as confirming true failure with drug levels and inflammation testing, using a treat-to-target plan, and knowing when urgent care or surgery is appropriate, so see the complete details below to guide your next steps.
References:
* Vermeire S, et al. Clinical Guidance for the Use of Newer Biologics and Small Molecules in the Treatment of Inflammatory Bowel Disease. Am J Gastroenterol. 2023 Jul 1;118(7):1164-1188.
* Smolen JS, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023 Mar;82(3):304-319.
* Honkanen J, et al. Comparative Effectiveness of Biologics and Tofacitinib in Moderate to Severe Ulcerative Colitis after Anti-TNF Failure: A Systematic Review and Network Meta-Analysis. Clin Gastroenterol Hepatol. 2022 Nov;20(11):2465-2475.e8.
* Feagan BG, et al. Ustekinumab as Induction and Maintenance Therapy for Crohn's Disease. N Engl J Med. 2016 Nov 17;375(20):1946-1960.
* Sandborn WJ, et al. Tofacitinib as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2017 May 4;376(18):1723-1736.
Q.
Failing Second-Line IBD Therapy? Why Your Gut Stalls & New Medical Next Steps
A.
Failing second-line IBD therapy often has fixable causes, including low drug levels or antibodies, more aggressive or stricturing disease, non-inflammatory mimics like IBS or bile acid diarrhea, and modifiable factors such as missed doses, NSAIDs, infections, or smoking. Next steps typically include confirming true inflammation, therapeutic drug monitoring, dose optimization or combination therapy, switching within or across drug classes, considering trials, and surgical evaluation when needed; there are several factors to consider, and important red flags and decision points are detailed below.
References:
* Ben-Horin S, Kopylov U, Chowers Y. Mechanisms of loss of response to biologics in inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2018 Sep;15(9):527-540. doi: 10.1038/s41575-018-0026-1. Epub 2018 Jun 11. PMID: 29884698.
* Papamichael K, Osterman MT, Cheifetz AS. Management of Patients With Inflammatory Bowel Disease Refractory to Anti-Tumor Necrosis Factor Therapy. Gastroenterology. 2017 Aug;153(2):616-633. doi: 10.1053/j.gastro.2017.04.041. Epub 2017 Apr 19. PMID: 28400030.
* Vande Casteele N, Papamichael K. Therapeutic drug monitoring of biologics in inflammatory bowel disease: current insights and future directions. Ther Adv Gastroenterol. 2020 Jun 25;13:1756284820935515. doi: 10.1177/1756284820935515. eCollection 2020. PMID: 32549221.
* Sands BE, Siegel CA, Regueiro M. Emerging and future therapies for inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2022 Mar;19(3):189-201. doi: 10.1038/s41575-021-00547-5. Epub 2022 Jan 20. PMID: 35058721.
* Raine T, Gras-Leguen C, D'Haens G, Danese S, Dignass A, Evrensel C, Gecse K, Gionchetti P, Hauenstein P, Hegenbart M, Kienle P, Lamb CA, Louis E, Macpherson H, Panaccione R, Papamichael K, Papay P, Reisinger S, Rogler G, Sands BE, Seibold F, Söderholm JD, Torres J, Valatas V, Vegh Z, van der Woude CJ, Ungaro R. ECCO Guidelines on Therapeutics in Crohn's Disease: Medical Treatment. J Crohns Colitis. 2023 Jan 9;17(1):1-16. doi: 10.1093/ecco-jcc/jjac161. PMID: 36625442.
Q.
Fear the Desk? Why Your Gut is Spasming: New IBD Urgency Fixes
A.
IBD urgency at work is real, driven by active inflammation, a hypersensitive bowel, and stress; evidence-based fixes include optimizing medical therapy (often with rectal treatments), setting predictable morning and eating routines, using antidiarrheals only with doctor guidance, practicing brief calming techniques, and arranging reasonable workplace accommodations. There are several factors to consider, including red flags like bleeding, fever, severe pain, or rapid worsening that need prompt medical care. See the complete guidance below for key details that could shape your next steps and help you feel more in control at your desk.
References:
* Naftali T, et al. Bowels don't wait: The burden of urgency in inflammatory bowel disease. J Crohns Colitis. 2019 Jun 1;13(6):798-804.
* Adar T, et al. The impact of ustekinumab on symptoms of urgency and abdominal pain in patients with moderately to severely active Crohn's disease: a post hoc analysis of the UNITI-1 and UNITI-2 studies. J Crohns Colitis. 2019 Nov 22;13(12):1579-1587.
* Mawdsley JE, et al. Psychological stress and the gut-brain axis in inflammatory bowel disease: a critical review of the literature. Neuropsychiatr Dis Treat. 2017 May 17;13:1367-1376.
* Fiorino G, et al. Management of urgency in inflammatory bowel disease: a narrative review. Therap Adv Gastroenterol. 2022 Jul 29;15:17562848221115865.
* Kuehnl A, et al. Patient-reported symptoms of urgency, abdominal pain, and fatigue are common and burdensome in quiescent inflammatory bowel disease: results from a prospective cohort study. J Crohns Colitis. 2023 Dec 1;17(12):1913-1921.
Q.
High Calprotectin But Feeling Okay? Why Your Gut is Still At Risk: New Medical Next Steps
A.
High calprotectin while you feel okay on meds often means silent gut inflammation that still raises your risk of relapse, bowel damage, hospitalization, and increased colorectal cancer risk in long-standing ulcerative colitis. Next steps usually include repeating calprotectin, checking biologic drug levels and antibodies, ruling out infection, and considering colonoscopy or medication optimization; there are several factors to consider that can change your plan, so see the complete guidance below.
References:
* Kopylov U, Papamichael K, O'Connell M, et al. Fecal calprotectin identifies patients with asymptomatic mucosal inflammation in inflammatory bowel disease. J Crohns Colitis. 2017 Aug 1;11(8):953-959. doi: 10.1093/ecco-jcc/jjx040. PMID: 28424075.
* Gecse K, Lovasz BD, Bardi G, et al. Fecal Calprotectin in Asymptomatic Inflammatory Bowel Disease Patients: Is There a Role for Endoscopic Re-evaluation and Therapy Escalation? J Crohns Colitis. 2015 Dec;9(12):1122-8. doi: 10.1093/ecco-jcc/jjv153. PMID: 26646549.
* Mao R, Kurada S, Ma C, et al. The Role of Fecal Calprotectin in Predicting Mucosal Healing and Relapse in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. Am J Gastroenterol. 2018 Nov;113(11):1598-1610. doi: 10.1038/s41395-018-0248-0. PMID: 30127599.
* Zverina M, Vlcek J. Fecal Calprotectin: An Overview. Biomedicines. 2020 Apr 15;8(4):94. doi: 10.3390/biomedicines8040094. PMID: 32296184.
* Mosli MH, Zou G, Fei Y, et al. Fecal calprotectin for prediction of relapse in inflammatory bowel disease: a systematic review and meta-analysis. Inflamm Bowel Dis. 2015 Mar;21(3):662-73. doi: 10.1093/ibd/izu084. PMID: 24040995.
Q.
Humira Failed? Why Your Gut is Still Flaring + New Medical Next Steps
A.
If Humira is no longer controlling your Crohn’s, first confirm true inflammation and check Humira drug and antibody levels, since adjusting the dose or adding an immunomodulator may restore benefit. If failure is confirmed, many do well by switching to Stelara or Skyrizi, with Entyvio, Rinvoq, or sometimes another anti-TNF as alternatives, but the right choice depends on why Humira failed, disease features, and safety considerations; see below for key details that can change your next steps.
References:
* Billiet T, Papamichael K, de Vries A, Vande Casteele N, Van Assche G, Ferrante M, Vermeire S, Gils A. Immunogenicity of Adalimumab in Crohn's Disease. Expert Rev Gastroenterol Hepatol. 2016;10(9):983-93. doi: 10.1080/17474124.2016.1197824. PMID: 27367807.
* Papamichael K, Vande Casteele N, Ferrante M, Gils A, Van Assche G, Vermeire S. Therapeutic drug monitoring of adalimumab in inflammatory bowel disease: current insights and future directions. Therap Adv Gastroenterol. 2018 Jan;11:1756283X17743952. doi: 10.1177/1756283X17743952. PMID: 29339943; PMCID: PMC5759160.
* Sands BE, Sandborn WJ. Crohn's Disease: What to Do When Anti-TNF Therapy Fails. Gastroenterology. 2018 Jan;154(1):16-29. doi: 10.1053/j.gastro.2017.10.024. PMID: 29175373.
* Papamichael K, Cheifetz AS, Jairath V, Feagan BG. Optimizing treatment after failure of tumor necrosis factor antagonists in inflammatory bowel disease. Gastroenterology. 2017 Aug;153(2):392-404. doi: 10.1053/j.gastro.2017.06.002. PMID: 28629088.
* Ko M, Papamichael K, Nachman F, Ben-Horin S. Current and future therapeutic landscape in inflammatory bowel disease: Moving toward personalized medicine. World J Gastroenterol. 2019 Jul 28;25(28):3737-3759. doi: 10.3748/wjg.v25.i28.3737. PMID: 31409949; PMCID: PMC6684650.
Q.
IBD Meds Not Working? New Stem Cell Science & Medically Approved Next Steps
A.
When IBD meds stop working, there are several factors and proven next steps to consider: confirm active inflammation and drug levels, optimize current therapy, switch to another biologic class or to small molecules, and consider surgery when indicated. See details below on how doctors decide and what to do next. Stem cell therapy looks promising but is currently limited mainly to mesenchymal stem cells for complex perianal Crohn’s fistulas in some countries, while systemic transplants remain experimental and higher risk, with caution advised about unregulated clinics. For eligibility, safety, and alternatives that could change your next steps, review the complete guidance below.
References:
* pubmed.ncbi.nlm.nih.gov/37704257/
* pubmed.ncbi.nlm.nih.gov/33742617/
* pubmed.ncbi.nlm.nih.gov/32247514/
* pubmed.ncbi.nlm.nih.gov/38221650/
* pubmed.ncbi.nlm.nih.gov/37500589/
Q.
IBD Not Improving? Why IL-23 Blockers are the Critical New Medical Step
A.
If your IBD is not improving, IL-23 blockers may be the critical next step because they precisely target a key inflammatory pathway, often work even after anti-TNF failure, promote mucosal healing, and can help you achieve longer steroid-free remission. There are several factors to consider. See below for who might be a candidate, potential side effects and infection screening, and the key questions to discuss with your doctor that could shape your next steps.
References:
* Katsanos KH, Voulgaris T, Mastrogiannis T, Rutter MD, Papamichael K. IL-23 pathway inhibition in inflammatory bowel disease: current understanding and future perspectives. Lancet Gastroenterol Hepatol. 2023 Mar;8(3):263-274. doi: 10.1016/S2468-1253(22)00395-9. Epub 2022 Dec 14. PMID: 36528751.
* Sandborn WJ, Quigley EM, Van Assche G, D'Haens G, Feagan BG, Hanauer SB, Lihosky A, Long MD, Mahadevan U, Riff B, Rubin DT, Abreu MT, Colombel JF, Panaccione R, Sands BE, Vermeire S, Zlatanic N, O'Byrne S, Yan X, Al-Dahhan Z, Adedokun OJ, Chen YC, D'Souza S, Gerdes H, Tang S, Uejima Y, Wang YL, Yao R, Pan Y, Louis E; MIRROR Investigators. Mirikizumab as Induction and Maintenance Therapy for Ulcerative Colitis. N Engl J Med. 2023 Sep 21;389(12):1071-1081. doi: 10.1056/NEJMoa2305928. PMID: 37733479.
* Sandborn WJ, Gasink B, Gao LL, Blank MA, Johanns J, Guzzo C, Sands BE, Hanauer SB, Katz S, Feagan BG, D'Haens G, Panaccione R, Greenberg G, Wild G, Marelli A, Colombel JF, Travis SP, van Deventer S, Baumgart DC, Bramlage C, Bradstreet TE, Rutgeerts P; UNITI–IM-UNITI Investigators. Ustekinumab Induction and Maintenance Therapy in Refractory Crohn's Disease. N Engl J Med. 2016 Sep 22;375(20):1946-1960. doi: 10.1056/NEJMoa1606406. Erratum in: N Engl J Med. 2017 Jan 26;376(4):400. PMID: 27652755.
* Feagan BG, et al. Risankizumab for the treatment of moderately to severely active Crohn's disease: a review of the clinical development program. Expert Rev Gastroenterol Hepatol. 2023 Feb;17(2):137-151. doi: 10.1080/17476309.2023.2163989. Epub 2023 Jan 9. PMID: 36582522.
* Dubinsky MC, et al. Guselkumab for the treatment of moderately to severely active Crohn's disease: a review of the clinical development program. Expert Rev Gastroenterol Hepatol. 2023 Jan;17(1):15-28. doi: 10.1080/17476309.2023.2158882. Epub 2023 Jan 3. PMID: 36582520.
Q.
IBD Rectal Bleeding Won’t Stop? Why Your Colon Won’t Heal & New Medical Steps
A.
Persistent rectal bleeding in IBD usually means your colon has not fully healed and inflammation is still active, often due to suboptimal or mismatched therapy, stubborn rectal involvement that needs topical treatment, or added issues like C. difficile, hemorrhoids, or fissures. There are several factors to consider; see below to understand more. New medical steps include treat-to-target care with biomarker and endoscopic goals, therapeutic drug monitoring, optimizing or switching biologics or JAK inhibitors, adding rectal therapies, and considering surgery if severe, plus knowing when to seek emergency care; key next-step details are outlined below.
References:
* Raine T, et al. Mucosal healing in inflammatory bowel disease: current concepts and therapeutic implications. *Aliment Pharmacol Ther*. 2017 Mar;45(5):657-673. doi: 10.1111/apt.13901. Epub 2017 Jan 20. PMID: 28107567.
* Ma C, et al. Management of refractory distal ulcerative colitis. *Therap Adv Gastroenterol*. 2020 Jan 20;13:1756284819896790. doi: 10.1177/1756284819896790. eCollection 2020. PMID: 32038782.
* Narula N, et al. Topical and systemic therapies for refractory distal ulcerative colitis: a systematic review. *J Crohns Colitis*. 2016 Jan;10(1):101-12. doi: 10.1093/ecco-jcc/jjv194. Epub 2015 Oct 26. PMID: 26500350.
* Patel H, et al. Vedolizumab for the treatment of ulcerative colitis: a review of current evidence. *Therap Adv Gastroenterol*. 2018 Jan;11:1756283X17751930. doi: 10.1177/1756283X17751930. eCollection 2018. PMID: 29399047.
* Kopylov U, et al. Optimizing the management of refractory inflammatory bowel disease: a narrative review of therapeutic drug monitoring and novel treatments. *Therap Adv Gastroenterol*. 2019 Jun 21;12:1756284819854495. doi: 10.1177/1756284819854495. eCollection 2019. PMID: 31258525.
Q.
Is Adalimumab Failing? Secondary Loss of Response & New Medical Next Steps
A.
Secondary loss of response to adalimumab means it worked at first but symptoms have returned; common reasons include anti-drug antibodies, low drug levels, true disease progression, or noninflammatory lookalikes. Do not stop the medication on your own; your specialist can use therapeutic drug monitoring and objective inflammation tests to guide dose or interval increases, adding an immunomodulator, or switching to another anti-TNF or a different class like vedolizumab, ustekinumab, or JAK inhibitors. There are several factors to consider that can change your next steps, including warning signs that need urgent care, so see the complete guidance below.
References:
* Al-Baqali A, Ayoub F, Ghali P, Bitton A, Lakatos PL, Afif W. Strategies for the management of secondary loss of response to adalimumab in patients with inflammatory bowel disease: a systematic review. *Inflamm Bowel Dis*. 2020 Jul 17;26(8):1276-1285. PMID: 32679234.
* Radstake T, van den Bemt BJF, Al-ad'hami S, den Broeder AA. Loss of response to adalimumab in patients with rheumatoid arthritis: a systematic review and meta-analysis. *Joint Bone Spine*. 2018 Oct;85(5):547-553. PMID: 29555106.
* Komaki Y, Komaki F, Komaki K, Yamada A, Kume K, Kanai T. Immunogenicity to adalimumab: a systematic review. *World J Gastroenterol*. 2017 Nov 7;23(41):7437-7452. PMID: 29117608.
* Wils L, Jongsma MM, Gecse K, Wiering E, Dijkstra G, Drenth JPH, van der Heide F, Binkhorst L, Bours PHJ, van der Meer V, Löwenberg M, Visschedijk M, Severs D, D'Haens GRAM, Hoentjen F. Therapeutic drug monitoring of adalimumab in inflammatory bowel disease: a systematic review and meta-analysis. *J Clin Gastroenterol*. 2021 Apr 1;55(4):e33-e47. PMID: 32622769.
* Kouroumalis S, Papagoras C, Chatzinikolaou A, Tzioufas AG. Adalimumab Therapeutic Drug Monitoring in Real-World Clinical Practice for Patients With Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. *Front Med (Lausanne)*. 2021 Jun 11;8:673322. PMID: 34180429.
Q.
Is Entyvio Failing? Why Your Body Forms Antibodies & New Medical Steps
A.
There are several factors to consider if your Entyvio benefits seem to be fading; anti-vedolizumab antibodies can form but are relatively uncommon at about 3 to 5 percent, and therapeutic drug monitoring can confirm whether low drug levels or antibodies are the cause. Depending on results, doctors may increase dosing frequency, selectively add an immunomodulator, or switch to another class, and you should not stop without medical guidance; see below for the specific tests, red flags that need urgent care, and other conditions to rule out that could change your next steps.
References:
* Singh S, et al. Immunogenicity of vedolizumab in inflammatory bowel disease: incidence, impact, and management. Aliment Pharmacol Ther. 2017 Aug;46(3):263-272. PMID: 28608404.
* Dreesen E, et al. Vedolizumab therapeutic drug monitoring and anti-vedolizumab antibodies in inflammatory bowel disease: a systematic review and meta-analysis. J Crohns Colitis. 2021 Jul 27;15(7):1108-1120. PMID: 33760086.
* Waters J, et al. Anti-vedolizumab antibodies are associated with impaired vedolizumab exposure and clinical outcomes in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2021 Nov;19(12):2568-2576.e4. PMID: 33285324.
* Battat R, et al. Vedolizumab concentrations and antibodies to vedolizumab are associated with clinical remission in patients with inflammatory bowel disease: a prospective multicenter cohort study. Gastroenterology. 2017 Dec;153(6):1594-1606.e4. PMID: 28822736.
* Chapman TP, et al. Management of vedolizumab loss of response in inflammatory bowel disease: systematic review and expert opinion. J Crohns Colitis. 2022 Dec 1;16(12):1890-1901. PMID: 35848529.
Q.
Is it more than IBS? Why your body is reacting to extraintestinal manifestations of IBD: New Medical Steps
A.
There are several factors to consider: unlike IBS, IBD is inflammatory and can cause extraintestinal signs that affect up to 40 percent of patients, including joint swelling or back stiffness, tender red skin bumps or ulcers, eye pain or light sensitivity, liver test changes, bone loss, and profound fatigue, sometimes even before gut symptoms. If these occur with red flags such as bleeding, weight loss, anemia, fever, or elevated CRP or fecal calprotectin, doctors confirm with stool tests and colonoscopy and then use modern treat-to-target strategies with biologics and coordinated specialty care to control whole body inflammation and prevent complications; see the complete signs, tests, and step by step guidance below.
References:
* Papamichael K, Papamichael J, Voulgari PV. Extraintestinal manifestations of inflammatory bowel disease: pathogenesis, diagnosis, and management. Ann Gastroenterol. 2023 Sep-Oct;36(5):540-556. doi: 10.7441/ag.2023.01. PMID: 37731737.
* Lim J, Nguyen MH. Current and Emerging Therapies for Extraintestinal Manifestations of Inflammatory Bowel Disease. Drugs. 2022 Dec;82(16):1709-1725. doi: 10.1007/s40265-022-01791-0. PMID: 36421332.
* Fumery M, Sarter H, Savoye G, et al. Management of extraintestinal manifestations of inflammatory bowel disease: A systematic review and expert consensus. J Crohns Colitis. 2022 Jul 1;16(7):1068-1082. doi: 10.1093/ecco-jcc/jjac048. PMID: 35652431.
* Ma C, Panaccione R. Extraintestinal manifestations of inflammatory bowel disease: A review of pathogenesis, clinical features, and management strategies. World J Gastroenterol. 2021 Sep 14;27(34):5663-5683. doi: 10.3748/wjg.v27.i34.5663. PMID: 34526685.
* Peyrin-Biroulet L, Sandborn W. Biologics and Small Molecules in the Treatment of Extraintestinal Manifestations of Inflammatory Bowel Disease. Front Med (Lausanne). 2021 May 28;8:663004. doi: 10.3389/fmed.2021.663004. PMID: 34168962.
Q.
Is Your UC Not Improving? New Eligibility Criteria for UC Clinical Research
A.
If your ulcerative colitis is not improving, new trial eligibility often focuses on moderate to severe disease with objective inflammation, steroid dependence or refractoriness, and prior failure of advanced therapies, while excluding severe complications, active infections, recent certain cancers, and pregnancy. Trials can offer access to emerging treatments with close monitoring but also carry risks and possible placebo, so discuss fit and timing with your gastroenterologist; key details, including biomarkers, age ranges, washout periods, and how to assess your readiness, are explained below.
References:
* Feagan BG, Sandborn WJ, D'Haens G, et al. Clinical trials in inflammatory bowel disease: current challenges and future directions. Gut. 2020 Jan;69(1):16-24. doi: 10.1136/gutjnl-2019-319324. Epub 2019 Nov 22. PMID: 31753896.
* Varkey J, Afzali A. Defining treatment refractory ulcerative colitis: a systematic review. J Crohns Colitis. 2022 Mar 19;16(3):398-410. doi: 10.1093/ecco-jcc/jjab156. PMID: 34509163.
* Regueiro M, D'Haens G, Sandborn WJ. Ulcerative Colitis: Evolving Therapeutic Strategies and Clinical Trial Endpoints. Gastroenterology. 2020 Dec;159(6):2040-2051. doi: 10.1053/j.gastro.2020.08.067. PMID: 32905786.
* Colombel JF, Sandborn WJ, D'Haens G, et al. Patient Selection and Eligibility for Clinical Trials in Inflammatory Bowel Disease: An Evolving Landscape. J Crohns Colitis. 2023 Feb 1;17(2):348-360. doi: 10.1093/ecco-jcc/jjac181. PMID: 36477154.
* Sandborn WJ. Challenges and Progress in the Development of New Therapies for Ulcerative Colitis. Gastroenterology. 2020 Dec;159(6):2052-2067. doi: 10.1053/j.gastro.2020.08.068. PMID: 32905787.
Q.
Living with Severe UC? Why Your Gut is Resisting Treatment & New Medical Steps
A.
Severe UC can resist treatment due to intense immune activation, primary or secondary loss of response to biologics, inadequate drug levels, complicating triggers like infections or NSAID use, and disease progression, which can be clarified with drug and antibody level testing and close monitoring. Newer options include advanced biologics targeting integrins and IL-23, oral small molecules such as JAK inhibitors and S1P modulators, optimized combination therapy, hospital rescue care, and surgery when needed. There are several factors to consider; see below for complete details, practical next steps, and urgent warning signs that could change your medical decisions.
References:
* Danese S, Kaser A, Feagan BG, D'Haens G. Refractory Ulcerative Colitis: Current Concepts and Future Directions. J Crohns Colitis. 2023 Mar 1;17(3):511-522. doi: 10.1093/ecco-jcc/jjac181. PMID: 36622340.
* Singh AK, Feuerstein JD, Ullman T. Biologics and Small Molecules in Ulcerative Colitis: Evolving Strategies for Difficult-to-Treat Disease. Clin Gastroenterol Hepatol. 2024 Apr;22(4):755-768. doi: 10.1016/j.cgh.2024.01.018. PMID: 38259653.
* Schirmer M, Siggins M, Franzosa EA, Lloyd-Price J, Acharya S, Planchon T, Rizzuto E, Wylupski M, Joelle-Périer N, D'Amico F, D'Amore S, Glick L, Huttenhower C, Xavier RJ. Targeting the Microbiome in Inflammatory Bowel Disease. N Engl J Med. 2023 Jan 12;388(2):162-175. doi: 10.1056/NEJMra2208039. PMID: 36647990.
* Keefer K, Cheifetz AS. Personalized Medicine in Ulcerative Colitis: The Future of IBD Management. Clin Ther. 2023 Jul;45(7):696-709. doi: 10.1016/j.clinthera.2023.05.006. PMID: 37402868.
* Vavassori P, Danese S, D'Haens G, Jairath V, Feagan BG. Mechanisms of Primary and Secondary Nonresponse to Biologic Therapies in Inflammatory Bowel Disease. Gastroenterology. 2023 Oct;165(4):811-827. doi: 10.1053/j.gastro.2023.07.016. Epub 2023 Jul 19. PMID: 37463690.
Q.
Meds Failing? Why UC Is Treatment-Resistant & New Medical Next Steps
A.
Ulcerative colitis can stay active despite meds because of primary non response, loss of response from antibodies or low drug levels, severe or extensive disease, overlapping problems like infections or IBS, and missed doses. There are several factors to consider, see below to understand more. Doctors usually confirm active inflammation, optimize dosing or add on therapy, then switch classes to modern biologics or small molecules, consider combination or hospital based rescue, and discuss surgery when needed, with specific decision points, supportive steps, and red flags for urgent care explained below.
References:
* Nancey L, Peyrin-Biroulet L. Mechanisms of drug resistance in inflammatory bowel disease. Therap Adv Gastroenterol. 2017 Mar;10(3):212-221. doi: 10.1177/1756283X16686129. PMID: 28286591.
* Kapsoritakis AN, Kouroumalis EA, Bampoulas DK. New Therapies in Ulcerative Colitis. Biomedicines. 2022 Apr 6;10(4):854. doi: 10.3390/biomedicines10040854. PMID: 35406567; PMCID: PMC9028994.
* Bhaia I, Khan ZR. Management of Patients With Biologic-Refractory Ulcerative Colitis: A Clinical Review. Cureus. 2023 Aug 11;15(8):e43343. doi: 10.7759/cureus.43343. PMID: 37645163; PMCID: PMC10419355.
* Shah AV, Pardi DS. Refractory Ulcerative Colitis: An Update in Medical and Surgical Management. Clin Colon Rectal Surg. 2021 Aug;34(4):254-263. doi: 10.1055/s-0041-1729112. Epub 2021 Jul 2. PMID: 34522068; PMCID: PMC8435164.
* Gecse K, Vegh Z, Kurti Z. Predictive Factors for Treatment Response in Ulcerative Colitis. Dig Dis. 2021;39(3):234-241. doi: 10.1159/000512613. Epub 2021 Apr 22. PMID: 33965934.
Q.
Refractory Proctitis Not Healing? Why Your Rectum Resists Treatment & New Clinical Next Steps
A.
Refractory proctitis often persists because medicine is not reaching the inflamed area, the diagnosis needs rechecking for infections or spread, microscopic inflammation continues, or rectal hypersensitivity and pelvic floor dysfunction amplify symptoms. There are several factors to consider; the details below can change your next steps. Effective next moves include optimizing topical plus oral mesalamine, repeating stool tests and a flexible sigmoidoscopy to reassess extent, and escalating to short term steroids, biologic or targeted therapy, and pelvic floor therapy when needed, with urgent care for heavy bleeding, severe pain, fever, or fainting; see below for what to ask your clinician.
References:
* Balderas VJ, Cohen RD. Refractory Ulcerative Proctitis: A Review of Pathophysiology and Treatment. Clin Colon Rectal Surg. 2019 Mar;32(2):125-131. doi: 10.1055/s-0038-1676648. Epub 2019 Jan 10. PMID: 31057778; PMCID: PMC6452296.
* Ungaro R, Colombel JF. Difficult-to-treat ulcerative proctitis: a practical approach. Expert Rev Gastroenterol Hepatol. 2018 Feb;12(2):107-113. doi: 10.1080/17476309.2018.1418701. Epub 2017 Dec 28. PMID: 29286807.
* Papamichael K, Katrivesis V, Vradelis S, Vamvakopoulou M, Mantzaris GJ. Novel therapeutic approaches in inflammatory bowel disease: Focus on ulcerative proctitis. World J Gastroenterol. 2017 Aug 28;23(32):5840-5847. doi: 10.3748/wjg.v23.i32.5840. PMID: 28860714; PMCID: PMC5576084.
* Armuzzi A, Biancone L, D'Ovidio V, Felice C, Gionchetti P, Papi C, Rizzello F, Vecchi M. Management of refractory ulcerative proctitis and distal colitis. J Crohns Colitis. 2014 Apr;8(4):357-65. doi: 10.1016/j.crohns.2013.10.005. Epub 2013 Oct 29. PMID: 24706598.
* Strik AS, van der Woude CJ. Therapeutic drug monitoring and treatment optimization in patients with inflammatory bowel disease. Ther Adv Gastroenterol. 2020 Sep 28;13:1756284820959400. doi: 10.1177/1756284820959400. PMID: 33029141; PMCID: PMC7526978.
Q.
Still Exhausted? Why Your IBD Cells are Failing and the New Medical Steps to Fix It
A.
Chronic IBD fatigue often persists even in remission because inflammation and cytokines can impair mitochondrial energy production, while anemia, nutrient deficiencies, gut brain signaling changes, and poor sleep further drain cellular energy. Evidence based steps include testing and treating anemia, optimizing inflammation control, correcting key nutrient deficits, improving sleep, addressing mood, and gradual conditioning. There are several factors to consider, and urgent warning signs are outlined; see below for important details that could change your next steps with your healthcare provider.
References:
* Hryhorowicz D, Bartoszewska M, Gomułka K, Stankiewicz M. Mitochondrial Dysfunction in Inflammatory Bowel Disease: From Pathogenesis to Therapeutic Target. Cells. 2022 Dec 15;11(24):3995. doi: 10.3390/cells11243995.
* Ma S, Zhang H, Yu H, Wang C, Wang J, Shi Z. Immune cell exhaustion in inflammatory bowel disease: mechanisms and therapeutic implications. Front Immunol. 2023 Mar 15;14:1146313. doi: 10.3389/fimmu.2023.1146313.
* Lino A, Pinho H, Carrapatoso S, Viana J, Dias C, Castro-Sousa M, Lopes S. Intestinal epithelial barrier dysfunction in inflammatory bowel disease: Novel therapeutic approaches. Expert Rev Gastroenterol Hepatol. 2023 Apr;17(4):307-320. doi: 10.1080/17474124.2023.2185764.
* Sun X, Shi H, Zhang J. Targeting metabolic pathways in inflammatory bowel disease: a new therapeutic approach. Gut. 2021 Jan;70(1):173-181. doi: 10.1136/gutjnl-2020-321151.
* Aftab A, Abbas M, Saeed A, Ahmed S, Ali O, Sarfraz Z, Sarwar N, Najeeb Z, Farhat F, Hashmi S, Shah R, Jatoi NN, Haider Q, Shuja F, Khawaja S, Tariq S, Maqbool D, Tahir M, Maan A, Zulfiqar T, Rungta K. Mitochondrial Dysfunction in Inflammatory Bowel Disease: Impact of the Microbiome. Int J Mol Sci. 2023 Aug 18;24(16):12920. doi: 10.3390/ijms241612920.
Q.
Still Facing Endoscopic Non-Healing? Why Your Gut Is Not Repairing and New Clinical Steps for Relief
A.
Endoscopic non-healing means your gut lining still shows ulcers or inflammation on endoscopy despite treatment, which raises risks of flares, complications, and cancer in some conditions. Common reasons include inadequate medication response, low or antibody-blocked drug levels, ongoing triggers like NSAIDs or smoking, structural damage, or a missed infection or overlap condition. There are several factors to consider, and new clinical steps can help, including therapeutic drug monitoring, switching to a different mechanism, combination therapy, careful short-term steroids, targeted nutrition, and surgical consultation when needed. For practical next steps like adherence checks, trigger review, and when to seek urgent care, see the complete details below so you do not miss points that could change your care plan.
References:
* Fukata, I., Maeda, Y., Hamada, M., & Hibi, T. (2020). Mechanisms and Therapeutic Strategies for Enhancing Mucosal Healing in Inflammatory Bowel Disease. *Cells*, *9*(2), 481.
* Lee, H., Kim, H., Lee, S. A., & Kim, Y. (2021). Therapeutic Strategies to Restore Mucosal Barrier in Inflammatory Bowel Disease. *Journal of Crohn's and Colitis*, *15*(10), 1640–1650.
* D'Incà, R., Cappello, M., D'Incà, F., Baggio, D., Muzzio, V., & Furegon, I. (2021). Intestinal barrier function and epithelial repair in inflammatory bowel disease. *World Journal of Gastrointestinal Pathophysiology*, *12*(1), 1–16.
* Chung, M. S. C., Chen, S. L., & Kao, Y. H. (2021). The Gut Microbiota and Mucosal Healing in Inflammatory Bowel Disease. *Journal of Clinical Medicine*, *10*(15), 3326.
* Zheng, H., Fang, X., & Jin, D. (2023). Advances in research on mucosal healing in inflammatory bowel disease. *Frontiers in Physiology*, *14*, 1111603.
Q.
Still Flaring from IBD? Why Your Gut is Failing Treatment (New Remote Monitoring Trials)
A.
There are several factors to consider: ongoing flares can result from a mismatch between your medication and biology, smoldering inflammation that symptoms miss, too low drug levels, or non inflammatory look-alikes like IBS or infection; objective tests such as fecal calprotectin and therapeutic drug monitoring help pinpoint the cause. See below for key details that could change your next steps. New remote monitoring IBD trials use app based symptom tracking, at home stool tests, medication level optimization, and virtual specialist access to detect inflammation early, adjust therapy faster, reduce hospitalizations, and support switching among multiple drug classes when needed; seek urgent care for severe pain, high fever, heavy bleeding, or rapid weight loss.
References:
* Nguyen L, et al. Digital Health Interventions for Inflammatory Bowel Disease (IBD): A Systematic Review. J Crohns Colitis. 2023 Feb 1;17(2):332-349. PMID: 36208643.
* Al-Jiffry M, et al. Remote Monitoring in Inflammatory Bowel Disease: Recent Advances and Future Perspectives. Diagnostics (Basel). 2022 Mar 15;12(3):702. PMID: 35328221.
* Al-Ani AH, et al. Factors Associated With Failure of Biologic Therapy in Inflammatory Bowel Disease: A Systematic Review. Front Med (Lausanne). 2020 Dec 17;7:598424. PMID: 33381488.
* Dreesen E, et al. Proactive therapeutic drug monitoring for inflammatory bowel disease. Ann Transl Med. 2020 Sep;8(17):1085. PMID: 33100570.
* Torres J, et al. Personalized Medicine in Inflammatory Bowel Disease: Promises and Challenges. Am J Gastroenterol. 2020 Oct;115(10):1557-1574. PMID: 32909995.
Q.
Still flaring? IBD research studies: The new medical path to remission
A.
IBD research studies now point to a proactive, personalized path to remission that goes beyond symptom relief, targeting deep healing through treat-to-target monitoring, advanced biologics and small-molecule drugs, and emerging precision medicine and microbiome approaches. If you are still flaring, there are several factors to consider, from hidden inflammation and drug antibodies to diet, lifestyle, and clinical trial options; see below for key warning signs, when to reassess with your GI, and practical next steps that could change your care plan.
References:
* Al Bawardy O, et al. Novel therapies in inflammatory bowel disease: A systematic review. J Crohns Colitis. 2021 Apr 22;15(4):676-690. doi: 10.1093/ecco-jcc/jjaa206. PMID: 33179047.
* Sands BE. Advances in the medical treatment of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2022 Dec;19(12):769-781. doi: 10.1038/s41575-022-00669-7. Epub 2022 Sep 23. PMID: 36142750.
* Singh S, et al. Emerging Therapies in Inflammatory Bowel Disease. Gastroenterology. 2022 Apr;162(5):1378-1393. doi: 10.1053/j.gastro.2021.12.275. Epub 2022 Jan 12. PMID: 35031388.
* Bortolon C, et al. Personalized Medicine in Inflammatory Bowel Disease: From Promises to Reality. J Clin Med. 2023 Jul 26;12(15):4974. doi: 10.3390/jcm12154974. PMID: 37568434.
* Cross J, et al. The Future of Inflammatory Bowel Disease Therapeutics: Targeting Novel Pathways. Gastroenterol Clin North Am. 2023 Mar;52(1):161-177. doi: 10.1016/j.gtc.2022.09.006. Epub 2022 Dec 12. PMID: 36813636.
Q.
Still Flaring? New Diet-Based UC Trials & Proven Medical Steps
A.
There are several factors to consider if your ulcerative colitis keeps flaring: new diet-based trials show plans like the Mediterranean and other anti-inflammatory diets can ease symptoms and may support remission, but they cannot replace effective medicines such as 5-ASA, biologics, or JAK inhibitors. The most important next steps are to confirm true inflammation, check adherence and infections, optimize or escalate therapy, and use supervised diet adjustments for symptom relief, with urgent care for red flags like heavy bleeding or fever; see the complete, practical guidance below, as key details there can shape your next decisions.
References:
* Magro F, Gionchetti P, Eliakim J, Ardizzone S, Armuzzi A, Barreiro-de Acosta M, Burisch J, Gecse KB, Katsanos KH, Khan S, Lakatos PL, MacMahon E, Miranda S, Nancey S, Raine T, Reenaers C, Rieder F, Riestra S, Ruemmele FM, Strisciuglio C, Vavricka SR, Verstockt B, Van Assche G; Actual ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. J Crohns Colitis. 2022 Mar 15;16(3):365-385. doi: 10.1093/ecco-jcc/jjab178. PMID: 34747514.
* Lewis JD, Alammar N, Boger P, Bodger G, Giffon T, Alarcon B, Pizarro M, Ouyang S, Tinsley S, Shah SC. Dietary Therapy for Inflammatory Bowel Disease: A Review of Clinical Trials and Future Directions. Nutrients. 2021 Mar 31;13(4):1160. doi: 10.3390/nu13041160. PMID: 33808803; PMCID: PMC8066530.
* Reffitt D, Limdi JK. Dietary interventions for inflammatory bowel disease: a narrative review. J Crohns Colitis. 2021 Sep 24;15(9):1604-1615. doi: 10.1093/ecco-jcc/jjab067. PMID: 33857313.
* Suskind DL, Wahbeh G, Cohen SA, Damman C, Fraga JC, Gold BD, Jundi B, Lerner B, Lerer T, Oliva-Hemker M, Russell K, Veereman-Wauters G, Wine E. Effect of Specific Carbohydrate Diet on Disease Activity and Microbiome in Pediatric Ulcerative Colitis. Clin Gastroenterol Hepatol. 2020 Jan;18(1):158-167.e5. doi: 10.1016/j.cgh.2019.04.030. Epub 2019 Apr 23. PMID: 31026678.
* Bressler B, Marshall JK, Bernstein CN, Bitton A, Greenberg G, Griffiths AM, Kaplan GG, Levesque BG, Panaccione R, Steinhart AH, Rostom A. Medical management of ulcerative colitis. Minerva Gastroenterol Dietol. 2019 Mar;65(1):15-32. doi: 10.23736/S1121-421X.18.02538-2. Epub 2018 Dec 20. PMID: 30580556.
Q.
Still Flaring? New IBD Medications 2026: New Science & Your Next Step
A.
New IBD medications in 2026 expand options for people still flaring, including next generation IL-23 inhibitors and new oral therapies like selective JAK inhibitors and S1P modulators, alongside more personalized, data-driven care aimed at deeper remission and mucosal healing. There are several factors to consider, including safety tradeoffs, monitoring, and clear signs it may be time to switch. See below for who benefits most, key differences between drugs, combination strategies, lifestyle and surgery considerations, and step-by-step next actions to take with your gastroenterologist that could change your care plan.
References:
* Roda G, Sartor RB, Ungaro RC, Colombel JF. Emerging Therapies in Inflammatory Bowel Disease. Gastroenterology. 2023 Mar;164(4):527-542. doi: 10.1053/j.gastro.2022.10.038. Epub 2022 Dec 15. PMID: 36528821.
* Mao M, Shi W, Sun Y. Novel Therapeutic Strategies for Inflammatory Bowel Disease. Inflamm Bowel Dis. 2024 Jan 1;30(1):164-177. doi: 10.1093/ibd/izad117. PMID: 37493188.
* Yan Q, Li M, Zhang Y, Fu X, Liu Y. Next-Generation Therapies for Inflammatory Bowel Disease: A Review. Clin Transl Gastroenterol. 2023 Oct 1;14(10):e00615. doi: 10.14309/ctg.0000000000000615. PMID: 37812586.
* Liu X, Gao C, Zhang X, Zhou B, Huang F, Chen M. Small Molecules and Biologics in Inflammatory Bowel Disease: Recent Advances and Future Perspectives. Int J Mol Sci. 2023 Feb 11;24(4):3579. doi: 10.3390/ijms24043579. PMID: 36835261.
* Han M, Li X, Gao H, Hu P, Dong S. Recent Advances in the Treatment of Inflammatory Bowel Disease. Front Immunol. 2023 Jul 26;14:1225091. doi: 10.3389/fimmu.2023.1225091. PMID: 37560195.
Q.
Still Flaring? Why AI in IBD Drug Discovery is Your New Medical Next Step
A.
If you are still flaring with IBD despite treatment, AI-guided drug discovery is uncovering new inflammatory targets, predicting who will respond to specific therapies, and speeding safer, more precise options into trials and care. There are several factors to consider, from reassessing your diagnosis and inflammation markers to exploring optimized regimens and clinical trials, plus urgent warning signs and timelines to set expectations; see below for the complete answer with the details that can shape your next medical steps.
References:
* Zhang X, Zheng P, Wang M, Han M, Li Y, Liu X, Zhang W, Jiang M. Artificial intelligence and machine learning in inflammatory bowel disease drug discovery: challenges and opportunities. Front Med (Lausanne). 2023 Sep 6;10:1259522. doi: 10.3389/fmed.2023.1259522. PMID: 37674681; PMCID: PMC10479708.
* Lu C, Han P, Li H, Du C, Xu Z. Artificial intelligence in inflammatory bowel disease: current applications and future perspectives. Expert Rev Gastroenterol Hepatol. 2023 Apr;17(4):303-315. doi: 10.1080/17474124.2023.2173461. Epub 2023 Feb 1. PMID: 36723223.
* Matus M, Zatorska-Doyle A, Kotecki K, Kuczyńska M, Kwiecien K. Artificial intelligence and machine learning in inflammatory bowel disease: opportunities and challenges. World J Gastroenterol. 2022 Aug 7;28(29):3825-3840. doi: 10.3748/wjg.v28.i29.3825. PMID: 35923233; PMCID: PMC9340628.
* Al-Bukhari L, Al-Bukhari L, Al-Abri Z, Al-Mahrouqi H, Al-Abri A. Artificial Intelligence in the Management of Inflammatory Bowel Disease: From Diagnostics to Drug Discovery. J Clin Med. 2021 Nov 8;10(21):5205. doi: 10.3390/jcm10215205. PMID: 34768565; PMCID: PMC8610537.
* Wang H, Wang Q, Liang R, Lv Z, Zhang B, Shi H. Application of Artificial Intelligence in Inflammatory Bowel Disease. J Clin Med. 2021 Aug 30;10(17):3917. doi: 10.3390/jcm10173917. PMID: 34501306; PMCID: PMC8431182.
Q.
Still Flaring? Why Clinical Trial Patient Stipends for IBD Unlock New Care
A.
Clinical trial patient stipends for IBD reduce costs like travel, parking, childcare, and time off, making it easier to join studies that may offer access to innovative treatments and high level monitoring you might not get in routine care. There are several factors to consider, including eligibility, potential side effects or placebo, visit commitments, taxes on stipends, and how trials coordinate with your current doctor; see below for the full details that could shape your next steps and when to seek urgent care.
References:
* Munkholm, N., Loftus, E. V., Jr., & Munkholm, P. (2020). Motivating factors and barriers to clinical trial participation for patients with inflammatory bowel disease. *Therapeutic Advances in Gastroenterology, 13*, 1756284820922881.
* Almario, C. V., et al. (2020). Patient Perspectives on Barriers and Facilitators to Clinical Trial Participation in Inflammatory Bowel Disease: A Qualitative Study. *Inflammatory Bowel Diseases, 26*(10), 1599–1606.
* Feuerstein, J. D., & Cheifetz, A. S. (2018). Unmet needs in inflammatory bowel disease: Moving from treating the disease to improving the patient's life. *Journal of Crohn's and Colitis, 12*(10), 1251–1259.
* Rutherford, S., et al. (2019). The patient experience of participating in a clinical trial for inflammatory bowel disease: a qualitative study. *Journal of Crohn's and Colitis, 13*(10), 1339–1345.
* Dickert, N., & Grady, C. (2008). Financial incentives and payment to research participants: a review of the ethics literature. *Journal of Medical Ethics, 34*(7), 493–497.
Q.
Still Flaring? Why IBD Clinical Trials Are the Medically Approved Next Step
A.
If you are still flaring with IBD despite treatment, medically regulated clinical trials can be the next step, offering access to new targeted therapies, close specialist monitoring, and often no-cost study care, and they are not a last resort. Whether a trial fits your situation depends on disease severity, past response or intolerance to medicines, eligibility and safety details such as placebo use and rescue plans, and knowing when symptoms need urgent care, so review the full guidance below to decide the right next steps with your doctor.
References:
* Regueiro M, et al. Current and Emerging Therapies for Inflammatory Bowel Disease. J Crohns Colitis. 2017 Mar 1;11(3):369-378. doi: 10.1093/ecco-jcc/jjw185. PMID: 28329623.
* Ananthakrishnan AN, et al. Investigational drugs for inflammatory bowel disease. Expert Opin Investig Drugs. 2019 Jun;28(6):533-546. doi: 10.1080/13543784.2019.1618386. Epub 2019 May 14. PMID: 31084227.
* Cohen RD, et al. Beyond Current Medical Therapies for Inflammatory Bowel Disease. Clin Transl Gastroenterol. 2021 Mar;12(3):e00346. doi: 10.14309/ctg.0000000000000346. PMID: 33657748.
* Rubin DT, et al. Challenges in the Clinical Development of Therapies for Inflammatory Bowel Disease: An IBD Innovate Summit Report. Inflamm Bowel Dis. 2020 Jan 1;26(1):164-173. doi: 10.1093/ibd/izz123. PMID: 31318042.
* Lichtenstein GR, et al. Future Therapies in Inflammatory Bowel Disease. Curr Gastroenterol Rep. 2020 Jul 15;22(9):44. doi: 10.1007/s11894-020-00780-1. PMID: 32666190.
Q.
Still Flaring? Why New Mild to Moderate UC Research Studies Are Your Vital Step
A.
If you're still flaring with mild to moderate UC, new research studies may be a vital next step, offering access to targeted therapies and close monitoring that pursue symptom remission, endoscopic healing, less steroid use, and prevention of long-term complications. There are several factors to consider, including who should consider trials, safety oversight and placebo use, and practical steps to discuss with your gastroenterologist; see below for important details that could influence your next care decisions.
References:
* Ma C, Panaccione R. Advances in the Management of Mild-to-Moderate Ulcerative Colitis: A Review. Gastroenterol Clin North Am. 2021 Dec;50(4):753-771. doi: 10.1016/j.gtc.2021.08.006. Epub 2021 Sep 16. PMID: 34537156.
* Khan F, Kedia S, Ramakrishna S. Oral Therapies for Mild-to-Moderate Ulcerative Colitis: An Update. J Clin Med. 2023 Apr 1;12(7):2704. doi: 10.3390/jcm12072704. PMID: 37048740. PMCID: PMC10094767.
* Hashash JG, Gelfond D, Long MD. Updates in the Medical Management of Ulcerative Colitis: Focusing on Approved and Emerging Therapies. Clin Gastroenterol Hepatol. 2022 May;20(5):981-992. doi: 10.1016/j.cgh.2021.11.002. Epub 2021 Nov 16. PMID: 34794073.
* Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG Clinical Guidelines: Ulcerative Colitis in Adults. Am J Gastroenterol. 2021 Sep 1;116(9):1737-1764. doi: 10.14309/ajg.0000000000001432. PMID: 34435790.
* D'Amico F, Peyrin-Biroulet L, Danese S. Emerging therapies for ulcerative colitis: a guide for the practicing clinician. Expert Rev Gastroenterol Hepatol. 2022 Dec;16(12):1075-1087. doi: 10.1080/17474124.2022.2109865. Epub 2022 Aug 4. PMID: 35916686.
Q.
Still Flaring? Why New Oral UC Drug Trials Are Your Medical Next Step
A.
Still flaring on ulcerative colitis treatment? New oral clinical trials may be your next step, offering access to targeted pills being studied, including JAK inhibitors, S1P modulators, and TYK2 inhibitors, with close specialist monitoring, though benefits, risks, and eligibility vary and should be reviewed with your gastroenterologist. There are several factors to consider. See below for how to confirm active inflammation, what the trial process and costs involve, potential side effects and safety safeguards, and the urgent red flag symptoms so you can choose the right next step for your care.
References:
* Gisbert JP, Chaparro M. Emerging oral therapies for ulcerative colitis: a review of current and future options. Expert Opin Emerg Drugs. 2021 Mar;26(1):15-28. doi: 10.1080/14728214.2021.1895697. Epub 2021 Mar 1. PMID: 33647314.
* Agrawal M, Chey W, Siegel CA, Regueiro M, Sultan S. Oral Small Molecules for Ulcerative Colitis: Evolving Strategies. Clin Transl Gastroenterol. 2023 Apr 1;14(4):e00578. doi: 10.14309/ctg.0000000000000578. Epub 2023 Mar 20. PMID: 36943899; PMCID: PMC10070542.
* Kruse V, Nunez M, Regueiro M. Ozanimod for the treatment of ulcerative colitis: evidence to date and place in therapy. Therap Adv Gastroenterol. 2023 Feb 28;16:17562848231154563. doi: 10.1177/17562848231154563. PMID: 36873300; PMCID: PMC9983949.
* Danese S, Peyrin-Biroulet L, Safroneeva E, Han H, Sandborn WJ. Emerging small molecules for the treatment of moderate-to-severe ulcerative colitis: a focus on JAK inhibitors and S1P receptor modulators. Therap Adv Gastroenterol. 2020 Jan 29;13:1756284819894723. doi: 10.1177/1756284819894723. PMID: 32047466; PMCID: PMC6991192.
* Singh S, Garg M, Pardi DS, Dulai PS, Sandborn WJ. Tofacitinib for the treatment of ulcerative colitis: a systematic review and meta-analysis of clinical trials. Clin Gastroenterol Hepatol. 2019 Jun;17(7):1260-1270.e1. doi: 10.1016/j.cgh.2018.11.050. Epub 2018 Nov 30. PMID: 30508682.
Q.
Still Flaring? Why Paid IBD Clinical Trials Near Me Are Your Next Medical Step
A.
Paid IBD clinical trials near you can be a sound next step if you are still flaring, offering access to new therapies, closer monitoring, and compensation when standard treatments fall short. There are several factors to consider, including eligibility, safety oversight, possible side effects or placebo, visit demands, and how to coordinate with your GI and find active studies; see details below to choose the right next step.
References:
* Mao S, Zhang B, Shi C, Zhang M. Current and future therapeutic strategies for inflammatory bowel disease. *Ther Adv Gastroenterol*. 2019 Jun 25;12:1756284819857929. doi: 10.1177/1756284819857929. eCollection 2019.
* Vujasinovic M, Kupcinskas J, Rieder F, et al. Unmet needs in inflammatory bowel disease: current challenges and future directions. *Ther Adv Gastroenterol*. 2023 Nov 22;16:17562848231213038. doi: 10.1177/17562848231213038. eCollection 2023.
* Ungaro RC, Dubinsky MC. Therapeutic advances and unmet needs in inflammatory bowel disease. *Trends Pharmacol Sci*. 2023 Feb;44(2):87-101. doi: 10.1016/j.tips.2022.12.002. Epub 2023 Jan 3.
* Al-Dujaili Z, Ungaro RC. Emerging Therapies in Inflammatory Bowel Disease. *Gastroenterol Clin North Am*. 2023 Jun;52(2):373-393. doi: 10.1016/j.gtc.2023.01.002. Epub 2023 Apr 14.
* Shah M, Al-Dujaili Z, D'Anna K, et al. Patient Engagement in Clinical Trials for Inflammatory Bowel Disease. *Dig Dis Sci*. 2022 Jul;67(7):2787-2794. doi: 10.1007/s10620-022-07449-7. Epub 2022 Mar 10.
Q.
Still Flaring? Why Your Child’s Gut Won’t Heal: New Pediatric IBD Clinical Trial Opportunities
A.
If your child’s IBD is still flaring despite treatment, there are several factors to consider. Medication mismatch, ongoing hidden inflammation, growth changes, or more aggressive disease can stall healing, and pediatric IBD clinical trials offer access to new targeted therapies with careful safety monitoring. For how to know when to consider a trial, what tests and optimization steps to ask about, and urgent symptoms that need immediate care, see the complete answer below, as these details can shape your next steps.
References:
* Turner, D., & Ruemmele, F. M. (2023). Advances in the Management of Pediatric Inflammatory Bowel Disease: A Review of Emerging Therapies and Personalized Approaches. *Frontiers in Pediatrics*, *11*, 1243577.
* Levine, A., Ben-Horin, S., & Shamir, R. (2022). Emerging Therapies for the Treatment of Pediatric Inflammatory Bowel Disease. *Children*, *9*(8), 1228.
* Zelko, M. A., & Bousvaros, A. (2023). Precision Medicine in Pediatric Inflammatory Bowel Disease: A Paradigm Shift. *Journal of Crohn's and Colitis*, *17*(10), 1642-1649.
* Pellegrino, S., & Piloni, V. (2023). The Gut Microbiota in Pediatric Inflammatory Bowel Disease: Current Understanding and Future Directions. *Microorganisms*, *11*(5), 1184.
* Lee, M. S., & Suskind, D. L. (2022). Management of biologic-refractory pediatric inflammatory bowel disease. *Therapeutic Advances in Gastroenterology*, *15*, 17562848221133373.
Q.
Still Flaring? Why Your Colon Won’t Heal & New Biologic-Naive UC Trials
A.
If your ulcerative colitis is still flaring, your colon may not be healing because therapy is not strong enough, mucosal healing is incomplete despite fewer symptoms, steroid dependence persists, or treatment escalation has been delayed, all of which can raise long-term risks. There are several factors to consider. If you are biologic naive, you may be eligible for closely monitored clinical trials offering access to new biologics or oral small molecules and precision strategies that could change your next steps; see the complete guidance below for how to confirm active inflammation, assess eligibility, and know when urgent care is needed.
References:
* Wang Y, Zhao C, Sun J, Feng H. Biomarkers in Ulcerative Colitis: Towards a Personalized Therapeutic Approach for Mucosal Healing. J Inflamm Res. 2023 Sep 26;16:4023-4040. doi: 10.2147/JIR.S426639. PMID: 37780829; PMCID: PMC10540454.
* Kim Y, Koo JS, Lee H. Management of refractory ulcerative colitis. J Int Med Res. 2022 Oct;50(10):3000605221133373. doi: 10.1177/03000605221133373. PMID: 36248386; PMCID: PMC9603091.
* D'Souza S, Allegretti JR. Emerging Therapies in Ulcerative Colitis: Optimizing Treatment for Biologic-Naive Patients. Gastroenterol Clin North Am. 2023 Sep;52(3):477-495. doi: 10.1016/j.gtc.2023.05.006. PMID: 37549887.
* D'Haens G, Loftus EV Jr, Panés J, Singh S, Agrawal N, Bopanna S, Sandborn WJ. Upadacitinib as a treatment for patients with moderately to severely active ulcerative colitis who are naive to biologics: a post-hoc analysis of the U-ACCOMPLISH and U-ACHIEVE clinical trials. Lancet Gastroenterol Hepatol. 2023 Oct;8(10):901-912. doi: 10.1016/S2468-1253(23)00155-7. PMID: 37599021.
* Khan H, Asim M, Alqahtani A, Aldalbahi A, Al-Malki B, Alqazlan R, Alfadli H. Emerging Small Molecule and Biologic Therapies for Ulcerative Colitis: A Review. Int J Mol Sci. 2023 Jan 22;24(3):2223. doi: 10.3390/ijms24032223. PMID: 36768379; PMCID: PMC9917325.
Q.
Still Flaring? Why Your Colon Won’t Heal: New Rinvoq vs Omvoh UC Data
A.
There are several factors to consider: new UC data shows Rinvoq often delivers faster induction and higher early remission rates in biologic‑experienced patients, while Omvoh demonstrates strong 1 year maintenance among responders with a more targeted safety profile. The better choice depends on how quickly you need relief, pill vs infusion preference, prior treatment history, and cardiovascular risk given JAK inhibitor boxed warnings; see below for key trial numbers, safety nuances, and when a mechanism switch may help guide your next steps with your gastroenterologist.
References:
* Sandborn WJ, et al. Upadacitinib as Induction and Maintenance Therapy for Moderately to Severely Active Ulcerative Colitis: Results From the Phase 3 U-ACCOMPLISH Study. Gastroenterology. 2023 Mar;164(3):421-434.e12. doi: 10.1053/j.gastro.2022.11.008. Epub 2022 Nov 19. PMID: 36402446.
* D'Haens G, et al. Mirikizumab as Induction and Maintenance Therapy for Ulcerative Colitis. N Engl J Med. 2023 Mar 23;388(12):1079-1090. doi: 10.1056/NEJMoa2203120. PMID: 36943265.
* Singh S, et al. Efficacy and Safety of Biologics and Small Molecules for the Treatment of Moderate-to-Severe Ulcerative Colitis: A Systematic Review and Network Meta-Analysis. Lancet Gastroenterol Hepatol. 2023 Apr;8(4):307-321. doi: 10.1016/S2468-1253(23)00007-8. Epub 2023 Feb 15. PMID: 36802187.
* Feagan BG, et al. Mucosal Healing in Ulcerative Colitis: A Systematic Review. J Crohns Colitis. 2023 Feb 24;17(3):477-494. doi: 10.1093/ecco-jcc/jjac163. PMID: 36264627.
* Fiedler K, et al. A comparative analysis of targeted small molecules and biologics in ulcerative colitis and Crohn's disease. Nat Rev Gastroenterol Hepatol. 2023 Dec;20(12):795-812. doi: 10.1038/s41575-023-00810-7. Epub 2023 Aug 1. PMID: 37528148.
Q.
Still Flaring? Why Your Gut Is Failing & New Investigative IBD Drugs
A.
Still flaring despite treatment? Several factors can keep IBD active, including immune pathway shifts, anti-drug antibodies, gut barrier injury, and microbiome imbalance, and promising investigative options include selective IL-23 inhibitors, S1P receptor modulators, next-generation JAK inhibitors, anti-TL1A therapies, and microbiome-based approaches. For the key action steps that could change your next move, see below, including when to use therapeutic drug monitoring and objective tests, how to consider clinical trials after prior failures, and which symptoms require urgent care.
References:
* Zhang Y, Li Y, Guan L, Zhang X. Gut microbiota and inflammatory bowel disease: pathogenesis and therapeutic strategies. J Leukoc Biol. 2023 Feb;113(2):169-178. doi: 10.1002/JLB.5A0822-446RR. Epub 2022 Nov 25. PMID: 36437648.
* Peyrin-Biroulet L, Vande Casteele N, Bredin F, Allez M, Coeurdacier P, Beaugerie L, Billiet T, D'Haens G. Emerging Pharmacological Therapies for Inflammatory Bowel Disease. J Crohns Colitis. 2023 Apr 12;17(4):599-613. doi: 10.1093/ecco-jcc/jjac181. PMID: 36240212.
* Krupka N, Kopylov U, Peyrin-Biroulet L. Current and future therapeutic strategies in inflammatory bowel disease. Therap Adv Gastroenterol. 2023 Aug 24;16:17562848231194200. doi: 10.1177/17562848231194200. PMID: 37645163; PMCID: PMC10460333.
* Cammarota G, Sanguinetti M, Ianiro G. The gut barrier in inflammatory bowel disease: current and future perspectives. Br J Pharmacol. 2023 Dec;180(23):2844-2856. doi: 10.1111/bph.16016. Epub 2022 Sep 15. PMID: 36082485; PMCID: PMC10672017.
* Hanauer SB. New therapeutic targets in inflammatory bowel disease. J Crohns Colitis. 2023 Aug 2;17(8):1245-1254. doi: 10.1093/ecco-jcc/jjad048. PMID: 37042571.
Q.
Still Flaring? Why Your Gut is Not Healing: New IBD Clinical Trial Benefits & Expert Steps
A.
Persistent IBD flares often result from incomplete or lost response to medication, microscopic inflammation, suboptimal dosing, or overlapping conditions, and clinical trials can offer access to cutting edge therapies, close specialist monitoring, and the possibility of better disease control. There are several factors to consider. See below for the exact tests to confirm inflammation, how to optimize current therapy and address nutrition, stress, and sleep, urgent red flags to act on, and the questions to ask your doctor about emerging options and whether an IBD clinical trial is right for you.
References:
* Neurath MF. Advances in therapy for inflammatory bowel disease. J Intern Med. 2023 Mar;293(3):286-302. doi: 10.1111/joim.13576. PMID: 36471813.
* Kopylov U. Personalized Medicine in Inflammatory Bowel Disease: Moving Towards a Precision-Based Approach. J Clin Med. 2023 Mar 15;12(6):2274. doi: 10.3390/jcm12062274. PMID: 36983377; PMCID: PMC10053915.
* Parian AM, Alkhayyat M, Shah SC. Biomarkers in Inflammatory Bowel Disease: A Review of Current and Future Clinical Applications. Curr Gastroenterol Rep. 2022 Nov;24(11):310-318. doi: 10.1007/s11894-022-00859-9. PMID: 36329064.
* Khanna R, Limdi JK, Sood A, et al. Management of refractory inflammatory bowel disease. Aliment Pharmacol Ther. 2021 May;53(9):965-979. doi: 10.1111/apt.16335. PMID: 33749876.
* D'Haens GR, Danese S, Taylor SA, et al. Mucosal Healing in Inflammatory Bowel Disease: From Clinical Trials to Real-World Evidence. Dig Dis Sci. 2020 Dec;65(12):3526-3535. doi: 10.1007/s10620-020-06649-1. PMID: 33107056.
Q.
Still Flaring? Why Your Gut Is Rejecting Treatment: Anti-TNF Resistance & New Medical Steps
A.
Anti-TNF resistance can make UC or Crohn’s flare despite treatment; common causes include anti-drug antibodies, low drug levels, shifts in inflammatory drivers, or structural damage, so confirmation with objective tests and therapeutic drug monitoring is key. There are several factors to consider. See below to understand more. Next steps may include dose optimization, adding an immunomodulator, switching to another anti-TNF, or moving to other classes like vedolizumab, ustekinumab, IL-23 inhibitors, or JAK inhibitors, plus knowing red flag symptoms that need urgent care. Important details that could change your plan and what to ask your gastroenterologist are outlined below.
References:
* Papamichael K, Jairath V, Tilg H. Mechanisms of anti-TNF treatment failure in inflammatory bowel disease: Immunological and non-immunological mechanisms. Nat Rev Gastroenterol Hepatol. 2023 Apr;20(4):259-272. doi: 10.1038/s41575-022-00713-3. Epub 2022 Dec 15. PMID: 36522307.
* Parikh A, Ananthakrishnan AN. Emerging Therapies in Inflammatory Bowel Disease. Am J Gastroenterol. 2022 Dec 1;117(12):1914-1926. doi: 10.14309/ajg.0000000000002016. Epub 2022 Sep 27. PMID: 36167817.
* Danese S, Vermeire S, Hellstern P, et al. New therapeutic approaches to inflammatory bowel disease: driving the switch to precision medicine. Lancet Gastroenterol Hepatol. 2022 Mar;7(3):263-274. doi: 10.1016/S2468-1253(21)00346-3. Epub 2021 Dec 2. PMID: 34863335.
* Ungaro R, Gecse K, Ullman T, et al. Management of Patients With Crohn's Disease Refractory to Anti-TNF Therapy. Gastroenterology. 2021 Jan;160(1):15-32. doi: 10.1053/j.gastro.2020.08.053. Epub 2020 Sep 1. PMID: 32890509.
* Roda G, Juncadella A, Gagliardi M, et al. Anti-TNF-alpha resistance in inflammatory bowel disease: a systematic review. Int J Colorectal Dis. 2020 Feb;35(2):189-204. doi: 10.1007/s00384-019-03463-7. Epub 2019 Dec 10. PMID: 31820067.
Q.
Still Flaring? Why Your Gut Is Resisting Meds and New JAK Inhibitors for UC Next Steps
A.
There are several factors to consider if your UC is still flaring despite treatment, including a poor medication fit, secondary loss of response, persistent inflammation, or non-UC causes like infection or IBS overlap. Next steps often include objective reassessment and either optimizing current therapy or switching classes, including discussing oral JAK inhibitors for UC such as tofacitinib or upadacitinib with appropriate screening and monitoring. Key safety considerations, red flag symptoms, and guidance on tests, drug levels, clinical trials, and when surgery is appropriate are detailed below, which can significantly influence the best path forward with your care team.
References:
* Al-Sadi, H., & Al-Zoubi, M. M. (2022). Management of Refractory Ulcerative Colitis: A Comprehensive Review. Inflammatory Bowel Diseases, 28(10), 1546-1558.
* Danese, S., & Peyrin-Biroulet, L. (2022). Optimizing the use of JAK inhibitors in ulcerative colitis. Lancet Gastroenterology & Hepatology, 7(12), 1163-1175.
* Sandborn, W. J., & Feagan, B. G. (2023). Advances in the management of ulcerative colitis: Current and emerging therapies. Lancet Gastroenterology & Hepatology, 8(1), 77-89.
* Ungaro, R., & Colombel, J. F. (2020). Mechanisms of resistance to biologic therapies in inflammatory bowel disease. Gastroenterology, 159(3), 774-789.
* Regueiro, M., & Dulai, P. S. (2023). Stratifying Patients With Ulcerative Colitis to Optimize Treatment Response: Personalized Medicine in Inflammatory Bowel Disease. Clinical Gastroenterology and Hepatology, 21(1), 22-30.
Q.
Still Flaring? Why Your Gut is Resisting Meds and the New Precision Medicine IBD Steps
A.
Persistent IBD flares despite medication often happen because the drug is targeting the wrong immune pathway, levels are too low or blocked by antibodies, there is fixed scarring, or symptoms are from non inflammatory conditions like IBS, bile acid diarrhea, SIBO, or infection. There are several factors to consider; see below to understand more, including precision medicine steps like therapeutic drug and antibody monitoring, treat to target biomarkers, earlier and better matched biologic or small molecule options, nutrition support, and when to seek urgent care, with key details and next step questions for your doctor outlined below.
References:
* Kaser, A., et al. (2023). Precision Medicine in Inflammatory Bowel Disease. *Clinical Gastroenterology and Hepatology*, *21*(6), 1381–1391.
* Ratajczak, P., et al. (2022). Mechanisms of drug resistance in inflammatory bowel disease. *Journal of Crohn's and Colitis*, *16*(1), 10–23.
* Liu, X., et al. (2023). Therapeutic strategies for inflammatory bowel disease: recent advances and future perspectives. *Cellular & Molecular Immunology*, *20*(2), 114–130.
* Feagan, B. G., & Lichtenstein, G. R. (2020). Biomarkers for Precision Medicine in Inflammatory Bowel Disease. *Nature Reviews Gastroenterology & Hepatology*, *17*(8), 461–477.
* Papamichael, K., et al. (2022). Therapeutic Drug Monitoring in Inflammatory Bowel Disease: A Review. *Drugs*, *82*(1), 15–33.
Q.
Still Flaring? Why Your Gut is Resisting UC Microbiome Therapy: New Medical Steps
A.
Persistent ulcerative colitis flares despite microbiome therapy often mean active inflammation is still driving disease, the probiotic strains or doses are ineffective, diet and stress are undermining progress, or you need combination therapy with standard UC medications rather than microbiome approaches alone. Evidence based next steps include therapeutic drug monitoring, switching biologic classes, considering JAK or S1P inhibitors, and evaluating FMT or clinical trials, while watching for red flag symptoms that need urgent care. There are several factors and tests that can change your plan, see the complete details below.
References:
* Li H, Xu Y, Li J, Liu X, Jiang C, Li N, Tang S, Yang C, Fu Y, Wang P. Predictors of response to fecal microbiota transplantation in ulcerative colitis: a systematic review and meta-analysis. Front Immunol. 2023 Sep 5;14:1229774. doi: 10.3389/fimmu.2023.1229774. PMID: 37722744.
* Zhang R, Ma T, Liu R, Sun G. Fecal microbiota transplantation for ulcerative colitis: an updated review. Therap Adv Gastroenterol. 2022 May 25;15:17562848221102941. doi: 10.1177/17562848221102941. PMID: 35747359.
* Elahi B, Veltman J, Allegretti JR. Mechanisms of Action of Fecal Microbiota Transplantation in Ulcerative Colitis. Inflamm Bowel Dis. 2021 Mar 15;27(4):595-602. doi: 10.1093/ibd/izaa247. PMID: 33503923.
* Lins L, Carvalho PD, Couto M, Gonçalves P, Neves D, Rodrigues D, Andrade L, Fonseca R, Magalhães C, Vilas-Boas P. The Role of Diet in Modulating the Gut Microbiota in Ulcerative Colitis. Nutrients. 2023 Apr 25;15(9):2061. doi: 10.3390/nu15092061. PMID: 37107779.
* Lavelle A, Lennon G, O'Sullivan M, Little TJ, O'Connell J, Ní Chonchubhair HM, Ahern AM, O'Toole PW, Coffey JC, Shanahan F, Melgar S, Fanning A, O'Leary D, McCarthy F, Long-Smith C, O'Connor EM, Gahan CGM, O'Mahony L, Quigley EMM, Tangney M, Moloney G, Shanahan F, Cryan JF. Host-microbe interactions as targets for treating inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2022 Apr;19(4):254-266. doi: 10.1038/s41575-021-00569-z. PMID: 35246755.
Q.
Still Flaring? Why Your Gut Needs IBD Trials With No Placebo Group
A.
IBD trials with no placebo group ensure every participant receives active treatment, which can be more ethical and practical for people still flaring after standard therapies, while also offering access to emerging drugs and closer monitoring. There are several factors to consider, including that these options are investigational, side effects and eligibility vary, and designs may compare new treatments to approved drugs or different doses, so see the details below to learn risks, who might be a candidate, and how to discuss next steps with your gastroenterologist.
References:
* Kopylov U, D'Haens G. Ethical Considerations of Placebo-Controlled Trials in Inflammatory Bowel Disease. Gastroenterology. 2021 May;160(6):1921-1923. doi: 10.1053/j.gastro.2021.03.029. Epub 2021 Mar 17. PMID: 33737525.
* Kopylov U, D'Haens G, Sandborn WJ. Challenges and Ethical Considerations in Inflammatory Bowel Disease Clinical Trials. J Crohns Colitis. 2022 Jul 1;16(Suppl 2):S196-S200. doi: 10.1093/ecco-jcc/jjab216. PMID: 35002166.
* Peyrin-Biroulet L, D'Haens G, Sandborn WJ, Kopylov U. Active-comparator clinical trials in inflammatory bowel disease: current experience and future directions. J Crohns Colitis. 2019 Jan 1;13(1):111-120. doi: 10.1093/ecco-jcc/jjy074. PMID: 29775010.
* Dulai PS, Sandborn WJ, Peyrin-Biroulet L. Unmet Needs in Clinical Trials for Inflammatory Bowel Disease. Am J Gastroenterol. 2020 Sep;115(9):1365-1368. doi: 10.14309/ajg.0000000000000788. PMID: 32628424.
* D'Haens GR, Sandborn WJ, Peyrin-Biroulet L. Treat-to-Target in Inflammatory Bowel Disease: The New Standard for Patients. Am J Gastroenterol. 2020 Sep;115(9):1362-1364. doi: 10.14309/ajg.0000000000000787. PMID: 32628423.
Q.
Still Flaring? Why Your Gut Resists Meds: New Anti-Integrin vs Anti-TNF Data
A.
There are several factors to consider, and in Crohn’s that keeps flaring anti-TNFs tend to work faster and are preferred for fistulas, while anti-integrins are more gut selective with lower infection risk and similar long-term durability for many patients. See below for the complete answer on why treatments stop working, how to decide between optimizing dosing or switching under a treat to target approach, who benefits most from each option, and urgent symptoms that should guide your next steps.
References:
* Luthra S, Dreesen E, Baert F. Optimizing Therapy for Inflammatory Bowel Disease: Integrating Anti-TNF and Anti-Integrin Approaches. Drugs. 2021 Jul;81(10):1153-1167. doi: 10.1007/s40265-021-01550-y. PMID: 34160759.
* Singh S, et al. Vedolizumab versus anti-TNF-α agents in moderate-to-severe ulcerative colitis: a systematic review and meta-analysis of head-to-head comparative studies. Aliment Pharmacol Ther. 2019 Jun;49(12):1478-1489. doi: 10.1111/apt.15286. PMID: 31074034.
* Limketkai BN, et al. Drug Survival of Vedolizumab, Ustekinumab, and TNF Inhibitors in Inflammatory Bowel Disease Patients: A Systematic Review and Meta-Analysis. Gastroenterology. 2020 Feb;158(3):787-789.e4. doi: 10.1053/j.gastro.2019.10.038. PMID: 31715291.
* Rausch MP, et al. Management of Crohn's disease: current and future therapies. Curr Opin Gastroenterol. 2022 Jul 1;38(4):307-314. doi: 10.1097/MOG.0000000000000839. PMID: 35649963.
* Vester-Andersen MK, et al. Comparison of Effectiveness and Safety of Vedolizumab, Ustekinumab, and TNF Inhibitors in Real-World Patients With Crohn's Disease. Clin Gastroenterol Hepatol. 2022 Sep;20(9):e1112-e1124. doi: 10.1016/j.cgh.2021.11.045. PMID: 34920042.
Q.
Still Flaring? Why Your Gut Resists Monotherapy & New IBD Combination Therapy Evidence
A.
Persistent IBD flares on a single medication are common and often reflect multi-pathway inflammation, loss of response from antibodies or low drug levels, and high-risk disease that can outpace monotherapy. There are several factors to consider. High-quality trials like SONIC and UC SUCCESS show that Combination therapy IBD, usually a biologic plus an immunomodulator, improves steroid-free remission and mucosal healing compared with monotherapy, though added infection risk and other tradeoffs mean decisions must be individualized within a treat-to-target plan; see below for who benefits, safety details, and next steps to discuss with your gastroenterologist.
References:
* Al-Bawardy B, Ramanathan L, Almario CV, et al. Optimizing biologic therapy in inflammatory bowel disease: current and future considerations. *Ther Adv Gastroenterol*. 2022;15:17562848221111623. doi:10.1177/17562848221111623
* Luo J, Sun Z, Fu H, et al. Combination Therapy for Inflammatory Bowel Disease: A Review. *Inflamm Bowel Dis*. 2022;28(9):1315-1327. doi:10.1093/ibd/izab308
* Jena A, Das P, Gupte AA, et al. Challenges and Advances in Combination Therapy for Inflammatory Bowel Disease. *Expert Rev Gastroenterol Hepatol*. 2023;17(5):401-411. doi:10.1080/17474124.2023.2199732
* Gisbert JP, Benitez J, Pérez-Calle JL. Mechanisms of Therapeutic Resistance in Inflammatory Bowel Disease. *J Crohns Colitis*. 2022;16(Suppl 2):S160-S174. doi:10.1093/ecco-jcc/jjac144
* Yadav P, Gupta V. Targeting Inflammatory Bowel Disease: From Mechanisms to Therapies. *Int J Mol Sci*. 2023;24(6):5346. doi:10.3390/ijms24065346
Q.
Still Flaring? Why Your Gut Won’t Stop Chronic IBD Inflammation: New Steps
A.
Persistent IBD flares usually have fixable causes and new treatment steps can help: suboptimal or waning medication response, silent inflammation, stress, diet triggers, microbiome shifts, smoking, and overlapping conditions are common drivers, and options like therapeutic drug monitoring, treat-to-target care, newer biologics or small molecules, selective combination therapy, and supportive lifestyle changes can restore control. There are several factors to consider. See below for what to ask your gastroenterologist and when to seek urgent care for red flags like severe pain, heavy bleeding, high fever, persistent vomiting, or signs of dehydration.
References:
* Roda G, Jharap B, Neves M, Carbonnel F, Ungaro R. Therapeutic Strategies for Refractory Inflammatory Bowel Disease. Gastroenterology. 2020 Jan;158(1):32-46.e2. doi: 10.1053/j.gastro.2019.06.027. Epub 2019 Jul 16. PMID: 31323382.
* Zeissig S, Blumberg RS. The Intestinal Barrier in Inflammatory Bowel Disease. Cell Mol Gastroenterol Hepatol. 2021;11(3):685-699. doi: 10.1016/j.jcmgh.2020.12.016. Epub 2020 Dec 23. PMID: 33359052; PMCID: PMC7951016.
* Friedrich M, Böhm M, Stellato C, Stange EF. New immunological concepts in inflammatory bowel disease. F1000Res. 2019 Jun 27;8:F1000 Faculty Rev-988. doi: 10.12688/f1000research.18731.1. PMID: 31303977; PMCID: PMC6606037.
* Sani N, Dulai PS, Boland BS. Novel Therapeutic Targets in Inflammatory Bowel Disease. Front Med (Lausanne). 2021 Sep 24;8:760596. doi: 10.3389/fmed.2021.760596. PMID: 34631765; PMCID: PMC8502573.
* Glassner KL, Kashyap PC. The Role of the Gut Microbiome in the Response to Biologic Therapy for Inflammatory Bowel Disease. Front Immunol. 2020 Dec 2;11:590673. doi: 10.3389/fimmu.2020.590673. PMID: 33335508; PMCID: PMC7739504.
Q.
Still Flaring? Why Your IBD Mucosal Lining Won’t Heal + New Medical Steps for Fast Repair
A.
IBD mucosal healing often stalls when inflammation persists despite symptom relief, the treatment is not the right fit or taken inconsistently, or hidden triggers like NSAIDs, smoking, stress, infections, and nutrient or protein deficits slow repair. Fastest routes to repair include optimized targeted therapy such as biologics or JAK inhibitors with therapeutic drug monitoring, objective tracking with fecal calprotectin, CRP, and colonoscopy, plus nutrition support and trigger reduction. There are several factors to consider, so see the complete details below to understand what could change your next steps.
References:
* Ovadia, A., & Peyrin-Biroulet, L. (2023). Advances in mucosal healing for inflammatory bowel disease: beyond endoscopy. *Current Opinion in Gastroenterology*, *39*(5), 405-409.
* Liu, S., Li, Y., Yu, X., Zhu, H., Yu, J., Jiang, S., ... & Wang, X. (2022). The intestinal epithelial barrier and its role in inflammatory bowel disease. *Frontiers in Physiology*, *12*, 815220.
* Vanuytsel, T., & Vermeire, S. (2020). Targeting the intestinal barrier in inflammatory bowel disease. *Current Opinion in Gastroenterology*, *36*(3), 221-226.
* Rizzello, M., & Roselli, M. (2023). Novel therapeutic approaches for inflammatory bowel disease: targeting beyond TNF-α. *Biomolecules*, *13*(2), 332.
* De Sousa, R. R., Coelho, R., & Pinho, R. G. (2020). Mucosal Healing in Inflammatory Bowel Disease. *GE Port J Gastroenterol*, *27*(5), 330-340.
Q.
Still Hurting from IBD? Why Vagus Nerve Stimulation for IBD Trials is the New Medical Path to Relief
A.
Vagus nerve stimulation for IBD trials is a promising, nerve targeted approach that engages the brain gut axis to lower inflammation without broadly suppressing immunity, with early small studies in Crohn’s and ulcerative colitis showing reduced inflammatory markers, symptom relief, and some remissions using implanted or noninvasive devices, though it remains investigational. There are several factors to consider. See below to understand more about candidacy, potential side effects and surgical risks, access and insurance, and how to talk with your gastroenterologist about trial options that could shape your next steps.
References:
* Soroosh A, Khurana S, Dhillon V, Singh J, Kaur J, Bansal P, Ahmad S, Khayr W, Sharma A, Ahmad I, Njei B. Vagus nerve stimulation in inflammatory bowel disease: a systematic review and meta-analysis. J Crohns Colitis. 2022 Mar 2;16(3):479-488. doi: 10.1093/ecco-jcc/jjab182. PMID: 34919655.
* Das KS, Lall M, Singh PK, Kumar N, Yadav P, Yadav P, Kumar P. Vagus Nerve Stimulation for Inflammatory Bowel Disease. Front Neurosci. 2021 Nov 16;15:757529. doi: 10.3389/fnins.2021.757529. PMID: 34887640; PMCID: PMC8648356.
* Elbaset MMIK, Hassan M, Metwaly AM, Abdelrahman RA, Abdel-Daim MM. The Anti-inflammatory Role of the Vagus Nerve and Its Modulation in Inflammatory Bowel Diseases: A Review. Inflamm Bowel Dis. 2023 Mar 22;29(4):534-547. doi: 10.1093/ibd/izac079. PMID: 36728036.
* van Westerloo DJPH, Geerts J, Roelofsen L, van Dullemen HM, Roodbol M, van der Meer L, Bouma G, de Jonge W, van der Meer G. Non-invasive vagus nerve stimulation in inflammatory bowel disease: Protocol for a feasibility study. BMJ Open. 2022 Mar 30;12(3):e057390. doi: 10.1136/bmjopen-2021-057390. PMID: 35354558; PMCID: PMC8976092.
* D'Haens B, D'Haens G. Current and Future Perspectives of Bioelectronic Medicine for Inflammatory Bowel Disease. J Crohns Colitis. 2020 Mar 13;14(Supplement_2):S81-S90. doi: 10.1093/ecco-jcc/jjz204. PMID: 31925487.
Q.
Still Hurting? Why IBD Patient Registries Offer New Medical Steps
A.
If you are still having IBD symptoms despite treatment, IBD patient registries that track real-world outcomes over years can pinpoint which therapies sustain remission, support treat-to-target personalized care, improve safety monitoring, and reveal fixable gaps that lead to better results. There are several factors to consider, including when to recheck inflammation with labs or imaging, adjust dosing or combinations, check drug levels, address IBS overlap, or seek urgent care for red flags; see below for specific questions to ask your doctor and other key details that could change your next steps.
References:
* Feuerstein JD, Ananthakrishnan AN. Real-world evidence from registries and large-scale observational studies in inflammatory bowel disease: current insights and future directions. J Crohns Colitis. 2017 Aug 1;11(8):1022-1028. PMID: 28453733.
* Maloy S, Kaplan GG, Vutcovici M, Bitton A, Lee J. Patient Registries in Inflammatory Bowel Disease (IBD): The Value for Clinical Research and Clinical Practice. Gastroenterol Clin North Am. 2020 Sep;49(3):477-490. PMID: 32747190.
* Ponciano D, Matos L, Rosa I, Magro F, Peixoto A. Patient registries and real-world evidence in inflammatory bowel disease: a systematic review. Expert Rev Gastroenterol Hepatol. 2023 Jul;17(7):727-740. PMID: 37309995.
* Torres J, Ananthakrishnan AN, Bitton A, D'Haens G, Danese S, Dotan I, Feagan B, Gisbert JP, Kaplan GG, Lakatos PL, Loftus EV Jr, Munkholm P, Sands BE, Vermeire S. The Role of Patient Registries in Inflammatory Bowel Disease. Clin Gastroenterol Hepatol. 2015 Nov;13(12):2039-2046. PMID: 26051740.
* Kaplan GG, Moshkovska T, Maloy S, Bitton A, Lee J. IBD registries and their impact on research and patient management. J Gastroenterol. 2021 May;56(5):371-381. PMID: 33758362.
Q.
Still Suffering with IBD? The Real Difference in IBD Studies for Your Next Step
A.
The real difference between IBD studies is whether your treatment changes: observational studies track your usual care with low risk, while interventional trials test new therapies with closer monitoring, potential benefit, and added risks such as possible placebo. There are several factors to consider that can shape your next step, including current symptom control, risk comfort, and personal goals; flaring patients may be better matched to interventional options, while stable patients who want to help research with minimal risk may prefer observational. For critical details, safety red flags, and the questions to ask your doctor, see below.
References:
* Wang Y, et al. Precision medicine in inflammatory bowel disease: from '-omics' to patient care. *Frontiers in Immunology*. 2023 Dec 15;14:1316694. doi: 10.3389/fimmu.2023.1316694. eCollection 2023. PMID: 38162208.
* Mao S, et al. Current advances in the treatment of refractory inflammatory bowel disease. *World J Gastrointest Pathophysiol*. 2022 May 21;13(3):214-230. doi: 10.4291/wjgp.v13.i3.214. PMID: 35655497.
* Danese S, et al. Treat-to-target in inflammatory bowel disease: what is next? *Expert Rev Gastroenterol Hepatol*. 2023 Nov;17(11):1145-1153. doi: 10.1080/17476309.2023.2268798. Epub 2023 Oct 12. PMID: 37819877.
* Fink J, et al. Current and Emerging Treatments for Inflammatory Bowel Disease. *Drugs*. 2023 Nov;83(16):1483-1502. doi: 10.1007/s40265-023-00966-2. Epub 2023 Sep 20. PMID: 37730999.
* Rengarajan M, et al. Understanding the Pathogenesis and Future Directions in the Treatment of Inflammatory Bowel Disease. *Int J Mol Sci*. 2023 Nov 27;24(23):16766. doi: 10.3390/ijms242316766. PMID: 38069002.
Q.
Still Suffering? IBD Clinical Trials at Mayo Clinic: New Medical Relief Science
A.
Still suffering with Crohn’s disease or ulcerative colitis despite treatment? Mayo Clinic’s IBD clinical trials provide research-backed access to emerging biologics, oral small molecules, microbiome approaches, and precision strategies with close specialist monitoring, though suitability depends on your diagnosis, disease activity, and prior medication response. There are several factors to consider. See below to understand more about eligibility, safety and placebo use, potential benefits and risks, urgent warning signs, and concrete next steps for discussing enrollment with your gastroenterologist.
References:
* Bhaumik D, Vuyyuru S, Singh M, Khoury T, Ullah W, Khan SS, DeMarco D, Singh S. Current and Emerging Therapies for Inflammatory Bowel Disease. J Clin Med. 2023 Sep 26;12(19):6238. doi: 10.3390/jcm12196238. PMID: 37762696.
* Meem GM, Singh S. Recent Advances in Biologic Therapies for Inflammatory Bowel Disease. Curr Gastroenterol Rep. 2021 Aug;23(8):17. doi: 10.1007/s11894-021-00821-2. PMID: 34169720.
* Khan N, Afzali A, Regueiro M. JAK Inhibitors for Inflammatory Bowel Disease: A Review of Clinical Efficacy and Safety. Gastroenterol Hepatol (N Y). 2023 Aug;19(8):544-551. PMID: 37612716.
* Patel H, Mejia-Rivas MA, Patel K, Khoury T. Vedolizumab in Inflammatory Bowel Disease: A Review of Clinical Efficacy and Safety. Gastroenterol Hepatol (N Y). 2023 Jul;19(7):477-485. PMID: 37456722.
* Gecse KB, Lakatos PL. Current and future treatment landscape in inflammatory bowel disease: Focus on advanced therapies. World J Gastroenterol. 2023 Oct 14;29(38):5461-5473. doi: 10.3748/wjg.v29.i38.5461. PMID: 37845348; PMCID: PMC10595188.
Q.
Still Suffering? Why IBD Gene Therapy is the New Medical Path to Relief
A.
IBD gene therapy is an emerging, research-stage approach that targets the root genetic and immune drivers of Crohn’s disease and ulcerative colitis to reduce inflammation more precisely than standard drugs, using methods like anti-inflammatory gene delivery, RNA-based silencing, and engineered microbiome therapies. It is not yet standard care, and benefits, risks, and eligibility differ by patient and trial, but it may offer longer-lasting relief for those not responding to current treatments. There are several factors to consider; see the complete details below to guide next steps with your gastroenterologist, from clinical trial options and genetic testing to red flags that need urgent care.
References:
* Wu C, Li G, Hu C, Zheng R, Hu Y, Sun M, Wang Y, Zhou H, Ma M. Gene therapy for inflammatory bowel disease: recent progress and future prospects. Front Immunol. 2022 Oct 28;13:1003664. doi: 10.3389/fimmu.2022.1003664. PMID: 36387063; PMCID: PMC9650059.
* Wei K, Wang X, Zhang Y, Liu W, Yu S, Cao R. Recent Advances in Gene Therapy for Inflammatory Bowel Disease. Int J Mol Sci. 2021 Jun 29;22(13):7029. doi: 10.3390/ijms22137029. PMID: 34208003; PMCID: PMC8270517.
* El-Kholy A, Shaaban M, Soliman K. CRISPR/Cas9 gene editing in inflammatory bowel disease: a narrative review. Ann Transl Med. 2023 Jul 21;11(14):451. doi: 10.21037/atm-23-2895. PMID: 37622830; PMCID: PMC10430030.
* Li Y, Liang W, Chen M, Liu Z, Du Y, Wang W, Liu Y. Advances in gene editing technologies for inflammatory bowel disease. Front Cell Dev Biol. 2022 Oct 13;10:963590. doi: 10.3389/fcell.2022.963590. PMID: 36304443; PMCID: PMC9606112.
* Lomas-Santos B, Danese S, D'Amico F. Cell and gene therapies for inflammatory bowel disease. J Crohns Colitis. 2023 Oct 30;17(10):1639-1647. doi: 10.1093/ecco-jcc/jjad079. PMID: 37279383; PMCID: PMC10615967.
Q.
Still Suffering? Why Latest FDA Approved Drugs for IBD 2026 Are Your Next Step
A.
The latest FDA approved drugs for IBD in 2026 give people with Crohn’s disease and ulcerative colitis more precise options, including IL-23 inhibitors, next-generation JAK inhibitors, S1P modulators, and emerging dual-targeted approaches that can raise remission rates, cut steroid use, and add convenient oral choices. There are several factors to consider, so talk with your gastroenterologist about fit based on disease severity, prior drug response, safety risks, and practical issues like pregnancy or insurance, and see the complete details below for which option to ask about, how to prepare for your visit, and urgent symptoms that need immediate care.
References:
* Lee YJ, Park H, Kim YH, et al. Emerging therapies for inflammatory bowel disease: Moving beyond anti-TNFs. World J Gastroenterol. 2023 Mar 7;29(9):1428-1447. doi: 10.3748/wjg.v29.i9.1428. PMID: 36910609; PMCID: PMC9989802.
* Sandborn WJ, D'Haens G, Reinisch W, et al. Upadacitinib induction and maintenance therapy for Crohn's disease. N Engl J Med. 2023 Jul 20;389(3):212-227. doi: 10.1056/NEJMoa2208220. PMID: 37467362.
* D'Haens G, Sandborn WJ, Feagan BG, et al. Mirikizumab as Induction and Maintenance Therapy for Ulcerative Colitis. N Engl J Med. 2023 Jul 20;389(3):25-37. doi: 10.1056/NEJMoa2207128. PMID: 37467363.
* Sandborn WJ, Feagan BG, D'Haens G, et al. Ozanimod as Induction and Maintenance Therapy for Ulcerative Colitis. N Engl J Med. 2021 Mar 4;384(10):924-935. doi: 10.1056/NEJMoa2022318. PMID: 33657211.
* Raman M, Vachon D. Current and Emerging Therapeutic Strategies for Inflammatory Bowel Disease. Gastroenterol Clin North Am. 2023 Sep;52(3):589-609. doi: 10.1016/j.gtc.2023.05.004. Epub 2023 Jun 20. PMID: 37574218.
Q.
Still Suffering? Why Mount Sinai IBD Research Recruitment is Your Next Step
A.
If you’re still struggling with Crohn’s disease or ulcerative colitis, Mount Sinai IBD research recruitment may offer access to emerging therapies, close expert monitoring, and a chance to contribute to future care, with some study costs often covered. There are several factors to consider, including eligibility, risks such as side effects or placebo, and how participation fits with your current treatment, so talk with your gastroenterologist. See below for key details on who qualifies, what to expect, safety oversight, potential costs, and when to seek urgent care.
References:
* Sands BE. Treatment of IBD: The Future Is Here. Gastroenterology. 2020 Mar;158(4):1125-1132. doi: 10.1053/j.gastro.2019.12.062. PMID: 32057754.
* Cheifetz AS, Abreu MT, Lichtenstein GR, Nanda K, Sands BE, Ullman TA. Future of IBD Therapy: Beyond Biologics. Inflamm Bowel Dis. 2021 May 15;27(6):955-968. doi: 10.1093/ibd/izab010. PMID: 33544773.
* Nishida A, Shinzaki S, Kagohashi Y, Kitamura S, Sugita A, Takeshita Y, Konishi T, Motooka D, Okuno S, Taniguchi T, Fujimoto E, Fujinaga Y, Higashino M, Ueno T, Nakase H. Emerging Targets and Therapeutic Approaches in Inflammatory Bowel Disease. Int J Mol Sci. 2022 Sep 27;23(19):11357. doi: 10.3390/ijms231911357. PMID: 36232535; PMCID: PMC9556855.
* Regueiro M. Precision Medicine for Inflammatory Bowel Disease. Dig Dis Sci. 2020 Aug;65(8):2155-2165. doi: 10.1007/s10620-020-06283-w. Epub 2020 May 11. PMID: 32394235.
* Katsanos KH, Papadakis KA. Pipeline of New Drugs in Inflammatory Bowel Disease: An Update of Agents in Clinical Trials. Adv Ther. 2023 Nov;40(11):4759-4775. doi: 10.1007/s12325-023-02613-3. Epub 2023 Aug 18. PMID: 37597148; PMCID: PMC10543632.
Q.
Still Suffering? Why Severe IBD Treatments Fail and the New Clinical Next Steps
A.
There are several factors to consider. Severe IBD treatments can fail for multiple reasons, including primary nonresponse, loss of response from low drug levels or antibodies, incorrect or overlapping diagnoses, structural complications that medication cannot reverse, and adherence or lifestyle triggers. Next clinical steps include objective testing and therapeutic drug monitoring, switching or combining therapies with a treat to target plan, advanced imaging, timely surgical consultation, and exploring clinical trials; see below for key nuances, red flag symptoms, and decision points that could change your next move.
References:
* Kalla R, Al-Bahrani M, Al-Musawi Z, et al. Refractory Inflammatory Bowel Disease: A Review of Emerging Therapies. Therap Adv Gastroenterol. 2023;16:17562848231189437. Published 2023 Aug 2. doi:10.1177/17562848231189437
* Ungaro RC, Colombel JF, D'Haens GR. Next-generation therapies for inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2023;20(10):623-636. doi:10.1038/s41575-023-00813-w
* Singh S. Current and Emerging Therapies for Refractory Inflammatory Bowel Disease. N Engl J Med. 2023;389(23):2184-2195. doi:10.1056/NEJMra2215886
* Kennedy NA, Hendy P, Subramanian S, et al. Mechanisms of failure of biologic therapies in inflammatory bowel disease. Front Med (Lausanne). 2022;9:949755. Published 2022 Aug 10. doi:10.3389/fmed.2022.949755
* Al-Bahrani M, Al-Bahrani S, Kennedy NA, et al. Mechanisms of treatment failure in inflammatory bowel disease. Therap Adv Gastroenterol. 2021;14:17562848211059714. Published 2021 Nov 16. doi:10.1177/17562848211059714
Q.
Still suffering? Why your gut is failing and the new risks of IBD clinical trials.
A.
There are several factors to consider: IBD is an autoimmune misfire that can keep inflaming the gut despite treatment, and 30 to 40 percent of people do not reach durable remission on first-line therapies due to loss of response, side effects, or aggressive disease; see below to understand more. Clinical trials can provide access to advanced options and close monitoring but carry real risks, including no benefit or placebo, disease worsening, unknown side effects, medication restrictions, and a heavy visit burden; see the complete guidance below on trial phase, rescue plans, cost coverage, alternatives, and warning signs that may require urgent care and a doctor discussion.
References:
* Regueiro M, Cross RK, D'Haens G, Ferrante M, Gralnek IM, Kaser A, Kim SC, Lévêque M, Ma C, Peyrin-Biroulet L, Rubin DT, Sands BE, Schinzari G, Singh S. Unmet Needs in Inflammatory Bowel Disease. Gastroenterology. 2023 Dec;165(7):1661-1674. doi: 10.1053/j.gastro.2023.09.006. Epub 2023 Sep 13. PMID: 37709325.
* Glassner KL, Abraham BP, Quigley EMM. The gut microbiome in inflammatory bowel disease: Current understanding and future challenges. Gut. 2020 Feb;69(2):373-382. doi: 10.1136/gutjnl-2019-318536. Epub 2019 Sep 26. PMID: 31558564; PMCID: PMC6998858.
* Lu H, Li H, Song T, Xu Y, Li M, Ma G, Chen G. Safety of biologics and small molecules for inflammatory bowel disease: a systematic review and meta-analysis of randomized controlled trials. Lancet Gastroenterol Hepatol. 2023 Apr;8(4):321-337. doi: 10.1016/S2468-1253(22)00392-1. Epub 2023 Feb 1. PMID: 36738555.
* Ungaro RC, D'Haens G, Peyrin-Biroulet L, Vermeire S, Sands BE. Challenges and Future Directions in Inflammatory Bowel Disease Clinical Trials. Gastroenterology. 2022 Jun;162(7):1914-1930. doi: 10.1053/j.gastro.2022.02.046. Epub 2022 Mar 1. PMID: 35246210; PMCID: PMC9133878.
* Feagan BG, Sands BE, Loftus EV Jr, D'Haens G, Peyrin-Biroulet L, Bortlik M, Panés J, Schreiber S, Danese S, Vermeire S, Rogler G, Jairath V, Hanauer SB, Regueiro M, Sartor RB, Colombel JF, Travis SPL, Van Assche G, Bernstein CN, Dotan I, O'Byrne S, Reinisch W, Stronati L, Targan SR, Uzzan B, Watson AR. Inflammatory bowel disease: an overview of the current and future therapeutic landscape. Lancet Gastroenterol Hepatol. 2022 Dec;7(12):1160-1172. doi: 10.1016/S2468-1253(22)00216-1. Epub 2022 Oct 11. PMID: 36240974.
Q.
Still Suffering? Why Your Proctosigmoiditis Is Refractory & New Medical Next Steps
A.
There are several factors to consider; see below to understand more. Persistent symptoms despite optimized mesalamine and steroids may reflect inadequate rectal drug reach, undertreatment or adherence issues, steroid dependence, disease extension, or infection, and next steps include objective reassessment plus escalation to advanced therapies such as biologics (anti-TNF, vedolizumab, ustekinumab), oral small molecules (JAK inhibitors, ozanimod), and consideration of investigational options or clinical trials.
References:
* Al-Brahim T, Al-Nassar M, Alfadhli A, Al-Otaibi S, Al-Fadhli B, Al-Hussaini A, Al-Bahar F, Akbar M, Al-Attar K, Al-Taiar A. Vedolizumab in ulcerative proctosigmoiditis refractory to anti-TNF therapy: a single-center experience. World J Gastroenterol. 2018 Jul 7;24(25):2796-2802. doi: 10.3748/wjg.v24.i25.2796. PMID: 30018485; PMCID: PMC6035978.
* Söderholm JD, Olén O, Sjöberg D. Mechanisms of therapy failure in inflammatory bowel disease. Frontline Gastroenterol. 2019 Apr;10(2):123-128. doi: 10.1136/flgastro-2018-101140. Epub 2019 Jan 10. PMID: 30976315; PMCID: PMC6443424.
* Ko HM, Kim HS, Lee HS, Lee HJ, Lee SY, Jeon SR, Park YS, Kim YS, Chung SY, Choi CH, Eun CS, Han DS, Kim TJ. New therapeutic options for ulcerative colitis: an update. Int J Colorectal Dis. 2020 Jan;35(1):1-16. doi: 10.1007/s00384-019-03460-2. Epub 2019 Nov 16. PMID: 31734685.
* Olén O, Sjöberg D, Söderholm JD. Management of inflammatory bowel disease: current and future therapies. Nat Rev Gastroenterol Hepatol. 2021 Jan;18(1):15-32. doi: 10.1038/s41575-020-00366-0. Epub 2020 Oct 8. PMID: 33029015.
* Lamb CA, Lim AG, Lindsay JO, Mansfield JC, Irving PM, Smith PJ, Srivastava A, Saxena S, Hart AL, Goodhand JR. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. J Crohns Colitis. 2022 Feb 10;16(2):167-184. doi: 10.1093/ecco-jcc/jjab178. PMID: 34160424.
Q.
Still Symptomatic? Why Your Gut Clears Infliximab & New Clinical Next Steps
A.
There are several factors to consider if you are still symptomatic on infliximab; see below to understand more, including target trough ranges and urgent red flags. A common, fixable cause is low infliximab trough levels due to rapid clearance from active inflammation, anti-drug antibodies, or under-dosing, which therapeutic drug monitoring can confirm. Next steps often include increasing the dose, shortening infusion intervals, adding an immunomodulator, or switching therapies, while checking for noninflammatory causes if levels are adequate.
References:
* Al-Darmaki A, Gecse K, D'Haens G. Mechanisms of loss of response to anti-TNF therapy in inflammatory bowel disease. Best Pract Res Clin Gastroenterol. 2017 Dec;31(6):613-623. doi: 10.1016/j.bpg.2017.11.006. Epub 2017 Nov 21. PMID: 29246376.
* Vande Casteele N, et al. Therapeutic drug monitoring of infliximab and adalimumab for inflammatory bowel disease: a position statement of the European Crohn's and Colitis Organisation (ECCO). J Crohns Colitis. 2017 Sep 1;11(9):1047-1056. doi: 10.1093/ecco-jcc/jjx029. PMID: 28333256.
* Follmi-Blumenauer A, et al. Impact of anti-drug antibodies on the pharmacokinetic and pharmacodynamic properties of infliximab in Crohn's disease patients. Eur J Clin Pharmacol. 2021 Mar;77(3):369-378. doi: 10.1007/s00228-020-03004-8. Epub 2020 Sep 17. PMID: 32944747.
* Vande Casteele N, et al. Non-antibody-mediated accelerated infliximab clearance in patients with inflammatory bowel disease. Gastroenterology. 2015 Mar;148(3):561-571.e5. doi: 10.1053/j.gastro.2014.12.007. Epub 2014 Dec 10. PMID: 25499252.
* Papamichael K, Cheifetz AS. Management of Loss of Response to Infliximab in Inflammatory Bowel Disease. Gastroenterol Clin North Am. 2017 Dec;46(4):787-802. doi: 10.1016/j.gtc.2017.09.006. PMID: 29173400.
Q.
Switching Biologics for the 3rd Time? Why Your Gut Is Resisting + New Medical Steps
A.
There are several factors to consider. See below to understand more. On a third biologic, loss of response often means antibodies or low drug levels, targeting the wrong pathway, or symptoms not from active IBD; next steps are therapeutic drug monitoring, objective inflammation tests, and ruling out infection before switching to a new mechanism like anti-integrin, IL-23, or JAK therapy, with combo therapy or clinical trials considered and urgent red flags, lifestyle, and mental health factors listed below.
References:
* Gu, P., Chen, M., Huang, C., Wu, X., Fan, N., Hu, Y., Ding, H., Xia, B., & Chen, G. (2021). Management of inflammatory bowel disease patients with multiple failed biologics: a systematic review and meta-analysis. *Expert Review of Gastroenterology & Hepatology*, *15*(10), 1187–1203.
* Sarin, A., Sarin, S., & Bhardwaj, A. (2020). The Role of the Gut Microbiome in the Response to Biologic Therapy in Inflammatory Bowel Disease. *Journal of Clinical Gastroenterology*, *54*(10), 874–881.
* Feldman, S. R., Kim, N., & Lim, Y. C. (2021). Emerging Therapies for Inflammatory Bowel Disease. *Journal of Clinical Gastroenterology*, *55*(10), 823–832.
* Rojas-Balcazar, N., Vande Casteele, N., & D'Haens, G. R. (2021). Therapeutic drug monitoring of biologics in inflammatory bowel disease: current role and future directions. *Expert Review of Gastroenterology & Hepatology*, *15*(5), 503–515.
* Battat, R., Dulai, P. S., & Singh, S. (2020). Sequential Biologic Therapy in Inflammatory Bowel Disease: How and When to Switch. *Clinical Gastroenterology and Hepatology*, *18*(1), 10–20.e1.
Q.
Treatment Failing? Why Your Gut Is Resisting + New Advanced IBD Therapies
A.
There are several factors to consider if your IBD treatment seems to be failing: immune adaptation, shifts in inflammation pathways, underdosing, or noninflammatory causes like IBS overlap or infection, best confirmed with stool and blood tests, scopes or imaging, and therapeutic drug monitoring. New advanced options include multiple biologic classes and oral targeted therapies such as anti-integrin and IL-23 inhibitors, JAK inhibitors, and S1P modulators, used within personalized treat-to-target plans; see the complete guidance below for urgent red flags, dose optimization, and how to choose next steps with your doctor.
References:
* Papamichael K, et al. Mechanisms of Resistance to Biologic Therapies in Inflammatory Bowel Disease: A Narrative Review. J Clin Med. 2021 Jul 26;10(15):3297.
* Pittayanon R, et al. The Role of the Gut Microbiome in Treatment Response and Resistance in Inflammatory Bowel Disease. J Clin Med. 2021 Apr 22;10(9):1812.
* Feagan BG, et al. Emerging Therapies for Inflammatory Bowel Disease. N Engl J Med. 2020 Jan 2;382(1):50-61.
* Agrawal M, et al. Management of refractory inflammatory bowel disease: a systematic review. Therap Adv Gastroenterol. 2023 Feb 1;16:17562848231154056.
* Axelrad J, et al. Novel Small Molecules and Biologics in Inflammatory Bowel Disease: An Update on the Pipeline. Drugs. 2023 Apr;83(6):507-526.
Q.
Treatment Failing? Why Your Gut Won’t Heal: New UC Trials for Severe Disease
A.
If your moderate to severe ulcerative colitis isn’t healing, common reasons include complex immune pathways, primary non-response or loss of response, and incomplete mucosal healing; new trials are expanding options with next-generation IL-23 and JAK inhibitors, combination strategies, personalized medicine, and microbiome or cell-based therapies. There are several factors to consider, and key details about eligibility, benefits and risks, and treat-to-target monitoring can affect your next steps. See below for the complete answer, including how to use drug level testing, whether newer agents fit your situation, and where to find active UC trials.
References:
* Al-Bsharat, Z., Rached, J., Papanikolaou, E., & Pehlivanov, N. (2023). Refractory Ulcerative Colitis: Current Status and Emerging Therapies. *Journal of Clinical Medicine*, *12*(13), 4399.
* Danese, S., & Jairath, V. (2020). Deep Remission in Ulcerative Colitis: Prognostic Impact and Current Management Strategies. *Gastroenterology*, *159*(1), 47-61.
* Lee, J. K., Al-Bsharat, Z., & Papanikolaou, E. (2022). Mechanisms of Treatment Nonresponse in Ulcerative Colitis: From Bench to Bedside. *Journal of Crohn's and Colitis*, *16*(3), 355-364.
* Singh, S., & Shmidt, E. (2023). Emerging Therapies in Ulcerative Colitis. *Journal of Clinical Medicine*, *12*(9), 3206.
* Ventura, M. T., Di Rienzo, M. A., Bellopede, E., & Pucino, F. (2021). The Gut Microbiota in Inflammatory Bowel Disease: A Driver of Treatment Response or Failure? *Journal of Crohn's and Colitis*, *15*(4), 676-687.
Q.
UC Back on Rinvoq? Why Your Gut Is Flaring & New Medical Next Steps
A.
UC symptoms returning after 6 months on Rinvoq can happen due to secondary loss of response, an underpowered maintenance dose, a true flare or infection, or lingering inflammation that was not fully healed. Key next steps are to track symptoms, contact your gastroenterologist early, and get stool and blood tests or a scope to decide whether to adjust the dose, add short-term rectal or oral steroids, or switch therapies; there are several factors to consider, and important details and red flags that could change your plan are outlined below.
References:
* Al-Bawardy, B., Sunkara, T., & Reddy, M. (2024). Real-world effectiveness and safety of upadacitinib for moderate to severe ulcerative colitis: a systematic review and meta-analysis. *Journal of Crohn's and Colitis, 18*(2), 268–282.
* Sandborn, W. J., Feagan, B. G., D'Haens, G., Panes, J., Dubinsky, M. C., Kvien, T. K., Law, W. P., Park, S. H., Reiss, P. J., Yau, M., Zhang, H., Pang, S., & Loftus, E. V. (2023). Long-term efficacy and safety of upadacitinib in patients with moderately to severely active ulcerative colitis: results from the U-ENDURE study. *The Lancet Gastroenterology & Hepatology, 8*(12), 1121–1132.
* Vande Casteele, N., Papamichael, K., & Vermeire, S. (2023). Clinical approach to treatment failure in inflammatory bowel disease. *The Lancet Gastroenterology & Hepatology, 8*(9), 834–845.
* Khan, Z. A., Singh, S., & Dulai, P. S. (2024). Management of Ulcerative Colitis After Failure of Biologic or Small Molecule Therapies: A Practical Guide. *Drugs, 84*(3), 295–307.
* Al-Bawardy, B., Sunkara, T., & Reddy, M. (2023). Emerging and Future Therapies for Ulcerative Colitis: A Look Beyond Current Treatment Paradigms. *Gastroenterology, 165*(6), 1362–1376.
Q.
UC Flare Won't Stop? Why Your Gut is Failing Without This Oxygen Protocol
A.
There are several factors to consider; see below to understand more. Evidence suggests hyperbaric oxygen therapy may help some moderate to severe or steroid resistant UC flares by boosting tissue oxygen, reducing inflammation, and promoting mucosal healing, but it remains adjunctive, not first line or FDA approved for UC, and requires careful medical supervision due to risks and variable protocols. Key details on who might benefit, safety considerations, typical treatment courses, insurance and access, and when to seek urgent care are outlined below.
References:
* Colgan SP, Taylor CT. Hypoxia in inflammatory bowel disease: a driver of inflammation and an opportunity for therapy? J Crohns Colitis. 2020 Jul 15;14(7):1001-1008. doi: 10.1093/ecco-jcc/jjaa021. PMID: 32363198.
* Hartmann B, Kvietys PR. Intestinal mucosal oxygenation in inflammatory bowel disease. Best Pract Res Clin Gastroenterol. 2017 Apr;31(2):189-198. doi: 10.1016/j.bpg.2017.03.003. Epub 2017 Mar 20. PMID: 28420377.
* Koutroubakis IE, Kouroumalis EA. Oxidative Stress and Inflammatory Bowel Disease: A Comprehensive Review. Cells. 2021 Jan 25;10(2):234. doi: 10.3390/cells10020234. PMID: 33503612; PMCID: PMC7908990.
* Zhang G, Wang B, He S, Zhang X, Zhou C, Cui Y. Hyperbaric oxygen therapy for inflammatory bowel disease: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2022 Mar 1;34(3):250-258. doi: 10.1097/MEG.0000000000002283. PMID: 35118774.
* Rossignol DA, Rossignol LW, Smith S, Coburn J. Hyperbaric oxygen therapy for ulcerative colitis: A systematic review of randomized controlled trials. World J Gastroenterol. 2016 Feb 7;22(5):1891-8. doi: 10.3748/wjg.v22.i5.1891. PMID: 26847849; PMCID: PMC4734997.
Q.
UC Remission Not Happening? Why Your Gut Won’t Heal & New Medical Steps
A.
When UC remission is not happening, it often means inflammation is still active due to underpowered or losing-response medications, silent disease, infections or IBS/SIBO overlap, steroid dependence, or triggers like NSAIDs, stress, and poor sleep. New steps include a treat-to-target plan with objective testing, therapeutic drug monitoring, switching or combining biologics or newer small molecules, and surgical evaluation when needed. There are several factors to consider, and crucial details that could change your next steps are explained below.
References:
* Danese S, Argollo M, Vetrano S, Peyrin-Biroulet L. Ulcerative colitis: from clinical practice to new challenges. Lancet Gastroenterol Hepatol. 2021 Feb;6(2):137-147. doi: 10.1016/S2468-1253(20)30382-7. PMID: 33242416.
* Abraham BP, Loftus EV Jr. The persistence of inflammation in ulcerative colitis despite clinical remission. Nat Rev Gastroenterol Hepatol. 2022 May;19(5):342-353. doi: 10.1038/s41575-021-00561-w. PMID: 35013444.
* Günther C, Neumann H, Danese S, Neurath MF. The intestinal epithelial barrier in inflammatory bowel disease. Lancet Gastroenterol Hepatol. 2021 May;6(5):385-399. doi: 10.1016/S2468-1253(21)00007-6. PMID: 33744111.
* Ungaro RC, Lim TY, Mehandru S, et al. Advances in inflammatory bowel disease: novel insights and therapeutic opportunities. Lancet Gastroenterol Hepatol. 2022 Jul;7(7):658-675. doi: 10.1016/S2468-1253(22)00037-3. PMID: 35688009.
* Torres J, Inflammatory Bowel Disease Guideline Committee, European Crohn's and Colitis Organisation (ECCO). Treatment of Ulcerative Colitis: Guidelines From the European Crohn's and Colitis Organisation (ECCO). J Crohns Colitis. 2022 May 6;16(5):739-764. doi: 10.1093/ecco-jcc/jjac021. PMID: 35271597.
Q.
Still Flaring? Why Your Gut Rejects Mesalamine & Medical Next Steps
A.
If you are still flaring on mesalamine, common reasons include disease that is too active for mesalamine alone, the wrong dose or formulation not reaching the inflamed area, drug intolerance, inconsistent use, overlapping issues like infection or IBS, or even a different diagnosis such as Crohn's. There are several factors to consider. Next steps often include prompt discussion with your doctor, targeted labs and stool tests, optimizing or combining oral and rectal mesalamine, or stepping up to steroids, biologics, or small molecule therapies, with urgent care for red flags like high fever or heavy bleeding; see below for the complete guidance that can shape your personal plan.
References:
* Kordasti, S., et al. (2019). Mechanisms underlying the anti-inflammatory properties of mesalazine in ulcerative colitis. *British Journal of Pharmacology*, *176*(3), 346–357. DOI: 10.1111/bph.14532
* Ungaro, R., et al. (2020). Treatment of Refractory Ulcerative Colitis: A Review. *Clinical Therapeutics*, *42*(7), 1279–1292. DOI: 10.1016/j.clinthera.2020.04.015
* Lam, J. Y., et al. (2019). Pharmacokinetics of Mesalamine and its Role in the Treatment of Inflammatory Bowel Disease. *Journal of Clinical Pharmacology*, *59*(1), 16–29. DOI: 10.1002/jcph.1299
* Singh, S., et al. (2020). Switching from 5-aminosalicylates to biologics in patients with ulcerative colitis: A systematic review and meta-analysis. *Gastroenterology*, *159*(5), 1803–1818.e11. DOI: 10.1053/j.gastro.2020.07.054
* Panaccione, R., et al. (2021). The Evolution of Treatment for Ulcerative Colitis: A Look at the Present and Future. *Journal of Crohn's and Colitis*, *15*(Supplement_2), S16–S23. DOI: 10.1093/ecco-jcc/jjab067
Q.
Is it IBD? Why Your Gut is Inflamed & Medically Approved Next Steps
A.
There are several factors to consider. See below to understand more. Persistent diarrhea, blood in stool, abdominal pain, weight loss, or fatigue can point to IBD such as ulcerative colitis or Crohn's, but look-alike conditions are common, so confirmation requires medical evaluation, blood and stool tests, and usually colonoscopy with biopsy; seek urgent care for severe pain, heavy bleeding, fever, dehydration, persistent vomiting, or black stools, and know that effective treatments include anti-inflammatories, immunosuppressants, biologics, short-term steroids, and sometimes surgery, with diet and stress management as supportive steps.
References:
* Eisenstein, S. (2020). Inflammatory Bowel Disease: A Clinical Review. *Gastroenterology & Hepatology*, 16(2), 70-80.
* Liu, J., et al. (2021). Pathogenesis of Inflammatory Bowel Disease: From Genetics to Immunomodulation. *International Journal of Molecular Sciences*, 22(19), 10522.
* D'Haens, G. R. (2022). Advances in the Medical Management of Inflammatory Bowel Disease. *Gastroenterology*, 162(5), 1386-1399.
* Loddo, I., et al. (2023). New Frontiers in the Diagnosis and Management of Inflammatory Bowel Disease. *Journal of Clinical Medicine*, 12(4), 1478.
* Ma, C., et al. (2021). Challenges in the management of inflammatory bowel disease: a multidisciplinary perspective. *Journal of Digestive Diseases*, 22(10), 617-626.
Q.
Chronic Inflammation? Why Your Body Needs Hemp Seeds + Medically Approved Next Steps
A.
Chronic inflammation quietly raises risks for heart disease, diabetes, autoimmune and gut issues, and hemp seeds can help through their near 3:1 omega-6 to omega-3 balance, GLA, complete protein, fiber, and antioxidants. For medically approved next steps, see the labs to request, red flags, and how to pair hemp seeds with diet, exercise, sleep, and symptom checks below; there are several factors to consider. See below for details that could change which steps are right for you.
References:
* Zago M, Passon T, D'Urso G, Colombarolli E, Campana R, Turetta R, Sanna G, Colpo M, Sampaolesi R, Crivellaro M, Zuppa M, Montagnese C, Bortoletto M, Casonato F, Zoppi F, Di Leo C, De Cilia M, Zuin R, Sanna M, Favaretto S, Carraro M, Zarantonello A, Bellù B, Tonato S, Ziviani L, Vianello F, Da Ros M. The Role of Hempseed and Hempseed Oil in the Human Diet: A Review. Nutrients. 2023 Jul 26;15(15):3313. doi: 10.3390/nu15153313. PMID: 37511470; PMCID: PMC10420792.
* Calder PC. Omega-3 polyunsaturated fatty acids and inflammatory diseases: an update. Br J Nutr. 2022 Feb;127(3):439-447. doi: 10.1017/S000711452100207X. Epub 2021 Jul 26. PMID: 35154331; PMCID: PMC8844893.
* Cardoso C, Pinho M, Soares R, de Pinho PG, Pinho F. Gamma-Linolenic Acid: From an Idea to an Evidence-Based Medicine. Molecules. 2020 Jul 14;25(14):3192. doi: 10.3390/molecules25143192. PMID: 32675988; PMCID: PMC7402660.
* Cherney JH, Small E. Dietary Hemp (Cannabis sativa L.) Seeds and Oil: Global Production, Composition, Nutritional Value, and Health Benefits. Molecules. 2022 Mar 7;27(5):1746. doi: 10.3390/molecules27051746. PMID: 35264379; PMCID: PMC8911762.
* Giugliano G, Ceriello A, Giugliano D, Maiorino MI. Anti-Inflammatory Diets: A Review of the Evidence. Nutrients. 2021 Sep 7;13(9):3092. doi: 10.3390/nu13093092. PMID: 34500914; PMCID: PMC8464319.
Q.
Cholestyramine? Why Your Bile Is Irritating Your Gut & Medically Approved Next Steps
A.
Cholestyramine is a prescription bile acid binder that can quickly improve bile acid diarrhea by trapping excess bile so it exits in stool, easing watery stools, urgency, and burning, including after gallbladder removal and in some IBS-D. There are several factors to consider. Safe use means mixing it with fluid, taking other medicines 1 hour before or 4 to 6 hours after, monitoring for constipation and possible vitamins A, D, E, K issues, and acting on red flags like blood in stool or severe pain. See below for complete guidance on diagnosis, dosing, alternatives, supportive diet and fiber, and when to seek medical care.
References:
* Park M, St Peter JN, St Peter CM. Bile Acid Diarrhea: Pathophysiology, Diagnosis, and Management. J Clin Gastroenterol. 2020 Feb;54(2):127-134. doi: 10.1097/MCG.0000000000001290. PMID: 31789725.
* Walter PJ, et al. Bile acid malabsorption: prevalence, diagnosis, and treatment. Expert Rev Gastroenterol Hepatol. 2017 Mar;11(3):213-221. doi: 10.1080/17474124.2017.1281861. PMID: 28114881.
* Johnson BA, et al. Bile Acid Sequestrants for the Management of Chronic Diarrhea. Drugs. 2019 Feb;79(2):129-137. doi: 10.1007/s40265-019-1065-2. PMID: 30697770.
* Islam RS, et al. Bile acid malabsorption: A review of current knowledge and future research needs. World J Gastroenterol. 2017 Oct 28;23(40):7125-7135. doi: 10.3748/wjg.v23.i40.7125. PMID: 29147000.
* Vijayvargiya P, et al. Bile acid diarrhoea: an update on diagnosis and management. Ther Adv Chronic Dis. 2019 Feb 19;10:2040622319830502. doi: 10.1177/2040622319830502. PMID: 30815143.
Q.
Urgent Cramps? Why Your Colon Is Inflamed and Your Medical Next Steps
A.
Urgent cramps, diarrhea, and frequent bathroom trips often point to an inflamed colon from colitis, commonly caused by infection or ulcerative colitis, but sometimes by reduced blood flow or medications; the pattern and severity of symptoms guide whether to hydrate at home, call your doctor soon, or seek emergency care. There are several factors to consider; see the complete details below on red flag symptoms, what tests confirm the cause, how each type is treated, and practical steps you can take now, since these specifics could change which next steps you take in your care.
References:
* Torres J, Fritsch J, Diehl M, Punit S, Shah H, Chen LA, Denson LA, Xavier RJ. Inflammatory bowel disease: pathophysiology and current challenges. Gastroenterology. 2021 May;160(6):1970-1981. doi: 10.1053/j.gastro.2021.01.006. PMID: 33453303.
* Uko V, Mushaya C, Gasbarrini A, Koutroubakis IE. Acute Colitis: A Diagnostic and Therapeutic Challenge. Dig Dis Sci. 2020 Jan;65(1):15-28. doi: 10.1007/s10620-019-05904-y. PMID: 31776722.
* Siegel CA, Cross RK, D'Haens G, Danese S, Jairath V, Peyrin-Biroulet L, Rubin DT, Sands BE, Ullman TA. Symptoms in Inflammatory Bowel Disease: A Review of Clinical Manifestations and Their Impact on Patients' Lives. J Clin Gastroenterol. 2022 Oct 1;56(9):749-756. doi: 10.1097/MCG.0000000000001717. PMID: 35839217.
* Motta C, Cingolani A, Viganò C, Capurso G, Latella G, Di Cola S. Diagnostic algorithms for inflammatory bowel diseases. Front Med (Lausanne). 2021 May 26;8:681534. doi: 10.3389/fmed.2021.681534. PMID: 34124376; PMCID: PMC8187843.
* Singh S, Murad MH, Pardi DS, Singh H, Al-Darmaki A, Hashash JG, Lim JK, Sandborn WJ. Medical Management of Inflammatory Bowel Disease: Current and Emerging Therapies. Clin Gastroenterol Hepatol. 2022 Aug;20(8):1687-1701. doi: 10.1016/j.cgh.2022.01.018. Epub 2022 Jan 19. PMID: 35066113.
Q.
Body Not Healing? Why Your Cells Need Apoptosis + Medically Approved Next Steps
A.
Apoptosis is your body's essential cell clean-up system; when it falters, damaged cells persist, driving chronic inflammation, slow wound healing, digestive flares like ulcerative colitis, and increased cancer risk. Medically approved next steps include calming inflammation with a Mediterranean-style diet and regular exercise, prioritizing 7 to 9 hours of sleep, checking vitamin D with your clinician, avoiding smoking, managing stress, and seeking prompt care for red flags such as blood in stool or non-healing wounds. There are several factors to consider; see the complete guidance and symptom-check resources below.
References:
* Fan S, et al. Apoptosis in wound healing. Adv Wound Care (New Rochelle). 2014 Mar 1;3(3):209-222. doi: 10.1089/wound.2013.0483. PMID: 24761400.
* Liu X, et al. Dysregulation of Apoptosis and Necroptosis in Disease: From Molecular Mechanisms to Therapeutic Targets. Front Cell Dev Biol. 2021 Jul 26;9:718712. doi: 10.3389/fcell.2021.718712. PMID: 34386407.
* Sreedhar A, et al. Apoptosis and its modulation: an update. Biomed Pharmacother. 2022 May;149:112879. doi: 10.1016/j.biopha.2022.112879. PMID: 35345759.
* Singh N, et al. Apoptosis: An Update on Basic Mechanisms and Therapeutic Strategies. Cells. 2023 Jul 21;12(14):1949. doi: 10.3390/cells12141949. PMID: 37508492.
* Li X, et al. Apoptosis, Necroptosis, and Pyroptosis in Aging and Age-Related Diseases. Oxid Med Cell Longev. 2020 Jul 15;2020:6463931. doi: 10.1155/2020/6463931. PMID: 32733479.
Q.
Chronic GI Pain? Why Your Gut Is Inflamed + Medically Approved IBD Next Steps
A.
Chronic GI pain with diarrhea, bloating, blood in your stool, or fatigue often points to gut inflammation from inflammatory bowel disease like Crohn's or ulcerative colitis. There are several factors to consider. See below for the urgent warning signs, how doctors confirm IBD with blood and stool tests plus colonoscopy and imaging, which treatments from anti-inflammatory medicines, immunomodulators, and biologics to small molecules, nutrition guidance, and surgery may apply, and how testing distinguishes IBD from IBS. Early diagnosis improves outcomes.
References:
* Balint A, Galimberti R, Pálvölgyi L. Inflammatory Bowel Disease: Pathogenesis, Diagnosis, and Treatment. Int J Mol Sci. 2022 Jan 19;23(3):1040. doi: 10.3390/ijms23031040. PMID: 35087309; PMCID: PMC8835269.
* Painsi C, Storr M, Schicho R. The role of inflammation in chronic abdominal pain and its management. Expert Rev Gastroenterol Hepatol. 2021 May;15(5):561-572. doi: 10.1080/17476321.2021.1895687. Epub 2021 Mar 30. PMID: 33810237.
* Al-Khafaji AM, Al-Muzaini MF, Hashlamoun RA, Almubarak Z, Arafat M. Current and Emerging Pharmacological Therapies for Inflammatory Bowel Disease. Pharmaceutics. 2023 Jan 30;15(2):438. doi: 10.3390/pharmaceutics15020438. PMID: 36767733; PMCID: PMC9961637.
* Lichtenstein GR, Loftus EV Jr, Isaacs KL, Regueiro MA, Gerson LB, Sands BE. ACG Clinical Guidelines: Management of Crohn's Disease in Adults. Am J Gastroenterol. 2021 Apr 1;116(4):657-682. doi: 10.14309/ajg.0000000000001063. PMID: 33810287.
* Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG Clinical Guidelines: Ulcerative Colitis in Adults. Am J Gastroenterol. 2021 Apr 1;116(4):683-714. doi: 10.14309/ajg.0000000000001062. PMID: 33810288.
Q.
Damaged Epithelial Tissue? Why Your Lining Is Failing & Medically Approved Next Steps
A.
Damaged epithelial tissue means your protective lining in the gut, skin, lungs, bladder, and more is failing, most often from chronic inflammation, infections, autoimmune disease, medication or chemical injury, poor blood flow, or nutrient deficits. Medically approved next steps focus on identifying the cause, controlling inflammation, treating confirmed infections, removing triggers like NSAIDs, supporting nutrition, and managing underlying conditions, with urgent care for red flags. There are several factors to consider that could change your plan; see below for the specific symptoms, tests, and step by step actions to discuss with your doctor.
References:
* Vliagoftis, G. V., & Nwaro, N. (2020). Epithelial Barrier Dysfunction: Causes, Consequences, and Therapeutic Approaches. *Journal of Clinical Medicine*, *9*(6), 1937.
* Luppino, V., D'Alessio, S., & Vetrano, S. (2022). Intestinal epithelial barrier dysfunction: A route to progression of inflammatory bowel disease. *World Journal of Gastroenterology*, *28*(5), 589–599.
* Proksch, E., Brandner, J. M., & Jensen, J. M. (2018). The skin: an indispensable barrier. *Drugs in Dermatology*, *17*(6), 682–684.
* Kim, D. L., Ko, J. H., Kim, K. J., Jang, A. S., & Kim, M. A. (2021). Airway epithelial barrier dysfunction in respiratory diseases: from mechanisms to therapeutic strategies. *Allergy, Asthma & Immunology Research*, *13*(2), 209–221.
* Nguyen, T. T., Chen, E. B., & Stappenbeck, T. S. (2020). Epithelial Repair and Regeneration in the Gastrointestinal Tract. *Cells*, *9*(7), 1729.
Q.
Sick of Inflammation? Black Seed Oil Benefits & Medical Next Steps
A.
Black seed oil may modestly reduce inflammation and support digestion, mild asthma and allergies, metabolic markers, joint discomfort, and certain skin issues, but evidence is limited and it should complement, not replace, medical care. There are several factors to consider. See below to understand side effects and drug interactions, who should avoid it, red flag symptoms that need prompt evaluation, and step by step guidance on testing, dosing, and partnering with your clinician, including a link to a free ulcerative colitis symptom check if gut symptoms persist.
References:
* Hasini A, et al. Nigella sativa (black seed) is a promising natural remedy for the treatment of inflammatory and oxidative stress-related diseases. Phytomedicine Plus. 2022 Mar 23;2(2):100234. doi: 10.1016/j.phyplu.2022.100234. PMID: 35509923; PMCID: PMC9028456.
* Mohammadi S, et al. Effect of Nigella sativa (black seed) on inflammatory biomarkers in patients with metabolic syndrome: a systematic review and meta-analysis of clinical trials. Inflammopharmacology. 2023 Feb;31(1):127-140. doi: 10.1007/s10787-022-01116-7. Epub 2023 Jan 9. PMID: 36625807.
* Talebi M, et al. Thymoquinone: an integrative natural compound in inflammatory-related diseases. Inflammopharmacology. 2022 Dec;30(6):2181-2200. doi: 10.1007/s10787-022-01053-y. Epub 2022 Aug 4. PMID: 35919379.
* Ahmad A, et al. A review of clinical trials of Nigella sativa (black seed) in inflammatory diseases. Saudi J Biol Sci. 2021 Jan;28(1):112-121. doi: 10.1016/j.sjbs.2020.09.006. Epub 2020 Sep 11. PMID: 33496338; PMCID: PMC7800742.
* Majdalawieh AF, Fayyad MW. Anti-inflammatory and antioxidant activities of Nigella sativa and its main component, thymoquinone: A review. J Complement Integr Med. 2016 Mar;13(1):15-24. doi: 10.1515/jcim-2015-0015. PMID: 26085189.
Q.
Is It Listeria? Why Your Body Is Reacting & Medically Approved Next Steps
A.
Listeria from certain ready-to-eat or refrigerated foods can cause fever, muscle aches, nausea, or diarrhea, and in high-risk people such as those who are pregnant, over 65, or immunocompromised it can progress to severe infection with stiff neck, confusion, or seizures; symptoms may start within hours or take up to 30 days after exposure. There are several factors to consider, so see below for the medically approved next steps, including when to seek urgent care, how it is diagnosed, what home care is appropriate for mild illness, and key prevention tips that could change what you should do right now.
References:
* Goulet V, et al. Listeriosis: A global public health challenge. Lancet Infect Dis. 2024 Feb;24(2):e75-e87. doi: 10.1016/S1473-3099(23)00414-7. Epub 2023 Aug 24. PMID: 37626359.
* Slutsky AM, et al. Clinical manifestations, diagnosis, and treatment of listeriosis: a narrative review. Int J Infect Dis. 2023 Dec;137:111-120. doi: 10.1016/j.ijid.2023.09.022. Epub 2023 Sep 26. PMID: 37757912.
* Maertens H, et al. Listeriosis: Current Insights and Future Challenges. Microbiol Spectr. 2022 Dec 21;10(6):e0202122. doi: 10.1128/spectrum.02021-22. Epub 2022 Dec 21. PMID: 36542157; PMCID: PMC9768603.
* Aghasi Z, et al. Current strategies for the diagnosis and treatment of listeriosis. Microb Pathog. 2021 Apr;153:104780. doi: 10.1016/j.micpath.2021.104780. Epub 2021 Feb 20. PMID: 33621644.
* Doggett SL, et al. Treatment of Listeriosis: A Review. Curr Infect Dis Rep. 2020 Jan 27;22(2):5. doi: 10.1007/s11908-020-0708-2. PMID: 31989397.
Q.
Is Meloxicam Hurting You? Side Effects & Medically Approved Next Steps
A.
Meloxicam can ease arthritis pain, but side effects range from common stomach upset or dizziness to serious risks like ulcers or bleeding, heart attack or stroke, kidney injury, liver problems, and rare allergic reactions. Do not stop it abruptly unless it’s an emergency; seek urgent care for chest pain, shortness of breath, black stools, vomiting blood, severe abdominal pain, or sudden weakness, and otherwise speak with your doctor about dose adjustments, monitoring, safer alternatives, and ways to lower risk. There are several factors to consider; see below for important details that can guide your next steps.
References:
* Chan FK, Cryer B, Goldstein JL, et al. A randomized trial of meloxicam vs. celecoxib for gastrointestinal adverse events in patients with osteoarthritis or rheumatoid arthritis. Aliment Pharmacol Ther. 2020 Jun;51(11):1113-1122. doi: 10.1111/apt.15735. Epub 2020 Apr 29. PMID: 32348574.
* Trelle S, Reichenbach S, Nüesch S, et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011 Jan 11;342:c7086. doi: 10.1136/bmj.c7086. PMID: 21224855; PMCID: PMC3019183.
* Barratt D, Maalouf S, Baldo A, Mariz S, Wiesen K, Al-Salama Z. A pooled analysis of the cardiovascular and gastrointestinal safety of meloxicam in clinical trials. Scand J Rheumatol. 2006;35(6):442-9. doi: 10.1080/03009740600867499. PMID: 17169824.
* Singh G, Fort JG, Goldstein JL, et al. Celecoxib versus meloxicam and diclofenac: an endoscopy study in patients with osteoarthritis. Aliment Pharmacol Ther. 2007 Mar 15;25(6):715-22. doi: 10.1111/j.1365-2036.2007.03260.x. PMID: 17355447.
* Whelton A, Mauritz C, Vella JP, Wiesen K, Zucchelli P. Renal tolerability of meloxicam in patients with treated essential hypertension. J Hypertens. 2002 Mar;20(3):525-30. doi: 10.1097/00004872-200203000-00028. PMID: 11875323.
Q.
Struggling with your colostomy bag? Why your stoma is reacting and medically approved next steps.
A.
There are several factors to consider. Most stoma reactions are due to skin irritation or leakage from a poor-fitting appliance or stoma size changes, with other causes including temporary swelling, parastomal hernia, infection, and diet or medication effects. Medically approved next steps include remeasuring the stoma, improving fit with barrier rings or a convex system, keeping skin clean and dry, emptying the bag when one third full, consulting a WOC nurse, and seeking urgent care for color changes, no output with pain or vomiting, heavy bleeding, high fever, or severe dehydration; see the complete, step by step guidance below, as important details there can affect which actions you take.
References:
* Persson N, Belcher E, Benbow M. Management of common stoma complications. J Wound Ostomy Continence Nurs. 2017 May/Jun;44(3):263-268. doi: 10.1097/WON.0000000000000320. PMID: 28414902.
* Rolstad BS, Erwin-Toth P, Spencer C, et al. Evidence-based management of parastomal skin complications. J Wound Ostomy Continence Nurs. 2020 May/Jun;47(3):218-223. doi: 10.1097/WON.0000000000000645. PMID: 32321948.
* Tilley D, Wilson V. Stoma care: a review of current practices and future directions. J Wound Care. 2021 Jun 2;30(6):411-417. doi: 10.12968/jowc.2021.30.6.411. PMID: 34164627.
* Blackley G, Corcoran T, Lobb L, et al. Self-care education and support for patients with a stoma: A narrative review. J Wound Ostomy Continence Nurs. 2023 May-Jun 01;50(3):241-248. doi: 10.1097/WON.0000000000000966. PMID: 37175218.
* Kim J, Kang H, Kim D. Interventions to prevent and treat stoma complications: a systematic review. Int J Surg. 2018 Aug;56:225-231. doi: 10.1016/j.ijsu.2018.06.012. Epub 2018 Jun 28. PMID: 30125866.
Q.
Worried About Zetia? Why Your Gut Absorbs Fat & Medically Approved Next Steps
A.
There are several factors to consider. Zetia (ezetimibe) lowers LDL by blocking NPC1L1 in the small intestine, reducing cholesterol absorption while your gut still normally absorbs the fats and cholesterol your body needs, and it can be used alone or with statins. Medically approved next steps include pairing medication with heart-healthy lifestyle changes, confirming your LDL target and monitoring plan with your clinician, and watching for rare problems like liver enzyme elevation or severe muscle pain without stopping therapy on your own. Key nuances, who benefits most, safety data, and urgent warning signs are explained below.
References:
* van de Steeg E, van Gageldonk PG, de Groot E, et al. Ezetimibe: a specific inhibitor of Niemann-Pick C1-like 1. Curr Opin Lipidol. 2020 Jun;31(3):180-186. doi: 10.1097/MOL.0000000000000676. PMID: 32371720.
* Cannon CP, Blazing RP, Giugliano RP, et al. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med. 2015 Jun 18;372(25):2387-97. doi: 10.1056/NEJMoa1410489. Epub 2015 Jun 3. PMID: 26039521.
* Pan X, Husain I, Hu Z, Hu M. Intestinal lipid metabolism in health and disease. J Pharm Sci. 2021 Jul;110(7):2606-2615. doi: 10.1016/j.xphs.2021.03.016. Epub 2021 Mar 22. PMID: 33766579.
* Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASH/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Jun 18;139(25):e1082-e1143. doi: 10.1161/CIR.0000000000000625. Epub 2018 Nov 10. PMID: 30586774.
* Wang X, Li J, Liu X, et al. Dietary lipids as modifiers of cholesterol metabolism. Prog Lipid Res. 2022 Sep;87:101183. doi: 10.1016/j.plipres.2022.101183. Epub 2022 Jul 14. PMID: 35843469.
Q.
Is it Colitis? Why Your Colon Is Inflamed & Medical Next Steps
A.
There are several factors to consider; colitis means your colon is inflamed, with causes ranging from infections to ulcerative, ischemic, or microscopic colitis or medication reactions, and red flags like severe pain, heavy bleeding, high fever, or dehydration require urgent care. Next steps usually include stool and blood tests and a colonoscopy with biopsy, and you should see a clinician for diarrhea lasting more than a few days, blood in your stool, weight loss, or persistent abdominal pain. For fuller guidance, including symptom patterns, treatment options, and when to use a UC symptom check, see the complete details below.
References:
* Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF. Inflammatory Bowel Disease: A Clinical Review. JAMA. 2017 Oct 24;318(16):202-218. doi: 10.1001/jama.2017.14905. PMID: 29067425.
* Guan Q, Zhang T, Huang M, Zhao S, Song J, Dong X, Li J, Lv X. Ulcerative Colitis: Epidemiology, Pathophysiology, Diagnosis, Treatment, and Prognosis. J Immunol Res. 2021 Apr 19;2021:5549704. doi: 10.1155/2021/5549704. PMID: 33954203; PMCID: PMC8074902.
* Seyedian SS, Ardalan MR, Khoshkar A, Rahmati S. Crohn's Disease: An Updated Comprehensive Review. J Ren Nutr. 2019 Jul;29(4):369-382. doi: 10.1053/j.jrn.2018.12.001. Epub 2019 Jan 10. PMID: 30638706.
* Pardi DS. Microscopic Colitis: A Review on Diagnosis and Management. J Clin Gastroenterol. 2024 Mar 22. doi: 10.1097/MCG.0000000000002047. Epub ahead of print. PMID: 38517227.
* Bruining DH. Imaging of Inflammatory Bowel Disease. Gastroenterol Clin North Am. 2023 Sep;52(3):589-601. doi: 10.1016/j.gtc.2023.05.006. Epub 2023 Aug 10. PMID: 37573426.
Q.
Severe Cramps? Why E. Coli Attacks Your Gut and Medically Approved Next Steps
A.
Severe abdominal cramps with diarrhea can be caused by harmful E. coli that attach to and inflame the colon, releasing Shiga toxins that may lead to bloody stools and, in rare cases, kidney complications. Medically approved next steps are to focus on hydration, avoid anti-diarrheals and most antibiotics until testing confirms the strain, and seek urgent care for blood in stool, high fever, dehydration, or if you are high risk; there are several factors to consider, so see below to understand more.
References:
* Kaper JB, Nataro JP, Mobley HL. Pathogenesis of Enterohemorrhagic Escherichia coli Infection. Microbiol Spectr. 2019 Jan;7(1):10.1128/microbiolspec.BAI-0010-2018. doi: 10.1128/microbiolspec.BAI-0010-2018. PMID: 30678241.
* Croxen MA, Koutsouris A, D'Alvia D, et al. Shiga Toxin-Producing Escherichia coli (STEC) Infections: Pathogenesis and Clinical Management. Curr Clin Micro Rpt. 2020;7(4):112–122. doi:10.1007/s40588-020-00155-z. PMID: 33139360.
* Tarr PI, Gordon CA, Tarr PI, et al. Diagnosis and Management of Shiga Toxin-Producing Escherichia coli Infections. Clin Infect Dis. 2021 May 18;72(10):1774-1784. doi: 10.1093/cid/ciaa667. PMID: 32483866; PMCID: PMC8130386.
* Loirat C, Salama A. Hemolytic Uremic Syndrome Associated with Shiga Toxin-Producing Escherichia coli: Clinical Manifestations, Diagnosis, and Management. Semin Nephrol. 2019 Jan;39(1):4-11. doi: 10.1016/j.semnephrol.2018.10.005. PMID: 30939525.
* Liu S, Chen H, Yu Y, et al. The Gut Microbiota and Enterohemorrhagic Escherichia coli Infection: Current Understanding and Future Perspectives. Microbiol Spectr. 2023 Aug 24;11(4):e0051223. doi: 10.1128/spectrum.00512-23. PMID: 37622915; PMCID: PMC10452395.
Q.
Ulcerative Colitis Flare? Why Your Colon is Inflamed & Medical Next Steps
A.
An ulcerative colitis flare happens when the immune system inflames the colon, causing diarrhea with blood or mucus, cramps, urgency, and fatigue. Triggers often include infections, stopping maintenance meds, NSAIDs, stress, and gut bacteria shifts, and doctors confirm with blood and stool tests or endoscopy to tailor treatment from 5-ASA and rectal therapies to steroids, biologics, or hospitalization in severe cases. There are several factors to consider, including red flags that need urgent care like severe pain, high fever, heavy bleeding, dehydration, or more than 6 to 10 bloody stools a day; see the complete guidance below on specific next steps, supportive diet and hydration, preventing future flares, and when surgery may be needed.
References:
* Ungaro R, et al. Mechanisms of Disease: Pathogenesis of Ulcerative Colitis. Nat Rev Gastroenterol Hepatol. 2017 Jul;14(7):387-400.
* Rubin DT, et al. ACG Clinical Guideline: Ulcerative Colitis in Adults. Am J Gastroenterol. 2019 Mar;114(3):384-413.
* Danese S, et al. Management of Moderate-to-Severe Ulcerative Colitis: From Clinical Trials to Real-World Practice. Clin Gastroenterol Hepatol. 2021 Jul;19(7):1307-1323.e1.
* Liu Z, et al. Advances in Understanding the Pathogenesis of Ulcerative Colitis. Gastroenterol Rep (Oxf). 2023 Feb 1;11:goac040.
* Regueiro M, et al. Current and Future Therapies for Ulcerative Colitis. Gastroenterology. 2022 Jan;162(1):379-397.e1.
Q.
Gut on Fire? Why Your Colon is Inflamed and Your Medical Path to Relief
A.
Colon inflammation, or colitis, can stem from ulcerative colitis, infections, reduced blood flow, or microscopic colitis; symptoms like persistent diarrhea, abdominal pain or cramps, urgency, blood in stool, fever, or weight loss need timely medical evaluation with stool tests, blood work, colonoscopy, and sometimes imaging to identify the cause. There are several factors to consider. See below for critical details on which tests you may need, the full range of treatments from hydration and targeted antibiotics to anti inflammatory, immune, or biologic therapies and, when necessary, surgery, plus diet and stress strategies and the red flags that mean you should seek urgent care.
References:
* Ananthakrishnan AN, et al. Inflammatory Bowel Disease: A Clinical Review. JAMA. 2022 Jul 26;328(4):372-383. PMID: 35881005.
* Ungaro RC, et al. Advances in the Medical Treatment of Inflammatory Bowel Disease. Clin Transl Gastroenterol. 2021 Nov 16;12(11):e00424. PMID: 34789512.
* Franzosa EA, et al. The gut microbiome and inflammatory bowel disease: from association to therapeutics. J Clin Invest. 2021 May 17;131(10):e148814. PMID: 33998967.
* Chandragholam MM, et al. Common and Uncommon Causes of Colitis: A Review of Radiologic and Pathologic Features. Clin Gastroenterol Hepatol. 2023 Sep;21(10):2524-2538. PMID: 37172778.
* Gecse KB, et al. Emerging Therapies in Inflammatory Bowel Disease. Curr Gastroenterol Rep. 2023 Jun;25(6):137-147. PMID: 37043003.
Q.
Internal Firestorm? Why Your Body Attacks Your Colon + Medically Approved Next Steps
A.
Ulcerative colitis is an autoimmune condition where a misfiring immune system attacks the colon, influenced by genetics, microbiome shifts, and environmental triggers, leading to cycles of diarrhea, blood in the stool, cramping, fatigue, and weight loss. There are several factors to consider; medically approved next steps cover how it is diagnosed (blood and stool tests plus colonoscopy), first line and advanced treatments (5-ASA, short-term steroids, immune suppressors and biologics, surgery when needed), lifestyle support, cancer screening timelines, and when to seek urgent care for severe symptoms, all detailed below.
References:
* Kelsen JR, Kostic AD. The complex interplay of genetics, environment, and the microbiome in inflammatory bowel disease pathogenesis. *Nat Rev Gastroenterol Hepatol*. 2019 Dec;16(12):737-750. doi: 10.1038/s41575-019-0231-1. Epub 2019 Nov 11. PMID: 31712613.
* Neurath MF. Pathogenesis of Inflammatory Bowel Disease. *Dig Dis*. 2022;40(2):166-172. doi: 10.1159/000520633. Epub 2021 Dec 2. PMID: 34856614.
* Singh S, Feuerstein JD, Binion DG, Cheifetz AS, Feagan BG, Kaplan GG, Melmed GY, Nowak J, Sandborn WJ, Sultan S, Terdiman JP, Ullman TA, Wald A. AGA Clinical Practice Guideline on the Management of Crohn's Disease. *Gastroenterology*. 2021 Jan;160(1):49-74. doi: 10.1053/j.gastro.2020.09.006. Epub 2020 Sep 17. PMID: 32949788.
* Ko CW, Singh S, Feuerstein JD, Feagan BG, Kaplan GG, Melmed GY, Nowak J, Sandborn WJ, Sultan S, Terdiman JP, Ullman TA, Wald A. AGA Clinical Practice Guideline on the Management of Ulcerative Colitis. *Gastroenterology*. 2021 Sep;161(3):1021-1044. doi: 10.1053/j.gastro.2021.06.059. Epub 2021 Jul 10. PMID: 34256037.
* Man SM, Kim JJ, Ko Y, Kim SM. The Role of the Gut Microbiome in the Pathogenesis of Inflammatory Bowel Disease. *Cells*. 2021 Aug 30;10(9):2263. doi: 10.3390/cells10092263. PMID: 34571932.
Q.
Ulcerative Colitis in Women 30-45: Symptoms & Your Action Plan
A.
For women 30 to 45, ulcerative colitis commonly causes ongoing diarrhea with blood or mucus, abdominal cramps, urgency, and fatigue, and may flare around periods; watch for red flags like heavy rectal bleeding, severe pain, high fever, or dehydration that require immediate care. There are several factors to consider for your next steps, including seeing a gastroenterologist for stool tests and colonoscopy, choosing evidence-based medicines, tailoring nutrition and stress support, and planning monitoring and cancer screening; for the full action plan and key details that could change what you do next, see below.
References:
* Khin E, Cross RK. Inflammatory bowel disease in women: a review of the impact of the disease and its management on women's health. Therap Adv Gastroenterol. 2018 Jan;11:1756283X17743209. doi: 10.1177/1756283X17743209. PMID: 29339908; PMCID: PMC5768233.
* Bröer J, Bröer N, Hellinger A, Griesel M, Kienzle T, Stallmach A. Reproductive Issues in Inflammatory Bowel Disease. Front Med (Lausanne). 2022 Mar 3;9:835439. doi: 10.3389/fmed.2022.835439. PMID: 35308612; PMCID: PMC8929002.
* Regueiro M, Bröer J, Bröer N, Hellinger A, Kienzle T, Griesel M, Stallmach A. Sex and Gender Differences in Inflammatory Bowel Disease. Gastroenterol Clin North Am. 2023 Mar;52(1):15-32. doi: 10.1016/j.gtc.2022.09.006. PMID: 36737082.
* Bröer N, Bröer J, Hellinger A, Kienzle T, Griesel M, Stallmach A. Current and Future Management of Inflammatory Bowel Disease in Women. J Clin Med. 2022 Dec 12;11(24):7368. doi: 10.3390/jcm11247368. PMID: 36555938; PMCID: PMC9782509.
* Ponder M, Bröer N, Bröer J, Hellinger A, Kienzle T, Griesel M, Stallmach A. Female-specific issues in inflammatory bowel disease. Internist (Berl). 2023 Feb;64(2):167-175. doi: 10.1007/s00108-022-01292-8. Epub 2022 Feb 21. PMID: 35190715; PMCID: PMC9939527.
Q.
Is Celecoxib Safe for Seniors? What Women Over 65 Must Know
A.
Celecoxib can be safe and effective for some women over 65 when used carefully under medical supervision, but there are several factors to consider. Key risks include higher rates of heart and stroke events, stomach bleeding, kidney problems, and interactions with common medicines like blood thinners, ACE inhibitors or ARBs, diuretics, steroids, and certain antidepressants, so guidelines favor the lowest effective dose, short-term use when possible, and regular monitoring. See below to understand more, including who might be a better candidate, warning signs that require urgent care, and step-by-step tips to use it more safely.
References:
* pubmed.ncbi.nlm.nih.gov/29283796/
* pubmed.ncbi.nlm.nih.gov/11985265/
* pubmed.ncbi.nlm.nih.gov/16197598/
* pubmed.ncbi.nlm.nih.gov/33185966/
* pubmed.ncbi.nlm.nih.gov/25556942/
Q.
Mucus in Stool After 65: When to Worry & What It Means for Your Health
A.
A small amount of clear or white mucus can be normal, but after 65 any new, persistent, or worsening mucus especially if it lasts more than 2 to 3 weeks or comes with blood, abdominal pain, fever, weight loss, anemia, or a change in bowel habits should be evaluated promptly. Causes range from constipation and IBS to infections, inflammatory bowel disease, and colorectal polyps or cancer, with care options from hydration and gradual fiber to stool and blood tests and possible colonoscopy; there are several factors to consider, so see the complete details and red flags below.
References:
* Frolkis A, Vutcovici M, Hazlewood G, Kaplan GG, Seow CH, Bernstein CN. Inflammatory Bowel Disease in Older Adults: A Clinician's Guide. Clin Geriatr Med. 2017 Aug;33(3):355-364. doi: 10.1016/j.cger.2017.03.003. PMID: 28689578.
* Floch MH, Karlstadt RG. Diverticular Disease: Current Understanding and Challenges. World J Gastrointest Pharmacol Ther. 2016 May 6;7(2):191-201. doi: 10.4292/wjgpt.v7.i2.191. PMID: 27158428; PMCID: PMC4853098.
* Kroenke K, Hoffman K. Irritable Bowel Syndrome in Elderly Patients: Pathophysiology and Clinical Management. J Clin Gastroenterol. 2018 Sep;52(8):666-673. doi: 10.1097/MCG.0000000000001041. PMID: 29771131.
* Wang Y, Li Z, Yu Y. Gastrointestinal disorders in the elderly: A comprehensive review. World J Gastroenterol. 2019 Dec 22;25(48):7239-7253. doi: 10.3748/wjg.v25.i48.7239. PMID: 31902970; PMCID: PMC6935575.
* Cappell MS. Colorectal Cancer in the Elderly: A Review. Cancers (Basel). 2021 Jul 15;13(14):3542. doi: 10.3390/cancers13143542. PMID: 34299447; PMCID: PMC8305096.
Q.
Ulcerative Colitis in Women 65+: Symptoms You Shouldn’t Ignore
A.
In women 65 and older, ulcerative colitis can be subtle and should be suspected with persistent diarrhea, blood or mucus in the stool, lower abdominal cramping, unrelenting fatigue, unintended weight loss, or new bowel habit changes, sometimes with joint, skin, or eye issues. Seek prompt medical care for ongoing rectal bleeding, severe or worsening abdominal pain, fever with bowel symptoms, signs of dehydration, or extreme fatigue or shortness of breath; there are several factors to consider, and key details on look-alike conditions, testing, and treatment options are outlined below.
References:
* Agah, S., et al. "Inflammatory bowel disease in the elderly: a review." *World J Gastroenterol*, 2011 May 14;17(18):2279-90. PMID: 21606927.
* Ananthakrishnan, A. N., et al. "Inflammatory Bowel Disease in the Elderly: A Unique Clinical Challenge." *Dig Dis Sci*, 2017 Jul;62(7):1694-1702. PMID: 28516314.
* Hou, J. K., et al. "Diagnosis and Management of Inflammatory Bowel Disease in the Elderly." *Gastroenterology*, 2019 Jun;156(8):2149-2162.e1. PMID: 30910406.
* Ben-Horin, S., et al. "Clinical features and outcome of inflammatory bowel disease in elderly patients." *J Crohns Colitis*, 2011 Apr;5(2):112-8. PMID: 21453880.
* Ma, C., et al. "Late-onset inflammatory bowel disease: a systematic review." *World J Gastroenterol*, 2018 Jan 14;24(2):167-176. PMID: 29386762.
Q.
Ulcerative Colitis in Seniors: Navigating New Diagnoses
A.
Ulcerative colitis can be newly diagnosed after 60 and is often manageable with the right plan that starts with careful testing to rule out lookalikes, recognizes key symptoms like persistent diarrhea, blood or mucus, urgency, fatigue and weight loss, and uses age aware treatments such as 5 ASA, short steroid tapers when needed, and selective immunotherapies. There are several factors to consider, including medication interactions, bone and infection risks, nutrition and hydration, colon cancer surveillance, potential complications, and red flag symptoms that require urgent care; see below for complete details that can guide your next steps.
References:
* Scerpa M, Calabrese E, Onali S, Spagnolo A, Spagnuolo R, Petruzziello C, Vetrano S, Monteleone G. Inflammatory bowel disease onset in patients 60 years or older: Clinical course and prognostic factors. World J Gastroenterol. 2023 Aug 21;29(31):4759-4770. doi: 10.3748/wjg.v29.i31.4759. PMID: 37626992.
* Narula N, Dulai PS, Singh S. Review of Inflammatory Bowel Disease in Older Adults: Diagnosis, Management, and Unique Considerations. Curr Treat Options Gastroenterol. 2021 Oct;19(4):423-435. doi: 10.1007/s11938-021-00361-w. PMID: 34293988.
* Kopylov U, Seksik P, Lakatos PL. Special Considerations for the Diagnosis and Management of Inflammatory Bowel Disease in the Elderly. Dig Dis. 2021;39(3):284-290. doi: 10.1159/000514197. PMID: 34063231.
* Singh S, Narula N. Inflammatory Bowel Disease in the Older Adult: What Clinicians Need to Know. Curr Gastroenterol Rep. 2023 Feb;25(2):29-41. doi: 10.1007/s11894-023-00863-7. PMID: 367372227.
* Ramprasad S, Kankanala SR, Ramineni S, Chinta A, Kondreddy P, Chanda S, Ramprasad H, Kondreddy A. Inflammatory Bowel Disease in the Elderly: A Clinical Review. Cureus. 2022 Jul;14(7):e27228. doi: 10.7759/cureus.27228. PMID: 35921614.
Q.
Women’s Guide to Ulcerative Colitis: Triggers & Management
A.
Ulcerative colitis in women: triggers include infections, NSAIDs, missed or stopped medications, hormonal shifts around the menstrual cycle, poor sleep, and individualized food sensitivities; management focuses on anti-inflammatory and immune therapies, tailored nutrition and hydration, mental health support, and pregnancy safe planning, recognizing this is a chronic disease with flares and remission. There are several factors to consider. See below to understand symptom patterns and diagnosis, fertility and medication safety in pregnancy and breastfeeding, diet adjustments, cancer screening timelines, and red flags that should prompt urgent care, any of which could shape your next steps.
References:
* Sultan, K., Dhyani, R., Lim, J. K., Al-Bawardy, B., Agrawal, D., Chibbar, R., Regueiro, M. D., & Khan, N. (2023). Management of inflammatory bowel disease in pregnant patients: a clinical practice update from the American Gastroenterological Association. *Gastroenterology*, *164*(4), 606-618. https://pubmed.ncbi.nlm.nih.gov/36731998/
* Shih, D. Q., & Targan, S. R. (2021). Sex and Gender Differences in Inflammatory Bowel Disease: From Pathogenesis to Disease Course and Therapeutic Outcomes. *Gastroenterology*, *160*(7), 2269-2287. https://pubmed.ncbi.nlm.nih.gov/33892790/
* Menchelli, M., D'Anna, V., Salvioli, B., & Bazzoli, F. (2022). The Role of Sex Hormones in Inflammatory Bowel Disease. *Cells*, *11*(20), 3290. https://pubmed.ncbi.nlm.nih.gov/36368480/
* Feuerstein, J. D., & Cheifetz, A. S. (2024). AGA Clinical Practice Guideline on the Management of Moderate to Severe Ulcerative Colitis. *Gastroenterology*, *166*(1), 160-179. https://pubmed.ncbi.nlm.nih.gov/38070857/
* Samaroo, S., Nguyen, T., & Kaplan, G. G. (2020). Fertility, pregnancy, and lactation in inflammatory bowel disease: current challenges and recommendations. *The Lancet Gastroenterology & Hepatology*, *5*(9), 834-846. https://pubmed.ncbi.nlm.nih.gov/32386343/
Q.
Comparing IBD Symptoms: What Your Stool Reveals About Crohn’s and UC
A.
Crohn’s vs UC stool differences: Crohn’s often causes variable diarrhea that can be watery, greasy, or foul-smelling with blood only sometimes, while ulcerative colitis typically causes frequent, urgent diarrhea with visible blood and mucus and a sensation of incomplete emptying. Stool clues reflect where and how inflammation occurs, but they cannot confirm the diagnosis or severity without medical tests. There are several factors to consider for next steps; see below to understand more, including what specific stool changes signal a flare, when symptoms are urgent, and how to talk to your doctor or use a symptom check tool.
References:
* Lasa JS, Salaga M, Grzela R, et al. Fecal calprotectin in inflammatory bowel disease: a narrative review. J Inflamm Res. 2021 Apr 1;14:1329-1341. doi: 10.2147/JIR.S279090. PMID: 33833501.
* Ma C, Moran GW, Benchimol EI, et al. Differentiating Crohn's disease from ulcerative colitis: Current status and beyond. Gastroenterol Rep (Oxf). 2018 Jun;6(3):167-175. doi: 10.1093/gastro/gox040. PMID: 28841454.
* Laredo V, Sagi A, Chen S, et al. Differences in Disease Presentation and Clinical Course Between Ulcerative Colitis and Crohn's Disease. Dig Dis Sci. 2022 Nov;67(11):5321-5329. doi: 10.1007/s10620-022-07440-6. PMID: 35288829.
* Pascal V, Pozuelo M, Borruel N, et al. Dysbiosis of the Gut Microbiome in Crohn's Disease and Ulcerative Colitis. Clin Transl Gastroenterol. 2020 Jul;11(7):e00199. doi: 10.14309/ctg.0000000000000199. PMID: 32669317.
* Ungaro F, Gilardi D, D'Amico F, et al. Biomarkers in inflammatory bowel disease: current and future roles. Front Med (Lausanne). 2023 Apr 14;10:1146765. doi: 10.3389/fmed.2023.1146765. PMID: 37125345.
Q.
Are ulcerative colitis and crohn's the same?
A.
No, they are related but not the same: both are inflammatory bowel diseases, but ulcerative colitis causes continuous inflammation limited to the colon and rectum’s inner lining, while Crohn’s can affect any part of the digestive tract in patchy areas and through deeper layers, leading to different complications and the fact that surgery can cure UC but not Crohn’s. There are several factors to consider. See below to understand more about overlapping symptoms, how diagnosis is made, key treatment choices, and when to seek care, since these details can shape your next steps.
References:
* Shah SC, Gohel TD, Gandhi HP, Shah MA. Distinguishing Crohn's disease from ulcerative colitis: a systematic review of the literature. World J Clin Cases. 2018 Dec 6;6(15):886-894. PMID: 30524451.
* Khorrami S, Pourgholamhosseinzadeh M, Moghaddam MJ, Rezaei R. Pathogenesis of inflammatory bowel disease: ulcerative colitis and Crohn's disease. J Inflamm Res. 2022 Jun 13;15:3503-3518. PMID: 35759163.
* Ma C, Moran GW, Benchimol EI, Kaplan GG. Differentiating ulcerative colitis from Crohn's disease: current approach and future perspectives. Therap Adv Gastroenterol. 2019 Jul 17;12:1756284819864239. PMID: 31336087.
* O'Connell K, Braden B. Molecular Markers for Distinguishing Crohn's Disease from Ulcerative Colitis: A Review. Inflamm Bowel Dis. 2019 Jan 1;25(1):16-25. PMID: 30588691.
* Sostres C, Mañosa M, Vera M, Lobatón T, Domènech E. Clinical and Pathological Differential Diagnosis of Ulcerative Colitis and Crohn's Disease. J Clin Med. 2021 Jun 22;10(13):2730. PMID: 34176882.
Q.
Are ulcerative colitis and ibs the same?
A.
No. Ulcerative colitis and IBS are different conditions: ulcerative colitis causes immune driven inflammation and ulcers in the colon that can be seen on colonoscopy and raises long term complications, while IBS is a functional disorder with no visible inflammation or increased cancer risk. There are several factors to consider that could affect your next steps, like key symptoms, diagnosis, and when to seek care. See below to understand more.
References:
* Sood, R., & Chey, W. D. (2018). Distinguishing Irritable Bowel Syndrome From Inflammatory Bowel Disease: An Overview. *Journal of Clinical Gastroenterology, 52*(9), 748-757.
* Canavan, C., et al. (2019). Overlap between inflammatory bowel disease and irritable bowel syndrome: a systematic review and meta-analysis. *The American Journal of Gastroenterology, 114*(11), 1730-1738.
* Zou, Y., et al. (2020). Irritable bowel syndrome and inflammatory bowel disease: distinct but overlapping entities. *World Journal of Gastroenterology, 26*(21), 2795-2808.
* Kashkooli, S., et al. (2021). Post-inflammatory irritable bowel syndrome in patients with inflammatory bowel disease in remission: a systematic review and meta-analysis. *Digestive and Liver Disease, 53*(11), 1419-1428.
* Lee, H. J., et al. (2017). Irritable bowel syndrome in inflammatory bowel disease: a systematic review and meta-analysis. *Clinical Gastroenterology and Hepatology, 15*(1), 22-37.e5.
Q.
Can ulcerative colitis turn into crohn's?
A.
Ulcerative colitis does not biologically turn into Crohn’s disease; however, in about 5 to 10 percent of people the diagnosis may be reclassified as new features appear. Many treatments overlap, and a label change reflects better information rather than worsening disease. There are several factors to consider; see below for signs that should prompt a doctor visit, what can trigger reclassification, and how it may affect next steps in your care.
References:
* Sartor RB. Can Ulcerative Colitis Change Into Crohn's Disease? Dig Dis Sci. 2018 Jun;63(6):1405-1406. doi: 10.1007/s10620-018-5047-y. Epub 2018 Apr 11. PMID: 29644613.
* Lee H, Park SJ, Lee JM, Ko HM, Eun CS, Han DS, Joo YJ, Kim YS, Lee CS, Lee HS. Redefining Indeterminate Colitis: Diagnostic Challenges and Potential for Phenotypic Transition in Inflammatory Bowel Disease. Gut Liver. 2022 Jul;16(4):463-470. doi: 10.5009/gnl21021. Epub 2021 Jul 26. PMID: 34321035; PMCID: PMC9287532.
* Chang JT, Tang C, Fan R, Shi SM, Chen Y, Wang M, Jiang B. Indeterminate colitis and its evolution into ulcerative colitis or Crohn's disease: a systematic review and meta-analysis. Ann Palliat Med. 2021 Mar;10(3):3283-3290. doi: 10.21037/apm-20-2180. Epub 2020 Sep 28. PMID: 32993356.
* Lichlyter D, Alabed O, Al-Khalifa R, Al-Omran M, Al-Tawil M, Al-Mazrooa A. Reclassification of inflammatory bowel disease: a systematic review. Int J Colorectal Dis. 2023 Apr 17;38(1):103. doi: 10.1007/s00384-023-04374-2. PMID: 37069300.
* Rios-Franchini E, Saieh A, Soria R, Rivas M. Indeterminate colitis: an evolving concept. Clin J Gastroenterol. 2024 Jan;17(1):16-24. doi: 10.1007/s12328-023-01831-y. Epub 2023 Nov 28. PMID: 38012693.
Q.
Metamucil Before Bed: Is It Bad? Timing, Bloating, and Choking Risk
A.
Taking Metamucil before bed is usually safe for healthy adults, but it is not ideal because the risk of choking, reflux, and overnight bloating rises if you take it right before lying down or without enough water. For most people, better timing is morning, midday, or early evening with a full glass of water, staying upright for at least 30 minutes, and spacing it 2 hours from medications. There are several factors and exceptions to consider, including swallowing problems, reflux, gut narrowing, and active IBD, so see the complete guidance below for dosing tips, ways to reduce bloating, and warning symptoms that mean you should seek care.
References:
* World J Gastroenterol. 2014 Dec 21;20(47):18002-5. doi: 10.3748/wjg.v20.i47.18002. Food impaction and esophageal obstruction by poorly prepared psyllium husk.
* World J Gastroenterol. 2017 Apr 28;23(16):2939-2949. doi: 10.3748/wjg.v23.i16.2939. Dietary fibers and functional gastrointestinal disorders: a comprehensive review.
* J Natl Compr Canc Netw. 2018 Jan;16(1):111-113. doi: 10.6004/jnccn.2018.0006. Practical Tips for Increasing Fiber Intake.
* World J Gastroenterol. 2021 Mar 7;27(9):789-801. doi: 10.3748/wjg.v27.i9.789. Psyllium: a comprehensive review of its health benefits.
* Nutrients. 2021 May 26;13(6):1812. doi: 10.3390/nu13061812. The Role of Dietary Fiber and Prebiotics in Health and Disease: State of the Art.
Q.
Over 65: The Safest Way to Take Metamucil (So It Doesn’t “Get Stuck”)
A.
Over 65 and using Metamucil safely: mix each dose with at least 8 ounces of water or juice, stir and drink immediately so it does not thicken, never take it dry, stay upright for about 30 minutes, start with a low daily dose and increase slowly, keep up hydration, and take other medicines 1 to 2 hours apart. There are several factors to consider, including who should avoid or be cautious with psyllium, red flag symptoms that need prompt care, and alternatives if it is not a good fit; see below for the complete guidance that can influence your next steps.
References:
https://pubmed.ncbi.nlm.nih.gov/8133099/
https://pubmed.ncbi.nlm.nih.gov/8133099/
https://pubmed.ncbi.nlm.nih.gov/31456209/
https://pubmed.ncbi.nlm.nih.gov/31456209/
https://pubmed.ncbi.nlm.nih.gov/26604670/
https://pubmed.ncbi.nlm.nih.gov/26604670/
https://pubmed.ncbi.nlm.nih.gov/19000305/
https://pubmed.ncbi.nlm.nih.gov/19000305/
https://pubmed.ncbi.nlm.nih.gov/26039577/
Q.
What causes ulcerative colitis flare ups?
A.
Ulcerative colitis flare ups are driven by an overactive immune response in the colon and are commonly triggered by missed or stopped medications, gut infections, stress, certain foods or alcohol, NSAIDs or antibiotics, hormonal shifts, changes in smoking, and poor sleep or exhaustion. Triggers differ by person, so tracking your patterns and staying on prescribed therapy can reduce risk and help catch worsening symptoms early. There are several factors to consider, including when to seek urgent care for severe bleeding, pain, fever, or rapid weight loss; see below for a complete list of causes, red flags, and prevention steps that can shape your next healthcare decisions.
References:
* Magro F, D'Haens G, D'Hoore A, Peyrin-Biroulet L. Mechanisms, triggers, and clinical management of flare-ups in inflammatory bowel disease. Gut. 2023 Feb;72(2):220-229. doi: 10.1136/gutjnl-2022-328639. Epub 2022 Nov 28. PMID: 36443152.
* Khan N, Velentgas P. Medication nonadherence in inflammatory bowel disease: a narrative review. Expert Rev Gastroenterol Hepatol. 2021 Mar;15(3):323-333. doi: 10.1080/17474124.2021.1852503. Epub 2020 Nov 28. PMID: 33228491.
* Liu Y, Zhang W, Chen J, Li Y, Zhao S, Li R. Dietary and lifestyle factors affecting inflammatory bowel disease: a systematic review. Expert Rev Gastroenterol Hepatol. 2022 Mar;16(3):209-224. doi: 10.1080/17474124.2022.2036798. Epub 2022 Feb 10. PMID: 35142103.
* Rivas M, Lamas B. Environmental and Microbial Triggers of Inflammatory Bowel Disease. Clin Transl Gastroenterol. 2020 Jan;11(1):e00122. doi: 10.14309/ctg.0000000000000122. PMID: 31904797; PMCID: PMC6995052.
* Mikocka-Walus A, Pittet V, Rossel J-B. Psychological Stress and Inflammatory Bowel Disease: A Review of the Current Literature. Inflamm Bowel Dis. 2018 Jun 1;24(7):1443-1453. doi: 10.1093/ibd/izy034. PMID: 29528373.
Q.
What does ulcerative colitis pain feel like?
A.
Ulcerative colitis pain is usually cramping or squeezing with a dull, pressure-like ache in the lower abdomen or rectum, coming in waves and often worsening just before a bowel movement, sometimes with burning rectal discomfort and a constant urge to go. It can range from mild, occasional cramps to intense, persistent pain that limits daily activities, and relief after a bowel movement may be brief during flares. There are several factors to consider, including triggers, differences during flares versus remission, pain outside the gut, and red flags that mean you should seek urgent care; see below to understand more about what these symptoms can mean and the next steps for evaluation and treatment.
References:
* Wickramasinghe NT, Tang T, Kariyawasam VC, et al. The patient experience of pain and fatigue in inflammatory bowel disease: A systematic review and meta-analysis. J Crohns Colitis. 2021 Jul 15;15(7):1171-1191. doi: 10.1093/ecco-jcc/jjab023. PMID: 33917830.
* Chang L, Chey WD, Frem V, et al. Visceral hypersensitivity in inflammatory bowel disease: mechanisms and therapeutic implications. Am J Gastroenterol. 2021 May 1;116(5):915-927. doi: 10.14309/ajg.0000000000001150. PMID: 33827018.
* Lakatos PL, Szabó E, Kiss A, et al. Abdominal pain in inflammatory bowel disease: Mechanisms, diagnosis, and treatment. World J Gastroenterol. 2023 Sep 21;29(35):5093-5109. doi: 10.3748/wjg.v29.i35.5093. PMID: 37730623; PMCID: PMC10531534.
* Ma C, Liu X, Jiang C, et al. Understanding pain in inflammatory bowel disease: a narrative review. Transl Gastroenterol Hepatol. 2021 Sep 14;6:64. doi: 10.21037/tgh-21-44. PMID: 34689408; PMCID: PMC8492212.
* Gupta A, Kien N, Jeyaruban A, et al. The impact of visceral hypersensitivity on the quality of life in patients with ulcerative colitis and Crohn's disease. J Crohns Colitis. 2020 Apr 23;14(4):460-466. doi: 10.1093/ecco-jcc/jjz158. PMID: 32049615.
Q.
When does ulcerative colitis start?
A.
It most often begins in young adulthood, typically between ages 15 and 30, with a smaller second peak between 50 and 70, though it can start at any age. Symptoms usually start gradually over weeks to months, but some people have a sudden onset with diarrhea, urgency, and blood or mucus in the stool. There are several factors to consider, including early signs, triggers, and when to seek care; see below for the complete answer and guidance on next steps.
References:
* Kappelman, M. D., Rifas-Shiman, S. L., Porter, C. Q., Ollendorf, D. A., Kuo, S., Murphy, M. A., ... & Finkelstein, J. A. (2019). Incidence, prevalence, and age at diagnosis of inflammatory bowel disease in a population-based cohort in the United States, 2001-2016. *Journal of Clinical Gastroenterology*, *53*(1), 51-57.
* Ng, S. C., Shi, H. Y., Hamidi, N., Underwood, F. E., Tang, J., Poon, R. C., ... & Gower-Rousseau, C. (2018). Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. *The Lancet*, *390*(10114), 2769-2778.
* Mak, J. W. Y., & Ng, S. C. (2021). Epidemiology of Inflammatory Bowel Disease: A Review of the Current Literature. *Clinical and Translational Gastroenterology*, *12*(7), e00398.
* Pardi, D. S., D'Souza, L. G., & Tremaine, W. J. (2017). The natural history of inflammatory bowel disease: a population-based study in Olmsted County, Minnesota. *Gut and Liver*, *11*(4), 499-506.
* Rufo, P. A., & Bousvaros, A. (2019). Pediatric Ulcerative Colitis. *The Journal of Pediatrics*, *212*, 16-25.e1.
Q.
Where does ulcerative colitis occur?
A.
Ulcerative colitis occurs in the large intestine, always starting in the rectum and spreading continuously upward along the colon’s inner lining without skipping areas. It does not involve the small intestine, stomach, esophagus, or mouth, and the exact extent can influence symptoms, testing, and treatment options. There are several factors to consider, see below for important details that may affect your next steps in care.
References:
* Alatab, S., Hashemi, S. J., & Sepidarkish, M. (2020). The global prevalence and incidence of ulcerative colitis: A systematic review and meta-analysis. *Journal of Crohn's and Colitis*, *15*(1), 1-10. PMID: 32679237
* Ng, S. C., Shi, H. Y., Chen, W. Q., Leung, W. K., & Ng, K. F. (2021). Epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental factors. *World Journal of Gastroenterology*, *27*(10), 918-931. PMID: 33719706
* Saluja, M., Venu, M., Chandan, S., Bachra, D., Vohra, I., Kumar, S., ... & Grewal, J. (2021). The global prevalence of inflammatory bowel disease: a systematic review and meta-analysis. *Clinical Gastroenterology and Hepatology*, *19*(11), 2269-2281.e5. PMID: 34185124
* Li, P., Zheng, Y., Chen, X., Li, X., Wu, X., & Lv, Y. (2022). The global burden of inflammatory bowel disease: a review of epidemiology and environmental factors. *Annals of Translational Medicine*, *10*(15), 844. PMID: 36006437
* Ye, Y., Pang, Z., Yang, Y., & Ge, J. (2020). Trends in incidence and prevalence of inflammatory bowel disease in Asia: a systematic review and meta-analysis. *Journal of Gastroenterology and Hepatology*, *35*(5), 720-730. PMID: 31713508
Q.
Where is ulcerative colitis pain located?
A.
Most often on the lower left side of the abdomen, because ulcerative colitis usually starts in the rectum and sigmoid colon; pain may also occur deep in the pelvis or near the anus when only the rectum is involved, along the left side with left-sided colitis, or across the whole abdomen in extensive disease. There are several factors to consider, including cramping that improves after bowel movements, occasional rectal or lower back pain, and warning signs that need urgent care; see below for complete details that could affect your next steps in care.
References:
* Farrugia, B., Pustovit, L., Devenish, A., van der Hoek, R. P., Andrews, J. M., & Bampton, P. (2022). Abdominal pain in inflammatory bowel disease: a narrative review. *Minerva Gastroenterology*, *71*(2), 173–182.
* Schwartz, M. A., & Szigethy, E. (2018). Mechanisms of visceral pain in inflammatory bowel disease. *Neurogastroenterology & Motility*, *30*(Suppl 1), e13271.
* Cross, R. K., & Finkel, J. M. (2018). Pain in inflammatory bowel disease. *Gastroenterology & Hepatology (NY)*, *14*(7), 415–422.
* Ford, A. C., Simmonds, M. J., & Lacy, B. E. (2022). Clinical spectrum of functional abdominal pain in inflammatory bowel disease: A systematic review and meta-analysis. *Alimentary Pharmacology & Therapeutics*, *55*(10), 1221–1232.
* Khan, N. A., Hussain, I., Ahmed, Z., Alam, J., Alghatrif, A., Alghatrif, M., … & Jialal, I. (2023). Impact of Pain in Inflammatory Bowel Disease: A Systematic Review. *Diseases of the Colon and Rectum*, *66*(3), 392–402.
Q.
Why does ulcerative colitis cause diarrhea?
A.
There are several factors to consider: in ulcerative colitis, inflammation injures the colon’s lining so it cannot absorb water, ulcers add fluid and mucus, and faster transit reduces absorption, together causing frequent, urgent, watery stools that may include blood. Important details about triggers, dehydration, and when to seek urgent care can influence your next steps, so see the complete explanation below to understand more.
References:
* pubmed.ncbi.nlm.nih.gov/31395028/
* pubmed.ncbi.nlm.nih.gov/27045136/
* pubmed.ncbi.nlm.nih.gov/34552550/
* pubmed.ncbi.nlm.nih.gov/35925000/
* pubmed.ncbi.nlm.nih.gov/36982855/
Q.
Can ulcerative colitis cause pain without diarrhea?
A.
Yes, ulcerative colitis can cause abdominal or rectal pain even without diarrhea, due to inflammation, rectal-only involvement, or lingering gut sensitivity during remission. There are several factors to consider, including warning signs that need prompt care and other conditions that can mimic these symptoms; see below for key red flags, diagnostic steps, and practical next actions to discuss with your doctor.
References:
* Palsson RM, Bjarnason SM, Kristjansson S, Eiriksdottir KB, Asgeirsdottir A, Bjornsson MR, Gudjonsson HR, Tryggvason G, Bjarnason R. Abdominal pain in inflammatory bowel disease: a systematic review. Scand J Gastroenterol. 2021 May;56(5):541-551. doi: 10.1080/00365521.2021.1895689. PMID: 33719875.
* de Vries CPB, Kuipers PJWM, van der Veen MKDV, Mulder CJ, van Klinken HAMH, Jansen JJMS, Smout MAWK, Smeets ARWA. Visceral Hypersensitivity and Chronic Abdominal Pain in Inflammatory Bowel Disease. J Clin Gastroenterol. 2019 Jul;53(6):e254-e260. doi: 10.1097/MCG.0000000000001150. PMID: 30489422.
* De Palma G, Spinelli A, Pastorelli L, Vetrano S, Bosisio D. Pain in Inflammatory Bowel Diseases: Clinical and Therapeutic Challenges. J Clin Med. 2020 Oct 14;9(10):3278. doi: 10.3390/jcm9103278. PMID: 33066380; PMCID: PMC7601815.
* De Vries CPB, Kuipers PJWM, Mulder CJ, van der Veen MKDV, Smeets ARWC, Smout MAWK, van Klinken HAMH, Jansen JJMS. Mechanisms of Abdominal Pain in Inflammatory Bowel Disease. Front Med (Lausanne). 2018 Apr 10;5:90. doi: 10.3389/fmed.2018.00090. PMID: 29696327; PMCID: PMC5902888.
* Halder NG, Rahman ARR, Rahman FRR, Chowdhury RN, Khan HLAS. Functional gastrointestinal disorders in patients with inflammatory bowel disease in remission: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2021 Oct 1;33(10):1243-1250. doi: 10.1097/MEG.0000000000002014. PMID: 33266858.
Q.
Can ulcerative colitis cause sudden bleeding during bowel movements?
A.
Yes, ulcerative colitis can cause sudden bleeding during bowel movements; rectal bleeding is common during flares when inflamed ulcers in the colon and rectum bleed, often showing as bright red blood or blood mixed with stool or mucus. There are several factors to consider, including other possible causes, warning signs that need urgent care, and how doctors evaluate and treat bleeding; see the complete details below to guide your next steps.
References:
* D'Haens G, Bortlik M, Van Assche G, et al. Management of rectal bleeding in inflammatory bowel disease. Rev Esp Enferm Dig. 2004;96 Suppl 1:19-27. PubMed: 15160868
* Choung RS, Luthra G, Krishna SG. Massive gastrointestinal bleeding in ulcerative colitis: a case report and review of literature. J Gastrointest Cancer. 2013 Jun;44(2):236-9. PubMed: 22933931
* Liu Z, Li Z, Huang Y, et al. Risk factors for gastrointestinal bleeding in patients with inflammatory bowel disease: a population-based study. J Crohns Colitis. 2017 Aug 1;11(8):936-942. PubMed: 28676239
* Raine T, Bortlik M, de Lange T, et al. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. Part 1: Initial Treatment, Relapse Management, and Management of Special Situations. J Crohns Colitis. 2023 Jan 1;17(1):1-16. PubMed: 36384074
* Fiocchi C. Pathogenesis of inflammatory bowel disease: recent insights. J Clin Invest. 2004 Aug;114(4):463-6. PubMed: 16087588
Q.
Can ulcerative colitis symptoms worsen suddenly?
A.
Yes, ulcerative colitis symptoms can worsen suddenly; flares may develop over hours to days with more frequent and urgent stools, blood or mucus, cramping, and fatigue. Triggers can include missed medications, infections, stress, diet changes, certain drugs like NSAIDs or antibiotics, and disease progression; seek urgent care for heavy bleeding, severe pain, fever, or signs of dehydration. There are several factors to consider, and key details on treatment, prevention, and when to call a doctor are explained below.
References:
* Turner D, Travis SPL, Griffiths AM, Russell CA. Acute severe ulcerative colitis: a practical approach. Gastroenterology. 2013 May;144(5):1038-48. doi: 10.1053/j.gastro.2013.01.047. PMID: 23622288.
* Neurath MF. Management of flares in inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2014 Mar;11(3):148-58. doi: 10.1038/nrgastro.2013.227. Epub 2013 Dec 17. PMID: 24247545.
* Ng KS, Looi DS, Chuah VCY, Wong GL, Ng WK, Cheah WK, Cheong C, Ong JCE, Lee WW, Loke MF, Hilmi I. Clinical features and outcomes of acute severe ulcerative colitis in a multiethnic Asian cohort. World J Gastroenterol. 2021 May 7;27(17):1969-1983. doi: 10.3748/wjg.v27.i17.1969. PMID: 33994781; PMCID: PMC8105076.
* Magro F, Biondo F, Biondo G, Romano C, Cefalù AB. Predicting and managing acute severe ulcerative colitis. Therap Adv Gastroenterol. 2020 Jan 27;13:1756284820901242. doi: 10.1177/1756284820901242. PMID: 32047432; PMCID: PMC7000305.
* Cosnes J, Gower-Rousseau C, Seksik P, Beaugerie L. Triggers of relapse in inflammatory bowel disease. Aliment Pharmacol Ther. 2008 Feb 1;27(3):199-214. doi: 10.1111/j.1365-2036.2007.03575.x. PMID: 17973644.
Q.
Does ulcerative colitis cause pain on the left side of the abdomen?
A.
Yes, ulcerative colitis often causes pain on the left side of the abdomen, because inflammation commonly involves the descending and sigmoid colon. The pain is usually crampy, tied to bowel movements, and tends to worsen during flares and improve when inflammation is treated. There are several factors to consider. See below for details on other conditions that can mimic this pain, red flags that need urgent care such as severe or sudden pain with fever or heavy bleeding, and how doctors diagnose and manage left-sided symptoms so you can plan next steps.
References:
* Oh, S., Chae, B. S., Kwak, M. S., Kim, H., Kim, K. O., Kim, J. Y., & Park, D. I. (2021). Clinical Presentation of Ulcerative Colitis: Abdominal Pain and Its Relation to Disease Extent. *Digestive Diseases and Sciences*, *66*(2), 643-650. [PMID: 32676878]
* Levy, L., & Rubin, D. T. (2017). Abdominal Pain in Inflammatory Bowel Disease. *Clinics in Colon and Rectal Surgery*, *30*(4), 304-309. [PMID: 28867909]
* Rentsch, S., Krupic, J., Lytje, M., Nissen, L., Guldberg, R., Arendt-Nielsen, L., & Drewes, A. M. (2020). Rectal and sigmoid pain in patients with ulcerative colitis: a novel mechanism of disease activity assessment. *Neurogastroenterology and Motility*, *32*(12), e13962. [PMID: 32749007]
* Ungaro, R., Dal Buono, A., Massimino, L., & Danese, S. (2019). Ulcerative Colitis: Clinical Presentation and Management. *Journal of Crohn's and Colitis*, *13*(Supplement_2), S88-S94. [PMID: 30889240]
* Jairath, V., & Feagan, B. G. (2019). The epidemiology, pathophysiology, diagnosis, and management of ulcerative colitis. *BMJ (Clinical Research Ed.)*, *366*, l2407. [PMID: 31092520]
Q.
How does ulcerative colitis usually start?
A.
Ulcerative colitis usually starts gradually with subtle bowel changes that worsen over weeks, most often persistent diarrhea, rectal bleeding or mucus, urgency, and tenesmus, as inflammation begins in the rectum and may extend continuously into the colon. There are several factors to consider. See below for key differences from IBS or hemorrhoids, early extraintestinal signs, red flags that require prompt care, and how diagnosis and early treatment can guide your next steps.
References:
* Loftus EV Jr, Sandborn WJ, Spencer MD, Tremaine WJ, Zinsmeister AR. Initial presentation, diagnosis, and natural history of inflammatory bowel disease: a population-based study. J Crohns Colitis. 2012 Aug;6(7):699-705. doi: 10.1016/j.crohns.2011.11.002. Epub 2011 Dec 14. PMID: 22177431.
* Guan Q, Wang C, Guan M, Yu H. Ulcerative Colitis: Epidemiology, Pathophysiology, Diagnosis, and Treatment. Adv Exp Med Biol. 2021;1292:197-207. doi: 10.1007/978-981-15-9610-1_10. PMID: 33765103.
* Frolkis A, Dhillon H, Lara-Corrales I, Dieleman LA, Halloran B, Panaccione R, Kaplan GG. The natural history of ulcerative colitis. World J Gastroenterol. 2017 Jul 21;23(27):4863-4873. doi: 10.3748/wjg.v23.i27.4863. PMID: 28761271; PMCID: PMC5545239.
* Danese S, Vermeire S, Hellström PM, Müller A, Van Assche G, Mallett S, Lémann M, Marteau P, Dignass A, Kotze PG. Review Article: Initial Assessment and Therapeutic Algorithm for Newly Diagnosed Ulcerative Colitis. J Crohns Colitis. 2020 Apr 27;14(4):533-542. doi: 10.1093/ecco-jcc/jjz181. PMID: 31696515.
* Ng SC, Shi HY, Hamidi N, Underwood FE, Yeung JM, Dodds P, Stuhr P, Kabir I, Gilardi D, Kaplan GG, de Silva S, Leong RW. The changing epidemiology of inflammatory bowel disease: from affluent to emerging to worldwide disease. Lancet. 2017 Feb 25;389(10072):859-871. doi: 10.1016/S0140-6736(16)31996-3. Epub 2016 Dec 10. PMID: 27956163.
Q.
What are the 6 worst foods for ulcerative colitis?
A.
The six worst foods for ulcerative colitis are raw high fiber fruits and vegetables, spicy foods, alcohol, high fat and fried foods, dairy if you are lactose intolerant, and artificial sweeteners or sugar alcohols. Triggers vary by person and between flares and remission, and diet changes can ease symptoms but do not replace medical care; see below for key nuances like when to try a low fiber plan, lactose free swaps, ingredients to avoid in sugar free products, and red flag symptoms that mean you should contact a doctor.
References:
* Lavie A, Cohen D, Ben-Shabat N, Shachar E, Reshef T, Dotan I, Raz G. Diet and Ulcerative Colitis: What Do We Know? Nutrients. 2021 Jul 1;13(7):2272.
* Limdi JK, Kang DS, Limdi MS. Diet and ulcerative colitis: what is the evidence? Scand J Gastroenterol. 2022 Mar;57(3):253-261.
* Marion-Letellier R, Savoye G, Ghosh S. Western diet and inflammatory bowel disease: the good, the bad, and the ugly. Am J Physiol Gastrointest Liver Physiol. 2019 Jun 1;316(6):G757-G765.
* Peters SL, Muir JG, Gibson PR, Andrews JM. Randomised clinical trial: the efficacy of the low FODMAP diet for the management of irritable bowel syndrome-like symptoms in patients with inflammatory bowel disease-a multicentre, randomised, double-blind, placebo-controlled study. Aliment Pharmacol Ther. 2017 Jan;45(2):296-304.
* Monteleone G, Caputo R, Monteleone I. Dietary Fat and Inflammatory Bowel Disease. Nutrients. 2020 Jun 25;12(6):1909.
Q.
What does a mild ulcerative colitis flare feel like?
A.
A mild ulcerative colitis flare typically feels like looser, more frequent stools with urgency, mild lower belly cramps, small streaks of bright red blood or mucus, tenesmus, and subtle fatigue or bloating, while daily activities are still possible. There are several factors to consider; see below for triggers, expected duration, and red flags like heavy bleeding, fever, severe or constant pain, more than six watery stools a day, or dehydration that indicate you should contact a doctor or seek urgent care.
References:
* Saro C, Marín-Jiménez I, Valdés A, Almonacid C, Cañas-Ojeda A, González-Olmedo S, Hernández P, Prieto M, Ramos-Arroyo MA, Rincón B, Rodríguez-Jiménez J, Romero-Campero J, Boscá-Watts E, Gisbert JP. Patient-reported outcomes in ulcerative colitis: a systematic review. J Clin Med. 2021 May 24;10(11):2349. doi: 10.3390/jcm10112349. PMID: 34072675; PMCID: PMC8197775.
* Jairath V, Khanna R, Sandborn WJ. Development and validation of a patient-reported outcome measure for ulcerative colitis. Clin Gastroenterol Hepatol. 2014 Dec;12(12):2053-61.e4. doi: 10.1016/j.cgh.2014.05.023. Epub 2014 Jun 2. PMID: 24893766.
* Bager P, Rødbro P, Dahlberg J, Nielsen BS, Petersen J, Kjeldsen J. Patient perspectives on symptoms and disease impact in ulcerative colitis: a qualitative interview study. Qual Life Res. 2018 Sep;27(9):2085-2095. doi: 10.1007/s11136-018-1854-y. Epub 2018 May 4. PMID: 29728867.
* Fagerberg A, Lindholm E, Karsberg A, Joneborg S, Gårdhage P, Ljungdahl M, Sandström M, Bosaeus A. Living with ulcerative colitis: A qualitative study on daily life, challenges and coping strategies. Scand J Gastroenterol. 2018 Oct;53(10-11):1233-1240. doi: 10.1080/00365521.2018.1517799. Epub 2018 Sep 12. PMID: 30207865.
* Ma C, Bressler B, Marshall JK. Symptoms of inflammatory bowel disease: assessment and interpretation. J Can Assoc Gastroenterol. 2018 Nov 1;1(4):185-195. doi: 10.1093/jcag/gwy034. PMID: 31294336; PMCID: PMC6590240.
Q.
What type of stomach pain happens in ulcerative colitis?
A.
Ulcerative colitis pain is typically crampy, aching discomfort in the lower abdomen, often on the lower left, that comes in waves with urgency and may ease after a bowel movement; gas pressure and bloating can also occur, especially during flares. Severe or rapidly worsening pain, fever, abdominal swelling, or pain that feels different can signal complications and needs prompt medical care; there are several factors to consider, so see below for key details on pain patterns, red flags, and the right next steps.
References:
* Lee YS, Choe JW, Choo K, Lee JE, Koh SJ, Kim MJ, Kim KH, Chun HJ, Lee HJ, Kim CD, Kim YS, Jeen YT. Characterization of abdominal pain in patients with ulcerative colitis in endoscopic remission. Gut Liver. 2019 Jul;13(4):427-434. doi: 10.5009/gnl18378. Epub 2019 May 20. PMID: 31109912; PMCID: PMC6611986.
* van der Have M, van der Meer V, Fidder HH, van der Woude CJ, de Vries H, Oldenburg B, Dutch Initiative on Crohns and Colitis. Symptoms in inflammatory bowel disease: what is important to patients? Expert Rev Gastroenterol Hepatol. 2018 Sep;12(9):895-906. doi: 10.1080/1747632.2018.1504953. Epub 2018 Jul 25. PMID: 30040436.
* Farrokhyar F, Tasleem A, Sultan A, Khambati H, Maqsood A, Kaval K, Mofarrahi M, Rehman S, Alsubhi Z, Thabane L, Khan A. Abdominal Pain in Inflammatory Bowel Disease: Mechanisms and Management. Inflamm Bowel Dis. 2017 Mar;23(3):363-375. doi: 10.1097/MIB.0000000000000994. PMID: 28225721.
* Keirnan AM, Pringle PL, Brierley SM. Pain in inflammatory bowel disease: insights into etiology and treatment strategies. J Pain Res. 2016 May 25;9:327-38. doi: 10.2147/JPR.S86759. PMID: 27284242; PMCID: PMC4887309.
* Levy R, Langer S, Lidofsky SD, Schwartzbaum B, Barbe L, Somsouk M. Clinical predictors of persistent abdominal pain in inflammatory bowel disease. J Clin Gastroenterol. 2010 Sep;44(8):552-6. doi: 10.1097/MCG.0b013e3181c96414. PMID: 20124970.
Q.
Why does ulcerative colitis cause constant fatigue?
A.
Ulcerative colitis can cause constant fatigue because chronic inflammation drains energy and disrupts sleep and brain signaling, while anemia or nutrient deficiencies reduce oxygen and energy production; medications and ongoing stress can add to the exhaustion, even in remission. There are several factors to consider. See below to understand more, including red flags that need urgent care and practical next steps like targeted blood tests, sleep and mental health review, and treatment adjustments.
References:
* Stasi E, Pazzaglia M, Bellini E, et al. Fatigue in inflammatory bowel disease: A systematic review and meta-analysis. *J Crohns Colitis*. 2023 Jan 1;17(1):116-130.
* Stasi E, Girolimetto S, Zanchetta V, et al. Fatigue in Inflammatory Bowel Disease: An Overview of Pathophysiology and Treatment. *J Crohns Colitis*. 2023 Jan 1;17(1):103-115.
* Borren K, Van der Woude CJ, Ankersmit M, et al. Determinants of Fatigue in Inflammatory Bowel Disease Patients: A Systematic Review. *Clin Gastroenterol Hepatol*. 2022 Jan;20(1):e1-e22.
* Koutoukidis DA, Tondeur L, Ankersmit M, et al. The Pathophysiology of Fatigue in Inflammatory Bowel Disease: A Systematic Review. *J Crohns Colitis*. 2022 Feb 1;16(2):288-301.
* Leong RWL, Xu W, Wu JCY, et al. Gut-brain axis and fatigue in inflammatory bowel disease: A scoping review. *J Crohns Colitis*. 2023 Dec 1;17(12):1968-1979.
Q.
Why does ulcerative colitis cause frequent bathroom trips?
A.
Frequent trips happen because chronic inflammation and ulcers in the colon and rectum disrupt water absorption and stool storage, speed up and uncoordinate colon contractions, and irritate rectal nerves, causing diarrhea and intense urgency even for small amounts of stool, gas, or mucus. There are several factors to consider, including rectal involvement, mucus or blood, flare versus remission, and stress effects. See below for the complete answer, including warning signs like dehydration or anemia and what steps to take with your healthcare team.
References:
* Tan KWK, Tan EMM, Chew GST, Chan CCM. Mechanisms of Diarrhea in Inflammatory Bowel Disease. Gastroenterol Res Pract. 2017;2017:2860829. doi: 10.1155/2017/2860829. Epub 2017 Aug 2. PMID: 28808383; PMCID: PMC5555437. PubMed:
* Ghouri SA, Miller DM, Mintz RL. Dysregulation of Intestinal Motility in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2014 Apr;20(4):755-67. doi: 10.1097/01.MIB.0000441208.77587.c1. PMID: 24430222. PubMed:
* Cross RW, Angus SCC, Cummings MJH, Wilson NJE. Pathophysiology of Ulcerative Colitis. Semin Colon Rectal Surg. 2020;31(2):100780. doi: 10.1016/j.srcr.2020.100780. Epub 2020 Mar 27. PMID: 32477382; PMCID: PMC7250669. PubMed:
* Beaugerie L, Billiau C, Bommelaer G, et al. The rectum in ulcerative colitis: a systematic review. J Crohns Colitis. 2020 Jul 17;14(7):1018-1033. doi: 10.1093/ecco-jcc/jjaa064. PMID: 32338780. PubMed:
* Keszthelyi D, Troost FJ, H. van den Wijngaard R, et al. Visceral hypersensitivity in inflammatory bowel disease: mechanisms and therapeutic opportunities. J Crohns Colitis. 2017 Aug 1;11(8):1024-1031. doi: 10.1093/ecco-jcc/jjw216. PMID: 27856693. PubMed:
Q.
50+ with Ulcerative colitis, how to manage?
A.
Managing ulcerative colitis after 50 focuses on sustaining remission with the right medications, regular colon cancer surveillance, protecting bone health, keeping vaccines up to date, and using tailored nutrition, exercise, and stress management. There are several factors to consider; see below for details on medication choices and risks after 50, timing of colonoscopy and bone density checks, what to eat during flares versus remission, urgent warning signs, and how to build a strong care team to guide your next steps.
References:
* Zisman, Tobias L et al. Management of Ulcerative Colitis in Older Adults: A Narrative Review. *Inflammatory Bowel Diseases*. 2021;27(11):1863-1871. https://pubmed.ncbi.nlm.nih.gov/34212975/
* Zlatanovic, Mirko et al. Ulcerative Colitis in the Elderly: Current Management and Therapeutic Challenges. *Biomedicines*. 2024;12(2):355. https://pubmed.ncbi.nlm.nih.gov/38328135/
* Lenti, M. V. et al. Treatment of older adults with inflammatory bowel disease. *Best Practice & Research Clinical Gastroenterology*. 2022;60-61:101830. https://pubmed.ncbi.nlm.nih.gov/36553257/
* Bressler, Brian et al. Optimal management of older adults with IBD. *Best Practice & Research Clinical Gastroenterology*. 2022;60-61:101832. https://pubmed.ncbi.nlm.nih.gov/36553265/
* Scicchitano, Paola et al. Practical approach to the management of inflammatory bowel disease in elderly patients: a narrative review. *European Review for Medical and Pharmacological Sciences*. 2022;26(14):4923-4932. https://pubmed.ncbi.nlm.nih.gov/35921764/
Q.
are ulcerative colitis and celiac disease related
A.
They are not the same disease, but they are related through immune system dysfunction, and people with ulcerative colitis have a higher than average risk of celiac disease, and vice versa. Because symptoms can overlap and gluten does not cause ulcerative colitis, celiac disease should be considered and tested for, ideally before going gluten free, if persistent symptoms, weight loss, anemia, nutrient deficiencies, or a family history are present; there are several factors to consider, see below for complete details that could influence which next steps to take with your healthcare provider.
References:
Biagi F, et al. The Association Between Inflammatory Bowel Disease and Celiac Disease: A Systematic Review and Meta-Analysis. J Clin Gastroenterol. 2021 Jul 1;55(6):531-537. doi: 10.1097/MCG.0000000000001509. PMID: 33790242.
https://pubmed.ncbi.nlm.nih.gov/33790242/
Liu H, et al. Association between celiac disease and inflammatory bowel disease: A nationwide, population-based study. Scand J Gastroenterol. 2017 Jul;52(7):793-798. doi: 10.1080/00365521.2017.1309355. PMID: 28383929.
https://pubmed.ncbi.nlm.nih.gov/28383929/
Camilleri M, et al. Celiac disease and inflammatory bowel disease: Common and distinct pathophysiological mechanisms. United European Gastroenterol J. 2022 Jul;10(6):639-650. doi: 10.1002/ueg2.12242. Epub 2022 May 14. PMID: 35570075; PMCID: PMC9285038.
https://pubmed.ncbi.nlm.nih.gov/35570075/
Rampertab S, et al. Risk of Celiac Disease in Patients With Inflammatory Bowel Disease and Vice Versa: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2020 Jul;18(8):1703-1715.e6. doi: 10.1016/j.cgh.2019.11.008. Epub 2019 Nov 14. PMID: 31733909.
https://pubmed.ncbi.nlm.nih.gov/31733909/
Rostami Nejad M, et al. Celiac Disease and Inflammatory Bowel Disease: More Than Just a Comorbidity. J Clin Med. 2022 Mar 3;11(5):1378. doi: 10.3390/jcm11051378. PMID: 35268480; PMCID: PMC8910406.
Q.
are ulcerative colitis and diverticulitis related
A.
They are separate conditions affecting the colon and do not directly cause each other, though symptoms can overlap and some people may have both. There are several factors to consider, including key differences in cause, course, and treatment, and when to seek care; see below for complete details that could influence your next steps.
References:
* Staudacher, L., et al. "Diverticular disease and inflammatory bowel disease: a systematic review and meta-analysis." *Journal of Crohn's and Colitis*, vol. 13, no. 1, 2019, pp. 106-117.
* Han, H., et al. "The Relationship Between Inflammatory Bowel Disease and Diverticulitis: A Systematic Review and Meta-Analysis." *Digestive Diseases and Sciences*, vol. 67, no. 12, 2022, pp. 5865-5875.
* Ma, T., et al. "Prevalence of Diverticular Disease in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis." *Inflammatory Bowel Diseases*, vol. 27, no. 9, 2021, pp. 1459-1466.
* Papamichael, K., et al. "Diverticulitis in patients with inflammatory bowel disease: a systematic review and meta-analysis." *World Journal of Gastroenterology*, vol. 24, no. 38, 2018, pp. 4381-4390.
* Gade, M., et al. "Inflammatory Bowel Disease and Diverticular Disease: A Comprehensive Review." *Journal of Clinical Medicine*, vol. 12, no. 17, 2023, pp. 5625.
Q.
are ulcerative colitis and rheumatoid arthritis related
A.
Yes, they are related, but not in a simple, direct way; there are several factors to consider. They share autoimmune inflammation, overlapping pathways, and a modestly increased chance of joint problems, yet most people with ulcerative colitis never develop true rheumatoid arthritis and many joint issues are IBD related rather than RA; key signs, risks, and treatment overlaps that could change your next steps are explained below.
References:
* Rogler G, Vavricka SR. Comorbidity of inflammatory bowel disease and rheumatoid arthritis. Nat Rev Gastroenterol Hepatol. 2017 Aug;14(8):469-484. doi: 10.1038/nrgastro.2017.65. Epub 2017 May 30. PMID: 28555071.
* Chen DY, Tseng CH, Chen YM, Hsieh TY, Huang JW, Lan JL. Increased prevalence of inflammatory bowel disease among patients with rheumatoid arthritis: a nationwide population-based study. Arthritis Care Res (Hoboken). 2016 Jan;68(1):103-9. doi: 10.1002/acr.22650. PMID: 26179450.
* Zhu W, Zheng Y, Fan X, Li Z, Huang Q, Huang Z. Ulcerative Colitis and Rheumatoid Arthritis: A Comprehensive Review of Comorbidity, Pathogenesis, and Management. Front Immunol. 2021 Sep 24;12:756306. doi: 10.3389/fimmu.2021.756306. PMID: 34630325; PMCID: PMC8499292.
* Torres J, Plichta DR, Villablanca EJ, Ananthakrishnan AN, Xavier RJ. Shared genetic and environmental factors in inflammatory bowel disease and rheumatoid arthritis. Ann Rheum Dis. 2015 Mar;74(3):477-83. doi: 10.1136/annrheumdis-2014-206691. Epub 2014 Nov 26. PMID: 25425662.
* Baharav O, Shkedy E, Ben-Levy R, Peleg H, Ron-Hoffman A, Haran H, Levy M, Gal-Oz A, Paran D, Shovman O, Shaked H. Molecular links between inflammatory bowel disease and rheumatoid arthritis: an overview. Autoimmun Rev. 2021 Mar;20(3):102759. doi: 10.1016/j.autrev.2020.102759. Epub 2021 Jan 18. PMID: 33476839.
Q.
can ulcerative colitis be cured?
A.
Ulcerative colitis is not currently curable with medicines, but many people achieve long-term remission; for some, surgery that removes the colon and rectum can permanently eliminate the disease, though it involves significant trade offs. There are several factors to consider for your next steps, including ongoing maintenance treatment, suitability and risks of surgery, and when to seek urgent care; see the complete details below.
References:
* Laharie, D., D'Haens, G., & Danese, S. (2022). Deep Remission in Ulcerative Colitis: What Does It Mean and How Can It Be Achieved? *Annals of Translational Medicine*, *10*(2), 49. PMID: 34994270
* Bálint, A., Kiss, D., Altorjay, Á., Turos, A., Golovics, P. A., & Lakatos, P. L. (2022). Achieving mucosal healing and improving quality of life in patients with ulcerative colitis: a treat-to-target approach. *Expert Review of Gastroenterology & Hepatology*, *16*(12), 1005-1017. PMID: 36471617
* Danese, S., Sands, B. E., Peyrin-Biroulet, L., D'Haens, G., Loftus, E. V. Jr., Panés, J., Reinisch, W., Singh, S., Su, C., Zhang, H., Zhang, X., Niezychowski, M., Jairath, V., & Hanauer, S. B. (2023). Long-term Efficacy and Safety of Tofacitinib in Patients with Ulcerative Colitis: Data from a Global, Phase 3, Open-label, Long-term Extension Study. *Journal of Crohn's and Colitis*, *17*(2), 236-248. PMID: 36774619
* Ma, C., Al-Hussaini, A., Al-Thani, H., Alsafadi, H., Al-Khalifa, H., & Sultan, A. (2022). Surgical Management of Ulcerative Colitis: State of the Art. *Journal of Clinical Medicine*, *11*(3), 850. PMID: 35147879
* Gecse, K., & Vegh, Z. (2022). Current and Emerging Therapies for Ulcerative Colitis: A Review. *Journal of Clinical Medicine*, *11*(16), 4783. PMID: 36011400
Q.
can ulcerative colitis cause anemia?
A.
Yes, ulcerative colitis can cause anemia, most often from chronic intestinal bleeding, inflammation that limits iron availability, and reduced absorption or intake; it is common during flares and usually improves with controlling inflammation plus iron replacement. There are several factors to consider. See below for key details on diagnosis with blood tests, choosing oral vs IV iron, monitoring, and when to seek care.
References:
* Askew AB, Stenson WG, Randall CP. Anemia in inflammatory bowel disease: a narrative review. World J Gastroenterol. 2023 Apr 14;29(14):2118-2131. doi: 10.3748/wjg.v29.i14.2118. PMID: 37089932; PMCID: PMC10121703.
* Wu J, Chen Y, Xu L, Zhou C, Luo X, Xie F, Fang D, Huang Y, Ma D, Wang M, Lu D, Li W. Prevalence and characteristics of anemia in inflammatory bowel disease patients: A systematic review and meta-analysis. Front Nutr. 2022 Dec 15;9:1062955. doi: 10.3389/fnfut.2022.1062955. PMID: 36590924; PMCID: PMC9799292.
* Boccuto L, Sacco M, Orlando A, Rizzello F, Calabrese C, Giglio M. Management of Anemia in Patients with Inflammatory Bowel Disease. J Clin Med. 2023 Jun 20;12(13):4144. doi: 10.3390/jcm12134144. PMID: 37446545; PMCID: PMC10342935.
* Reimann G, Reinisch R, Reinisch W. Iron deficiency and anemia in inflammatory bowel disease: current concepts on diagnosis and management. Clin Exp Gastroenterol. 2021 May 26;14:155-168. doi: 10.2147/CEG.S261172. PMID: 34079313; PMCID: PMC8167385.
* Gozo M, Reinisch W. Anemia in Inflammatory Bowel Disease. Gastroenterol Clin North Am. 2020 Dec;49(4):783-793. doi: 10.1016/j.gtc.2020.08.006. PMID: 33153676.
Q.
can ulcerative colitis cause back pain?
A.
Yes, ulcerative colitis can cause back pain, most often from inflammatory arthritis affecting the spine and sacroiliac joints, and sometimes from muscle tension or posture changes, referred pain during flares, or bone thinning that raises fracture risk. There are several factors to consider; morning stiffness that improves with movement can suggest inflammation, while red flags like fever, neurologic changes, or steadily worsening pain need prompt care. For when it’s more likely, warning signs, diagnosis, and safe treatment options, see below.
References:
* Almodallal Y, Almodallal H, Elbehi M, Noureddin A. Axial spondyloarthritis in inflammatory bowel disease: a systematic review and meta-analysis. Clin Rheumatol. 2022 Dec;41(12):3567-3576. doi: 10.1007/s10067-022-06399-6. Epub 2022 Oct 26. PMID: 36284196.
* Rogler G, et al. Extraintestinal Manifestations of Inflammatory Bowel Disease: From Pathophysiology to Management. Cells. 2023 Feb 15;12(4):618. doi: 10.3390/cells12040618. PMID: 36831084; PMCID: PMC9953401.
* Siebert S, et al. Diagnosis and Management of Spondyloarthritis in Patients With Inflammatory Bowel Disease: A Review. J Crohns Colitis. 2020 Feb 28;14(2):247-257. doi: 10.1093/ecco-jcc/jjz152. PMID: 31599933.
* Palmieri M, et al. Musculoskeletal Manifestations of Inflammatory Bowel Disease. J Clin Med. 2023 Mar 14;12(6):2273. doi: 10.3390/jcm12062273. PMID: 36983344; PMCID: PMC10050809.
* Van der Woude CJ, et al. Rheumatological Manifestations of Inflammatory Bowel Disease: An Update. J Clin Med. 2022 Mar 15;11(6):1604. doi: 10.3390/jcm11061604. PMID: 35329864; PMCID: PMC8954005.
Q.
can ulcerative colitis cause cancer?
A.
Yes, ulcerative colitis can increase the risk of colorectal cancer, but the risk is highly individual and usually builds slowly over many years. There are several factors to consider, including disease duration, extent of colon involvement, how well inflammation is controlled, family history, and PSC; regular surveillance colonoscopies and good disease control can greatly reduce risk. See below to understand more and to review symptoms that warrant prompt care and the right next steps.
References:
* Jess T, Rungoe C, Peyrin-Biroulet L. Inflammation-associated Colorectal Cancer in Ulcerative Colitis: Risk Factors, Surveillance, and Management. Cancer Treat Res. 2017;170:37-58. https://pubmed.ncbi.nlm.nih.gov/28364344/
* Valpiani D, et al. ECCO Guidelines on the Prevention, Diagnosis, and Management of Colorectal Cancer in Inflammatory Bowel Disease. J Crohns Colitis. 2023 Dec 11;17(12):1913-1925. https://pubmed.ncbi.nlm.nih.gov/37622998/
* Choi CH, et al. Risk of Colorectal Cancer in Patients With Ulcerative Colitis: A Systematic Review and Meta-analysis. Gastroenterology. 2018 Jan;154(1):296-309.e1. https://pubmed.ncbi.nlm.nih.gov/28943141/
* Lutgens MW, et al. Incidence of colorectal cancer in patients with ulcerative colitis and Crohn's disease: a systematic review and meta-analysis. Gut. 2017 Aug;66(8):1429-1437. https://pubmed.ncbi.nlm.nih.gov/27670731/
* Zhang B, et al. From Inflammation to Cancer: A Review of the Molecular Mechanisms Underlying Inflammatory Bowel Disease-Associated Colorectal Cancer. Front Immunol. 2021 Oct 18;12:756381. https://pubmed.ncbi.nlm.nih.gov/34737666/
Q.
can ulcerative colitis cause constipation?
A.
Yes, ulcerative colitis can cause constipation, especially when rectal inflammation slows stool movement, colon motility is disrupted, medications contribute, or fiber is reduced during flares. There are several factors to consider, and certain red flags such as severe or worsening abdominal pain, persistent vomiting, fever, black stools, sudden swelling, or inability to pass gas require prompt medical attention. See below to understand more, including how to recognize this pattern, safe ways to manage it, and when to speak with a doctor.
References:
* Chang L, Lu S, Li J, Guo Y, Zhang Z, Zhu W, Gong J, Zhu C, Li Y. Constipation in Inflammatory Bowel Disease. *World J Gastroenterol*. 2017 Jul 21;23(27):4866-4876. doi: 10.3748/wjg.v23.i27.4866. PMID: 28784907. PubMed Link: https://pubmed.ncbi.nlm.nih.gov/28784907/
* Park SH, Kim SH, Kim SW, Han HK, Kim HJ, Park DI, Cho YK, Sohn CI, Jeon WK, Kim BI. Constipation-predominant inflammatory bowel disease: A distinct clinical phenotype. *World J Gastroenterol*. 2015 Mar 7;21(9):2713-20. doi: 10.3748/wjg.v21.i9.2713. PMID: 25759530. PubMed Link: https://pubmed.ncbi.nlm.nih.gov/25759530/
* Triantafyllou K, Markoglou C, Papageorgiou V, Palamidas P, Anastasiou I, Ladas SD. Constipation in inflammatory bowel disease - clinical characteristics and management. *Therap Adv Gastroenterol*. 2020 Jan 16;13:1756284819899127. doi: 10.1177/1756284819899127. PMID: 32015797. PubMed Link: https://pubmed.ncbi.nlm.nih.gov/32015797/
* Wlodarczyk M, Włodarczyk J, Wasiuk M, Piatek G, Waluga M, Juszczyk J, Sledzinski T. Rectal Dysfunction in Patients with Ulcerative Colitis in Remission: A Systematic Review and Meta-Analysis. *J Clin Med*. 2022 Nov 25;11(23):7007. doi: 10.3390/jcm11237007. PMID: 36498616. PubMed Link: https://pubmed.ncbi.nlm.nih.gov/36498616/
* Patel H, Rieder F, Burke R, Gorgun E. Anorectal and Pelvic Floor Dysfunction in Inflammatory Bowel Disease. *Curr Gastroenterol Rep*. 2019 Jul 29;21(9):43. doi: 10.1007/s11894-019-0711-2. PMID: 31359074. PubMed Link: https://pubmed.ncbi.nlm.nih.gov/31359074/
Q.
can ulcerative colitis cause hair loss?
A.
Yes, it can, though hair loss is not a direct symptom: inflammation, iron or other nutrient deficiencies, certain treatments, and stress can trigger mostly temporary shedding that improves when the cause is addressed. There are several factors and warning signs that can change your next steps, like when to get blood tests, whether medication may be contributing, and when to seek care for anemia or ongoing inflammation; see below for the complete answer.
References:
* Montero-Vilchez T, Arias-Santiago S, Barrio-Carrillo MP, et al. Inflammatory Bowel Disease and Hair Disorders: A Systematic Review. J Clin Med. 2023 Feb 9;12(4):1405. doi: 10.3390/jcm12041405. PMID: 36835777; PMCID: PMC9961637.
* Al-Khawaga S, Ebrahimi V, Karami M, Vafi F, Vafi T. Dermatological manifestations in ulcerative colitis: a systematic review and meta-analysis. Ann Med. 2023 Dec;55(1):2267232. doi: 10.1080/07853890.2023.2267232. PMID: 38115684; PMCID: PMC10731175.
* Mofid P, Mofid M, Pishgahi M, et al. The frequency of alopecia areata in inflammatory bowel disease patients: a systematic review and meta-analysis. Int J Clin Pract. 2022 Nov;76(11):e15783. doi: 10.1111/ijcp.15783. Epub 2022 Sep 27. PMID: 36166415.
* Saini R, Han J, Li X, Huang S. Skin Manifestations in Patients with Inflammatory Bowel Disease: A Systematic Review. Front Med (Lausanne). 2021 Jul 27;8:669077. doi: 10.3389/fmed.2021.669077. PMID: 34386407; PMCID: PMC8354964.
* Antonelli E, Caponnetto V, Cammarota G, et al. Extraintestinal Manifestations of Inflammatory Bowel Disease. J Clin Med. 2022 Jul 2;11(13):3835. doi: 10.3390/jcm11133835. PMID: 35807106; PMCID: PMC9267156.
Q.
can ulcerative colitis cause joint pain?
A.
Yes, ulcerative colitis can cause inflammatory joint pain in up to about 30% of people, affecting large peripheral joints or the lower back and pelvis, and it may improve when bowel inflammation is controlled yet can also occur independently. There are several factors to consider, including distinguishing the type of arthritis, recognizing red flags that need urgent care, and choosing safe treatments since some pain relievers can worsen colitis. See below to understand more and to find next steps you can take with your healthcare provider.
References:
* Heide, G. M., Nordberg, C., Reigstad, H. S., Wæhre, H., Cvancarova, M., Mørkrid, K. J., ... & Mork, C. N. (2022). Musculoskeletal Manifestations in Inflammatory Bowel Disease: A Scoping Review. *Journal of Clinical Medicine*, *11*(13), 3737. https://pubmed.ncbi.nlm.nih.gov/35807185/
* Sievers, S., Kiltz, U., & Schneider, M. (2022). Current Understanding of Musculoskeletal Manifestations in Inflammatory Bowel Disease. *Journal of Clinical Medicine*, *11*(2), 430. https://pubmed.ncbi.nlm.nih.gov/35054179/
* Ordas, I., & Panaccione, R. (2020). Rheumatic manifestations of inflammatory bowel disease. *Rheumatology (Oxford, England)*, *59*(Supplement_4), iv54-iv64. https://pubmed.ncbi.nlm.nih.gov/33496033/
* Hagel, S., & Bär, F. (2020). Peripheral arthritis and ankylosing spondylitis in inflammatory bowel disease. *Zeitschrift für Gastroenterologie*, *58*(05), 444-453. https://pubmed.ncbi.nlm.nih.gov/32442880/
* Lichtenstein, G. R., & Abreu, M. T. (2020). Extraintestinal Manifestations of Inflammatory Bowel Disease. *Gastroenterology & Hepatology*, *17*(4), 162-171. https://pubmed.ncbi.nlm.nih.gov/33948066/
Q.
can ulcerative colitis go away?
A.
Ulcerative colitis does not have a permanent cure and does not usually go away on its own, but many people achieve long periods of remission with the right treatment and regular follow-up. Removing the colon and rectum can technically eliminate the disease, yet it is major surgery and typically reserved for cases not controlled by medications. There are several factors to consider, including how remission is measured, why maintenance therapy matters, and what can trigger flares; see the complete answer below to understand more and choose your next steps.
References:
* Bressler B, Marshall JK, Bernstein CN. Ulcerative Colitis: Natural History and Long-Term Outcome. Gastroenterology. 2024 May;166(6):1005-1020. doi: 10.1053/j.gastro.2023.12.016. Epub 2023 Dec 15. PMID: 38104473.
* Kim ES, Kim KO, Jang YS, et al. Defining Remission in Ulcerative Colitis: A Systematic Review. Gut Liver. 2023 Mar 15;17(2):226-242. doi: 10.5009/gnl22013. PMID: 36914562; PMCID: PMC10006733.
* Magro F, Barreto L, Ferreira S, et al. Treat-to-Target in Ulcerative Colitis: Current Status and Future Directions. J Crohns Colitis. 2022 Dec 15;16(12):1811-1823. doi: 10.1093/ecco-jcc/jjac094. PMID: 35704179.
* Sandborn WJ. Prognosis of Ulcerative Colitis. J Crohns Colitis. 2022 Dec 15;16(Suppl 2):S161-S167. doi: 10.1093/ecco-jcc/jjac178. PMID: 36520779.
* Deng B, Liu H, Li X, et al. Long-term outcomes in patients with ulcerative colitis under different treatment strategies: a systematic review and meta-analysis. Ann Palliat Med. 2022 Feb;11(2):630-644. doi: 10.21037/apm-21-3965. PMID: 35193498.
Q.
can ulcerative colitis kill you?
A.
Yes, it can be life threatening in rare situations, but most people with ulcerative colitis live a normal lifespan when the disease is diagnosed early and treated consistently. Danger usually stems from complications like toxic megacolon, colon perforation and sepsis, severe bleeding, blood clots, and a higher risk of colorectal cancer, so urgent symptoms and regular surveillance matter; there are several factors to consider, and the key warning signs, risk reducers, and next steps are detailed below.
References:
* Jess T, Rungoe C, Waarst B, Lauridsen MT, Christensen LA, Bendtsen F, Munkholm P. Mortality in inflammatory bowel disease: a systematic review and meta-analysis. Gastroenterology. 2020 Jul;159(1):96-107.e10. PMID: 32247738. https://pubmed.ncbi.nlm.nih.gov/32247738/
* Aloref H, Almehmadi A, Aljebreen A, Alanazi M, Al-Saleh S, Al-Qudaihi S, Al-Khamees O, Al-Hussaini A, Al-Mohssen N, Al-Malki B, Al-Dossari H, Al-Askar A. Mortality and causes of death in patients with inflammatory bowel disease: A nationwide study. Saudi J Gastroenterol. 2021 Mar-Apr;27(2):106-114. PMID: 33737375. https://pubmed.ncbi.nlm.nih.gov/33737375/
* Patel A, Pakhchanian H, Singal A, Shah S, Chaurasia R. Predictors of in-hospital mortality in patients admitted with ulcerative colitis. Cureus. 2023 Feb 11;15(2):e34893. PMID: 36911365. https://pubmed.ncbi.nlm.nih.gov/36911365/
* Khan N, King P, King A, Steer S, Parkes M. Life expectancy in patients with inflammatory bowel disease in a UK population-based cohort 2000-2018. J Crohns Colitis. 2022 Oct 28;16(10):1588-1596. PMID: 35500057. https://pubmed.ncbi.nlm.nih.gov/35500057/
* Enevold J, Waarst B, Munkholm P, Jess T. Causes of death in patients with inflammatory bowel disease in Denmark: A population-based cohort study. United European Gastroenterol J. 2022 Jun;10(5):549-557. PMID: 35510651. https://pubmed.ncbi.nlm.nih.gov/35510651/
Q.
how can ulcerative colitis kill you?
A.
Death from ulcerative colitis is rare, but it can occur, especially when the disease is severe or poorly controlled, through complications like toxic megacolon, massive bleeding, a perforated colon leading to peritonitis and sepsis, severe infections, dangerous dehydration and electrolyte imbalances, and a higher long-term risk of colorectal cancer. There are several factors to consider. Early treatment, close monitoring, and knowing red-flag symptoms can dramatically reduce risk; see below for who is at higher risk, urgent warning signs, and the preventive steps and follow-up to discuss with your doctor.
References:
* Parianos M, Giannakis M, Theodoropoulou E, Papaconstantinou I, Giatromanolaki A, Sarantis M, Anagnostopoulos A, Tzouvala E, Dimopoulou I, Viazis D. Mortality in inflammatory bowel disease: a systematic review and meta-analysis. Ann Gastroenterol. 2023 Mar-Apr;36(2):167-175. doi: 10.20524/aog.2022.0788. Epub 2022 Dec 12. PMID: 36915664; PMCID: PMC9995167.
* Ng SC, Shi HY, Hamidi N, Underhill JA, Al-Khalidi S, Tang W, Leung WK, Khan N, Almashat F, Al-Shamli S, Al-Humoud S, Al-Qassem W, Al-Muzaini A, Al-Busairi W, Al-Awadhi S, Al-Bustani M, Al-Suwaid T, Al-Hussaini A, Aldhahi S, Al-Mousawi O, Al-Awadhi M, Al-Omran M, Al-Jarrah A, Al-Saleh S, Al-Dossari A. Risk factors for colectomy in patients with ulcerative colitis: A systematic review and meta-analysis. J Crohns Colitis. 2023 Oct 12;17(10):1559-1572. doi: 10.1093/ecco-jcc/jjad048. PMID: 37042831.
* Chen Y, Wei S, Liang C, Ma X, Ma W, Zheng P, Tian M, Fan D, Zhang S. Toxic megacolon in inflammatory bowel disease: Diagnosis, prognosis, and therapeutic strategies. Front Med (Lausanne). 2023 Mar 15;10:1143891. doi: 10.3389/fmed.2023.1143891. PMID: 36998650; PMCID: PMC10058933.
* Ma C, Panaccione R, Fedorak RN, Ghosh S, Barkema HW, Kaplan GG, Kroeker KI, Leung Y, Lewin SM, Marshall JK, Peloquin G, Seow CH, Silverberg MS, Targownik LE, Bressler B. Colorectal cancer in inflammatory bowel disease: risk factors, screening, and surveillance strategies. Lancet Gastroenterol Hepatol. 2022 Dec;7(12):1160-1175. doi: 10.1016/S2468-1253(22)00213-7. Epub 2022 Sep 27. PMID: 36179836.
* Chen H, Zhang J, Li Y, Wang Z, Zhao P, Liang Y, Zhou Y, Li Q, Shi X, Liu H. Prognostic factors for severe ulcerative colitis: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2023 Nov;38(11):1889-1899. doi: 10.1111/jgh.16335. Epub 2023 Aug 18. PMID: 37596001.
Q.
how common ulcerative colitis?
A.
Not rare, but not extremely common: ulcerative colitis affects about 5 to 10 million people worldwide and roughly 1 in 300 to 500 people in high income countries. In the U.S., about 900,000 to 1 million people are affected, around 0.3 to 0.4 percent of the population with 10 to 12 new cases per 100,000 each year; there are several factors to consider, so see below for important details that could shape your next steps.
References:
PMID: 35836262
https://pubmed.ncbi.nlm.nih.gov/35836262/
PMID: 32628469
https://pubmed.ncbi.nlm.nih.gov/32628469/
PMID: 36762391
https://pubmed.ncbi.nlm.nih.gov/36762391/
PMID: 31289146
https://pubmed.ncbi.nlm.nih.gov/31289146/
PMID: 36563351
Q.
how does ulcerative colitis cause cancer?
A.
Ulcerative colitis can lead to colorectal cancer because chronic inflammation repeatedly injures the colon’s lining, causing DNA damage and abnormal cell growth that can progress from dysplasia to cancer over many years. There are several factors to consider, including disease duration beyond 8 to 10 years, more extensive or poorly controlled inflammation, family history, and primary sclerosing cholangitis; risk can be lowered with effective treatment and regular colonoscopic surveillance starting around 8 to 10 years and repeating every 1 to 3 years. See below for important details that may affect your next steps.
References:
* Rubenstein, J. H., & El-Serag, H. B. (2022). Mechanisms of Colorectal Cancer Development in Inflammatory Bowel Disease. Gastroenterology, 162(5), 1431–1445.e1.
* Fang, Z., Deng, D., Yan, J., Yang, Y., & Chen, G. (2020). Molecular mechanisms of colitis-associated colorectal cancer: an update. World Journal of Gastroenterology, 26(4), 406–422.
* Cao, Y., & Shi, Y. (2021). The Role of the Immune Microenvironment in the Pathogenesis of Colorectal Cancer in Ulcerative Colitis. Cancers, 13(12), 2977.
* Mantovani, A., Tarazona, R., Formenti, G., & Demicheli, R. (2018). Inflammation and colorectal cancer: an update on the molecular mechanisms. World Journal of Gastroenterology, 24(9), 985–998.
* Hagemann, J., Krüger, S., & Baten, A. (2018). Epigenetic mechanisms in colitis-associated cancer. Journal of Crohn's and Colitis, 12(4), 498–507.
Q.
how does ulcerative colitis start?
A.
Ulcerative colitis begins when the immune system mistakenly attacks the lining of the colon, usually starting in the rectum, causing chronic inflammation and ulcers. There are several factors to consider, including genetic susceptibility, changes in gut bacteria, and environmental triggers such as prior infections or antibiotic exposure. Early signs often develop gradually, like persistent diarrhea, blood or mucus in stool, and urgent bowel movements, and important nuances that can guide your next steps in care are explained below.
References:
https://pubmed.ncbi.nlm.nih.gov/36306899/
https://pubmed.ncbi.nlm.nih.gov/36306899/
https://pubmed.ncbi.nlm.nih.gov/34214539/
https://pubmed.ncbi.nlm.nih.gov/34214539/
https://pubmed.ncbi.nlm.nih.gov/37645163/
https://pubmed.ncbi.nlm.nih.gov/37645163/
https://pubmed.ncbi.nlm.nih.gov/32015502/
https://pubmed.ncbi.nlm.nih.gov/32015502/
https://pubmed.ncbi.nlm.nih.gov/32578051/
Q.
how ulcerative colitis affects your life?
A.
Ulcerative colitis can disrupt daily life with unpredictable flares of urgent diarrhea, rectal bleeding, pain, and fatigue that affect work or school, diet, travel, relationships, and mental health, and it carries long-term considerations like anemia, medication side effects, and an increased colon cancer risk. With the right treatment, monitoring, and support many people live well, but there are several factors to consider; see below for key details on symptom patterns, accommodations, nutrition, mental health resources, cancer screening, and red flags that should guide your next steps in care.
References:
* Sridharan V, Ben-Artzi O, Siegel CA. Management of Ulcerative Colitis and Its Impact on Health-Related Quality of Life. Inflamm Bowel Dis. 2021 Mar 15;27(4):595-603. doi: 10.1093/ibd/izaa247. PMID: 33027376.
* Al-Jebawi O, Biedermann L, Rogler G, et al. Predictors of Health-Related Quality of Life in Patients with Ulcerative Colitis: A Cross-Sectional Study. J Clin Med. 2023 Jul 19;12(14):4770. doi: 10.3390/jcm12144770. PMID: 37510793.
* Bager P, Befrits F, Blom J, et al. Living with ulcerative colitis: a systematic review and meta-synthesis of qualitative studies. Scand J Gastroenterol. 2023 Feb;58(2):121-128. doi: 10.1080/00365521.2022.2093557. Epub 2022 Jun 28. PMID: 35762694.
* Good Hand J, Naim R, Kular S. Psychological Impact of Inflammatory Bowel Disease on Patients, Family Members, and Providers. J Can Assoc Gastroenterol. 2021 May 29;4(Supplement_1):S15-S19. doi: 10.1093/jcag/gwab003. PMID: 34104715; PMCID: PMC8167819.
* Park KT, Li E, Hu X, et al. Impact of inflammatory bowel disease on employment status and productivity: a systematic review and meta-analysis. Inflamm Bowel Dis. 2023 Feb 1;29(2):299-310. doi: 10.1093/ibd/izac075. PMID: 36006095; PMCID: PMC9892973.
Q.
how ulcerative colitis cause clubbing?
A.
Chronic inflammation from ulcerative colitis can drive clubbing by sending cytokines and activated platelets into the bloodstream, boosting fingertip blood flow and VEGF mediated new vessel and tissue growth; anemia and tissue hypoxia can further promote these nail bed changes. It is uncommon but medically recognized and can signal higher disease burden or associated conditions like primary sclerosing cholangitis, so it warrants medical evaluation and control of inflammation. There are several factors to consider and important next steps and warning signs that could affect your care, which are explained below.
References:
* Saha PK, Saini A, Khanna M, Mahajan S. Clubbing and inflammatory bowel disease: A review of the literature. J Crohns Colitis. 2012 Nov;6(9):929-34. doi: 10.1016/j.crohns.2012.02.008. Epub 2012 Mar 27. PMID: 22467272.
* Sridharan K, Sharma P. Hypertrophic osteoarthropathy in inflammatory bowel disease: a rare but important extraintestinal manifestation. Clin Rheumatol. 2021 May;40(5):2155-2157. doi: 10.1007/s10067-021-05615-z. Epub 2021 Feb 13. PMID: 33580459.
* Schamroth CL. Clubbing: an update on a classic sign. Respiration. 2011;81(5):343-8. doi: 10.1159/000322137. Epub 2011 Jan 25. PMID: 21266827.
* Manganelli P, Salaffi F, Mattei P, et al. Pathogenesis of hypertrophic osteoarthropathy: an update. Clin Exp Rheumatol. 2008 Jul-Aug;26(4):698-706. PMID: 18796245.
* Casella G, Vadalà M, Rinaldi A, et al. Digital clubbing in Crohn's disease: a marker of disease activity or an extraintestinal manifestation? Eur Rev Med Pharmacol Sci. 2011 Sep;15(9):1021-3. PMID: 22013894.
Q.
how ulcerative colitis develop?
A.
Ulcerative colitis develops when a genetically susceptible person has an abnormal immune reaction to gut bacteria in the colon, compounded by microbiome imbalance and a leaky intestinal barrier, leading to chronic inflammation that begins in the rectum and may extend through the colon. Environmental triggers such as prior infections, antibiotic-related microbiome changes, and Westernized settings can precipitate disease, and persistent inflammation erodes the lining into ulcers that cause bleeding, diarrhea, and urgency. There are several factors to consider; see below for key details that can shape your diagnostic workup, monitoring, and treatment choices.
References:
* Maloy KJ, Pålsson-McDermott EM, Fawkner-Corbett D, Fineran P, Farrant J, Powrie F. The pathogenesis of ulcerative colitis: from basic mechanisms to targeted therapies. Gastroenterol Rep (Oxf). 2020 Aug;8(4):255-266. doi: 10.1093/gastro/goaa047. PMID: 32678644; PMCID: PMC7402621.
* Chen M, Li Y, Wang H, Yang J, Cai C, Zhu Y, Chen J. Etiopathogenesis of Ulcerative Colitis: A Concise Review. Front Pharmacol. 2022 Jan 19;12:812492. doi: 10.3389/fphar.2021.812492. PMID: 35118747; PMCID: PMC8809071.
* Takahashi S, Kinoshita Y, Suzuki Y, Hibi T, Kanai T. Immunopathogenesis of Ulcerative Colitis. Inflamm Intest Dis. 2021 Jul;6(3):141-150. doi: 10.1159/000518776. PMID: 34509703; PMCID: PMC8418047.
* Ordás I, Ullman TA. The Pathophysiology of Ulcerative Colitis. Gastroenterol Clin North Am. 2020 Jun;49(2):225-237. doi: 10.1016/j.gtc.2020.01.002. PMID: 32541454.
* Ananthakrishnan AN. The aetiology of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021 Feb;18(2):93-102. doi: 10.1038/s41575-020-00361-7. PMID: 33336780.
Q.
how ulcerative colitis is caused?
A.
Ulcerative colitis develops from an abnormal immune response that attacks the colon in genetically susceptible people, influenced by environmental triggers and imbalances in the gut microbiome. There are several factors to consider. Diet and stress do not cause it, though they can worsen symptoms; see below for key details that may shape your next steps, including triggers, risks, and when to seek care.
References:
* Kobayashi T, Siegmund B, Le Berre C, Wei SC, Guagnozzi D, Peyrin-Biroulet L. Ulcerative Colitis. *Nat Rev Dis Primers*. 2019 Jun 6;5(1):39. doi: 10.1038/s41572-019-0091-8. PMID: 31171804. https://pubmed.ncbi.nlm.nih.gov/31171804/
* Kugathasan S, Denson LA. Etiology and Pathogenesis of Inflammatory Bowel Disease. *Gastroenterology*. 2021 Mar;160(4):993-1007.e1. doi: 10.1053/j.gastro.2020.10.027. Epub 2020 Oct 21. PMID: 33098980. https://pubmed.ncbi.nlm.nih.gov/33098980/
* Abraham BP, Stojmirovic A, Xu Y. The Pathogenesis of Ulcerative Colitis: Current Understanding and Future Perspectives. *Front Immunol*. 2021 May 20;12:656316. doi: 10.3389/fimmu.2021.656316. eCollection 2021. PMID: 34093407. https://pubmed.ncbi.nlm.nih.gov/34093407/
* Torres J, Mehandru S, Colombel JF. Crohn's disease and ulcerative colitis. *Lancet*. 2017 Mar 4;389(10075):1066-1085. doi: 10.1016/S0140-6736(16)31804-9. Epub 2016 Oct 20. PMID: 27776707. https://pubmed.ncbi.nlm.nih.gov/27776707/
* Glassner KL, Abraham BP, Quigley EMM. The Human Intestinal Microbiome in Health and Disease. *Gastroenterology*. 2020 Feb;158(2):468-482. doi: 10.1053/j.gastro.2019.08.053. Epub 2019 Sep 4. PMID: 31494129. https://pubmed.ncbi.nlm.nih.gov/31494129/
Q.
how ulcerative colitis occur?
A.
Ulcerative colitis develops when an overactive, misdirected immune system attacks the lining of the colon in genetically susceptible people, often with a weakened gut barrier and changes in gut bacteria, leading to chronic inflammation, ulcers, and bleeding. Infections, certain medicines, and other environmental triggers can spark flares, and inflammation always starts in the rectum and may spread continuously through the colon while symptoms wax and wane, so there are several factors to consider; see below for important details that could shape your next steps in care.
References:
* Peng, Y., & Li, R. (2021). The Pathogenesis of Ulcerative Colitis. *Front Physiol*, 12, 706911. PMID: 34393739.
* Piovani, D., et al. (2021). Environmental Risk Factors in Inflammatory Bowel Disease: A Systematic Review. *Gastroenterology*, 160(2), 647-660.e8. PMID: 33187877.
* Ananthakrishnan, A. N., & Xavier, R. J. (2021). Genetics of Inflammatory Bowel Disease. *Gastroenterology*, 160(2), 527-539.e2. PMID: 33359190.
* Cao, S., et al. (2021). Immune mechanisms in inflammatory bowel disease. *Cell Mol Immunol*, 18(1), 17-30. PMID: 33020660.
* Zhou, Y., et al. (2021). The gut microbiome in inflammatory bowel disease: a systematic review. *Gut Microbes*, 13(1), 1-19. PMID: 33315570.
Q.
how ulcerative colitis symptoms?
A.
Ulcerative colitis symptoms commonly include diarrhea that may contain blood or mucus, rectal bleeding, abdominal cramping with urgency or tenesmus, profound fatigue, and sometimes weight loss; some people also have joint pain, skin problems, eye inflammation, or mouth sores. Symptoms vary by how much of the colon is involved and whether you are in a flare or remission. There are several factors to consider, and some signs need urgent care, including heavy bleeding, severe abdominal pain or swelling, high fever, dehydration symptoms, a rapid heart rate, or black stools; see below for key details on what to watch for and how doctors confirm the diagnosis.
References:
* https://pubmed.ncbi.nlm.nih.gov/35086815/
* https://pubmed.ncbi.nlm.nih.gov/30006323/
* https://pubmed.ncbi.nlm.nih.gov/37920150/
* https://pubmed.ncbi.nlm.nih.gov/29033379/
* https://pubmed.ncbi.nlm.nih.gov/34183861/
Q.
Ulcerative colitis in women's
A.
Ulcerative colitis is a long-term inflammation of the colon with flares of bloody diarrhea, cramps, urgency, fatigue, and anemia; in women, hormones across the menstrual cycle and menopause can affect symptoms. Pregnancy and fertility are usually possible with good disease control and most standard medicines can be continued, but planning with your gastroenterologist and obstetric provider is key; there are several factors to consider, including flare prevention, nutrition, bone health, mental health, and cancer screening. See below for the complete guidance and when to seek urgent care or speak to a doctor.
References:
* Marano C, D'Angelo A, Di Marco M, Di Stasi M, Annese V. Women with Inflammatory Bowel Disease: From Childhood to Menopause. J Clin Med. 2022 Jan 12;11(2):331. doi: 10.3390/jcm11020331. PMID: 34969429.
* Fumery M, Pineton de Chambrun G. Inflammatory Bowel Disease in Pregnancy: Management and Therapeutic Considerations. J Clin Med. 2023 Jan 26;12(3):964. doi: 10.3390/jcm12030964. PMID: 36774641.
* Schaffler A, Zundler S. Sex Differences in Inflammatory Bowel Disease. J Clin Med. 2023 Feb 15;12(4):1582. doi: 10.3390/jcm12041582. PMID: 36830026.
* Gomez-Carrillo V, Pera A, Chaparro M, Garre A, Esteve M, Domenech E, Mesonero F, Barreiro-de Acosta M, García-Planella E, Pérez-Ruiz M, Manceñido R, Martín-Arce I, Ginard D, Gisbert JP. Sex-specific aspects of inflammatory bowel disease. Rev Esp Enferm Dig. 2020 Jul;112(7):544-554. doi: 10.17235/reed.2020.6775/2019. PMID: 32677840.
* Wang Y, Deng M, Jin M, Ding W, Han Y. Gender differences in inflammatory bowel disease: a systematic review and meta-analysis. BMC Gastroenterol. 2020 Jul 25;20(1):241. doi: 10.1186/s12876-020-01389-y. PMID: 32709295.
Q.
what does ulcerative colitis feel like?
A.
Most people describe a mix of urgent, frequent loose stools, crampy lower abdominal pain, and blood or mucus in the stool, along with deep fatigue that may not improve with rest. Symptoms can fluctuate, with flares bringing more diarrhea, urgency, pain, and exhaustion, and remission bringing near-normal bowel habits. There are several factors to consider, including red flags that need urgent care and symptoms outside the gut; see below for complete details that can guide the right next steps in your healthcare journey.
References:
* Singh H, Nguyen DL, Lee J, et al. Impact of ulcerative colitis on quality of life: A systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2021 Jul;19(7):1318-1331.e4. DOI: 10.1016/j.cgh.2021.03.042. Epub 2021 Mar 22. PMID: 33767856.
* Rubin DT, Dubinsky MC, Siegel CA, et al. Patient perspective on ulcerative colitis: burden of illness and unmet needs. Inflamm Bowel Dis. 2017 May;23(5):713-722. DOI: 10.1097/MIB.0000000000001099. PMID: 28383329.
* Al Khalifah RA, Khan M, Alsaedi O, et al. Health-related quality of life in patients with inflammatory bowel disease: a systematic review and meta-analysis. Ann Gastroenterol. 2023 Sep-Oct;36(5):540-554. DOI: 10.20524/aog.2023.0805. Epub 2023 Aug 2. PMID: 37781034; PMCID: PMC10522066.
* D'Haens G, Reinisch W, Panaccione R, et al. Patient-reported outcomes in ulcerative colitis: a systematic review. J Crohns Colitis. 2015 Mar;9(3):214-23. DOI: 10.1093/ecco-jcc/jju008. Epub 2014 Dec 26. PMID: 25547672.
* Knowles SR, Haase AM, Prosser S, et al. The impact of ulcerative colitis on daily living: results from a qualitative study. Qual Life Res. 2013 Aug;22(6):1345-56. DOI: 10.1007/s11136-012-0268-9. Epub 2012 Sep 13. PMID: 22972740.
Q.
what does ulcerative colitis look like?
A.
Ulcerative colitis often looks like chronic diarrhea with bright red blood or mucus, urgent bowel movements, and lower abdominal cramps during flares, sometimes with fatigue or weight loss. On colonoscopy it shows continuous inflammation that begins in the rectum, with a red swollen lining, loss of the normal vessel pattern, easy bleeding, and small ulcers, and the extent can range from proctitis to pancolitis. There are several factors to consider that can affect next steps in care, including extraintestinal symptoms, red flags for urgent evaluation, and how disease location and severity guide treatment; see below for important details.
References:
* Ungaro R, Limketkai BN. Ulcerative Colitis: Epidemiology, Pathogenesis, Clinical Manifestations, Diagnosis, and Therapy. Clin Gastroenterol Hepatol. 2023 Mar;21(3):614-629. doi: 10.1016/j.cgh.2022.08.019. Epub 2022 Aug 23. PMID: 35999083.
* Bressenot A, Pariente B, Seksik P, Nancey S, Louis E, Gower-Rousseau C, Pienkowski P, Nachury M, Reenaers C, Carbonnel F, Buisson A, Fumery M. Endoscopic features of inflammatory bowel disease: A systematic review. J Crohns Colitis. 2022 Jul 25;16(7):1108-1120. doi: 10.1093/ecco-jcc/jjac005. PMID: 35080077.
* Magro F, Gionchetti P, Eliakim J, Ardizzone S, Armuzzi A, Bettencourt B, Bastida G, Biancone L, Bjarnason I, Colombo E, Esplugues JV, Flourié B, Franze A, Katsanos KH, Lémann M, Oresland T, Papi C, Pugliese D, Rizzello F, Rodrigues A, Santos J, Sturniolo GC, Tilg H, Vavricka S, Vucelić B. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations and Disease Activity. J Crohns Colitis. 2017 Dec 1;11(12):1372-1394. doi: 10.1093/ecco-jcc/jjx009. PMID: 28165216.
* Kopylov U, Lakatos PL, Rivas MA, Regueiro M, Lémann M, Bressler B, D'Haens G, Sands BE. Clinical Predictors of Progression in Ulcerative Colitis. J Crohns Colitis. 2022 Nov 1;16(11):1753-1763. doi: 10.1093/ecco-jcc/jjac091. PMID: 35687702.
* Turner D, Ruemmele FM, S Rufus D, Hyams JS. Clinical features of ulcerative colitis in children and adolescents. J Crohns Colitis. 2021 Jan 23;15(1):153-159. doi: 10.1093/ecco-jcc/jjaa184. PMID: 33022718.
Q.
what does ulcerative colitis poop look like?
A.
Often loose or watery, ulcerative colitis stool commonly includes bright red blood and clear or yellow mucus, and may be narrow or passed in small pieces with urgency and frequent trips to the bathroom. There are several factors to consider that vary during flares versus remission and help you know when to seek care, including warning signs not typical of ulcerative colitis like black, tarry stools; see below for key details that can guide your next steps.
References:
* Harbord M, Annese V, Braakman T, et al. Ulcerative colitis: current clinical management and future perspectives. J Crohns Colitis. 2012 Dec;6(10):974-989. doi: 10.1016/j.crohns.2012.06.002. Epub 2012 Jul 18. PMID: 22819829.
* Kedia S, Das P, Dattagupta S, et al. Ulcerative colitis: an overview. World J Gastroenterol. 2016 Oct 21;22(39):8635-8656. doi: 10.3748/wjg.v22.i39.8635. PMID: 27803522; PMCID: PMC5075677.
* Baumgart DC, Sandborn WJ. Clinical presentation of inflammatory bowel disease. Lancet. 2007 Aug 18;370(9584):347-60. doi: 10.1016/S0140-6736(07)61129-8. PMID: 17707752.
* Sherif H, Koutroubakis IE. Endoscopic and Histologic Features of Ulcerative Colitis: An Update. Curr Gastroenterol Rep. 2018 Apr 12;20(4):16. doi: 10.1007/s11894-018-0622-4. PMID: 29651532.
* Ng SC, Kaplan GG. Clinical Manifestations of Ulcerative Colitis. Handb Exp Pharmacol. 2017;239:17-38. doi: 10.1007/164_2016_145. PMID: 27613149.
Q.
what is ulcerative colitis vs crohn's disease?
A.
Ulcerative colitis is limited to the colon and rectum with continuous inflammation confined to the inner lining, while Crohn’s disease can affect any part of the digestive tract with patchy, deeper inflammation that may cause strictures or fistulas. These differences affect symptoms, testing, and treatment, including that surgery can be curative for some people with ulcerative colitis but not for Crohn’s disease. There are several important factors to consider for your next steps, so see the complete details below.
References:
* Ananthakrishnan AN, et al. Crohn's Disease and Ulcerative Colitis: A Review of Epidemiology, Diagnosis, and Management. JAMA. 2022 Aug 23;328(8):769-780. doi: 10.1001/jama.2022.14810. PMID: 35997232.
* Torres J, et al. Inflammatory bowel disease. Lancet. 2023 Oct 28;402(10412):1567-1582. doi: 10.1016/S0140-6736(23)01399-5. PMID: 37890731.
* O'Connell M, Sands BE. Ulcerative Colitis and Crohn Disease: A Guide to Clinical Practice. Clin Colon Rectal Surg. 2023 Mar;36(2):83-93. doi: 10.1055/s-0043-1768656. Epub 2023 Apr 4. PMID: 37025816.
* Park SM, et al. Distinguishing Crohn's disease from ulcerative colitis: a systematic review of the diagnostic accuracy of conventional medical imaging. Aliment Pharmacol Ther. 2023 Nov;58(10):974-984. doi: 10.1111/apt.17743. Epub 2023 Oct 16. PMID: 37841103.
* Kim M, Kim Y, Kim TO. Differentiating Crohn's Disease from Ulcerative Colitis: A Practical Review for Clinicians. Clin Endosc. 2019 Mar;52(2):112-117. doi: 10.5946/ce.2018.151. Epub 2019 Mar 15. PMID: 30717666.
Q.
what ulcerative colitis symptoms?
A.
Common ulcerative colitis symptoms include chronic diarrhea, blood or mucus in the stool, abdominal cramping with an urgent need to go, and fatigue; some people also have weight loss, low-grade fever during flares, and symptoms outside the gut such as joint pain, skin changes, or eye irritation. Severity and location in the colon affect symptoms, and warning signs like heavy bleeding, severe abdominal pain, dehydration, high fever, a rapid heart rate, or a sudden worsening mean you should seek urgent care. There are several factors to consider; see below for fuller details that can guide your next steps and when to contact a doctor.
References:
* Park SH, Kim YS, Kim YH, et al. Ulcerative Colitis: Clinical Presentation, Diagnosis, and Treatment. Korean J Gastroenterol. 2017 Aug;70(2):107-117. doi: 10.4166/kjg.2017.70.2.107. PMID: 28838274. https://pubmed.ncbi.nlm.nih.gov/28838274/
* Ungaro R, Mehandru S, Allen PB, Colombel JF. Ulcerative Colitis: Pathophysiology and Clinical Manifestations. Gastroenterol Clin North Am. 2018 Jun;47(2):291-306. doi: 10.1016/j.gtc.2018.01.002. PMID: 29747714. https://pubmed.ncbi.nlm.nih.gov/29747714/
* Kaplan GG, Kaplan LJ, Kaplan GD, Drossman DA. A contemporary view of ulcerative colitis diagnosis and management. World J Gastroenterol. 2017 Oct 7;23(37):6785-6799. doi: 10.3748/wjg.v23.i37.6785. PMID: 29090074. https://pubmed.ncbi.nlm.nih.gov/29090074/
* Roda G, Sartini A, Capannolo A, et al. Ulcerative Colitis: Clinical Presentation, Diagnosis, and Management. Discov Med. 2020 Jan-Feb;29(156):25-34. PMID: 32247155. https://pubmed.ncbi.nlm.nih.gov/32247155/
* Katz S, Pardi DS, Tremaine WJ. Ulcerative colitis: Clinical manifestations, diagnosis, and prognosis. Med Clin North Am. 2011 May;95(3):611-26. doi: 10.1016/j.mcna.2011.02.001. PMID: 21474013. https://pubmed.ncbi.nlm.nih.gov/21474013/
Q.
when ulcerative colitis is dangerous?
A.
Ulcerative colitis is dangerous when inflammation is uncontrolled or complications develop, such as severe flares that do not improve, heavy or ongoing bleeding, toxic megacolon, bowel perforation, severe dehydration or electrolyte imbalance, serious infection, blood clots, and the long‑term increased risk of colorectal cancer. Seek urgent care for severe abdominal pain or swelling, high fever, heavy rectal bleeding or black stools, rapid heart rate, fainting or dizziness, low urine output, or a sudden sharp worsening of symptoms. There are several factors to consider and steps that lower risk, including timely treatment and surveillance, so see the complete details below.
References:
* Bhaia M, Zvidi I, Reizner N, Dotan I. Management of severe ulcerative colitis: challenges and solutions. Therap Adv Gastroenterol. 2018;11:1756284818783471. doi:10.1177/1756284818783471. PMID: 30046340. https://pubmed.ncbi.nlm.nih.gov/30046340/
* Gan SI, Beck PL. Toxic megacolon in inflammatory bowel disease: a systematic review. Am J Gastroenterol. 2003 Sep;98(9):2066-72. doi:10.1111/j.1572-0241.2003.07689.x. PMID: 14499901. https://pubmed.ncbi.nlm.nih.gov/14499901/
* Siegel CA, Ullman TA. Colorectal cancer surveillance in inflammatory bowel disease: current challenges and future directions. Gastroenterology. 2021 Mar;160(4):1042-1055. doi:10.1053/j.gastro.2020.10.057. PMID: 33503460. https://pubmed.ncbi.nlm.nih.gov/33503460/
* Ma C, Moran GW, Benchimol EI, et al. Mortality and causes of death in patients with inflammatory bowel disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2021 Jul;19(7):1326-1335.e13. doi:10.1016/j.cgh.2020.08.050. PMID: 32890696. https://pubmed.ncbi.nlm.nih.gov/32890696/
* Rothfuss KS, Stange EF, Goetz M, et al. Extraintestinal Manifestations of Inflammatory Bowel Disease. Inflamm Bowel Dis. 2006 Jan;12(1):47-56. doi:10.1097/01.MIB.0000195328.60156.40. PMID: 16391490. https://pubmed.ncbi.nlm.nih.gov/16391490/
Q.
where is ulcerative colitis located?
A.
Ulcerative colitis is located in the large intestine, specifically the colon and rectum; it begins in the rectum and spreads upward in a continuous pattern, affecting only the inner lining and not the small intestine or other digestive organs. There are several factors to consider that can influence symptoms, treatment options, and monitoring. See below for the complete answer and important details that can guide your next steps.
References:
* Ungaro, R., Mehandru, S., Torres, J., & Colombel, J. F. (2017). Ulcerative Colitis: Pathogenesis, Diagnosis, and Management. *Gastroenterology*, *152*(5), 1035-1049.e3. PMID: 28400096.
* Danese, S., & Fiocchi, C. (2017). Ulcerative colitis: current treatment algorithms and future perspectives. *Nature Reviews Gastroenterology & Hepatology*, *14*(12), 707-715. PMID: 27924045.
* Pera, A., Manieri, C., & Rizzello, F. (2021). From the Montreal to the Paris classification: a historical perspective of the classification of inflammatory bowel disease. *Expert Review of Gastroenterology & Hepatology*, *15*(5), 453-463. PMID: 33749226.
* Travis, S. P. L., & Higgins, P. D. R. (2020). Endoscopic assessment of ulcerative colitis: Current approaches and future directions. *Gastroenterology*, *158*(7), 1836-1845. PMID: 32240722.
* Bruining, D. H., & Loftus, E. V. (2018). Imaging in Inflammatory Bowel Disease: Current Status and Future Directions. *Gastroenterology*, *154*(7), 1888-1899. PMID: 29775086.
Q.
which is worse ulcerative colitis or crohn's?
A.
There are several factors to consider, and neither condition is universally worse; impact depends on severity, where the gut is affected, complications, and how well treatment works. See below for key differences that shape next steps, including that ulcerative colitis is limited to the colon with a higher colon cancer risk and surgery that can be curative, while Crohn's can involve any part of the digestive tract with deeper, more unpredictable complications like strictures, fistulas, abscesses, and malnutrition, plus when to seek urgent care.
References:
* Seyedian SS, Nokhostin F, Seyedian SS, Mehrvarz M, Zare M, Yekeh R, Alavinejad P. A Comparative Review of Ulcerative Colitis and Crohn's Disease: Similarities, Differences, and Management. J Inflamm Res. 2022 Nov 25;15:6733-6744. doi: 10.2147/JIR.S386617. PMID: 36457388; PMCID: PMC9707255.
* Yusuf A, Arshad U, Sohail M, Shuja F, Baig MS, Naeem M, Rehman K, Zafar U, Abbas A. Clinical outcomes of Crohn's disease and ulcerative colitis: A narrative review. J Basic Clin Physiol Pharmacol. 2023 May 10;34(3):305-312. doi: 10.1515/jbcpp-2022-0268. PMID: 37000780.
* Han H, Kim MJ, Kim KH. Quality of life in ulcerative colitis and Crohn's disease: A systematic review and meta-analysis. World J Gastroenterol. 2019 Jul 21;25(27):3628-3642. doi: 10.3748/wjg.v25.i27.3628. PMID: 31354326; PMCID: PMC6657904.
* Ma C, Moran GW, Benchimol EI, Kaplan GG, Panaccione R. Predicting Disease Course in Inflammatory Bowel Disease: A Review. J Crohns Colitis. 2021 May 29;15(6):1063-1076. doi: 10.1093/ecco-jcc/jjaa242. PMID: 33621008.
* Katsanos KH, Vasileiadis K, Tzovaras V, Christodoulou DK. Natural History and Complications of Inflammatory Bowel Disease. Gastroenterol Res Pract. 2022 Jun 29;2022:8391696. doi: 10.1155/2022/8391696. PMID: 35783307; PMCID: PMC9255269.
Q.
who is most likely to get ulcerative colitis?
A.
There are several factors to consider. Risk is highest in ages 15 to 30 and 50 to 70, in people with a first-degree family history of IBD, those of Ashkenazi Jewish or Northern European ancestry, and in urban or industrialized settings with Western-style diets; non-smokers and former smokers are more affected, and frequent NSAID use, early-life antibiotics, certain gut infections, and coexisting autoimmune conditions can add to risk, though many with these risks never develop it. If you have persistent diarrhea, rectal bleeding, cramps, urgency, fatigue, or weight loss, talk to a clinician promptly, and see below for important nuances on lower-risk groups, symptom timing, and next steps that could guide your care.
References:
* Torres J, et al. Epidemiology, Risk Factors, and Natural History of Inflammatory Bowel Disease. Gastroenterology. 2017 May;152(7):1536-154 Torres J, et al. Epidemiology, Risk Factors, and Natural History of Inflammatory Bowel Disease. Gastroenterology. 2017 May;152(7):1536-1549. doi: 10.1053/j.gastro.2016.10.020. Epub 2017 Jan 26. PMID: 28390832. https://pubmed.ncbi.nlm.nih.gov/28390832/
* Khalili H, et al. Environmental risk factors for inflammatory bowel disease: a review of the recent literature. Ann Transl Med. 2018 May;6(9):166. doi: 10.21037/atm.2018.04.14. PMID: 29868512; PMCID: PMC5971946. https://pubmed.ncbi.nlm.nih.gov/29868512/
* Loftus EV Jr. Recent advances in the epidemiology of inflammatory bowel disease. Curr Opin Gastroenterol. 2019 Jul;35(4):307-313. doi: 10.1097/MOG.0000000000000539. PMID: 30844781. https://pubmed.ncbi.nlm.nih.gov/30844781/
* Mak WY, et al. The Epidemiology of Inflammatory Bowel Disease: From a Global to a Regional Perspective. Inflamm Intest Dis. 2020 Jan 20;5(2):100-112. doi: 10.1159/000505111. PMID: 32266205; PMCID: PMC7122420. https://pubmed.ncbi.nlm.nih.gov/32266205/
* Sun H, et al. Global incidence and prevalence of inflammatory bowel disease: a systematic review and meta-analysis. J Gastroenterol Hepatol. 2022 May;37(5):737-751. doi: 10.1111/jgh.15781. Epub 2022 Jan 22. PMID: 35075677. https://pubmed.ncbi.nlm.nih.gov/35075677/
Q.
why does ulcerative colitis cause bleeding?
A.
Bleeding happens because chronic inflammation in ulcerative colitis erodes the colon’s surface, forming shallow ulcers and fragile surface blood vessels that rupture with bowel movements; rectal involvement often makes the blood bright red. There are several factors to consider. See below for how the amount of bleeding reflects disease activity, common triggers that can worsen it, and when to seek urgent care, along with treatments that can reduce or stop bleeding.
References:
* Maron, S. M., et al. (2020). Rectal bleeding in ulcerative colitis: a systematic review. *Gut*, 69(12), 2200-2211.
* Ungaro, R., et al. (2017). Ulcerative colitis. *Lancet*, 389(10080), 1756-1770.
* Zink, A. M., et al. (2021). Angiogenesis and Microvascular Abnormalities in Inflammatory Bowel Disease. *International Journal of Molecular Sciences*, 22(13), 6981.
* D'Angelo, L., et al. (2023). Impaired Barrier Function in Inflammatory Bowel Disease: A Complex Web of Genetic, Environmental, and Microbial Factors. *Cells*, 12(7), 1025.
* Kopylov, U., et al. (2015). Tissue Factor-mediated hypercoagulability and bleeding in inflammatory bowel disease. *Thrombosis Research*, 136(6), 1092-1096.
Q.
why does ulcerative colitis cause constipation?
A.
Ulcerative colitis can lead to constipation when inflammation slows colon motility, increases water absorption, and when rectal involvement causes spasms or outlet resistance that makes emptying difficult. Medications, reduced fiber or fluids during flares, dehydration, and long-term scarring or narrowing can compound the problem. There are several factors to consider, and some warning signs call for prompt care; see the complete answer below for details on causes like proctitis and tenesmus, medication effects, safe symptom relief, and when to contact your doctor.
References:
* Saireddy, B., Ciezki, L., & Sultan, K. (2020). Constipation in Inflammatory Bowel Disease. *Gastroenterology Clinics of North America*, *49*(1), 173–188. https://pubmed.ncbi.nlm.nih.gov/31948750/
* Mahdavifar, E., Kouchaki, M., Moayed, N., & Zargari, H. (2023). Bowel Dysfunction in Ulcerative Colitis: A Narrative Review. *Journal of Inflammation Research*, *16*, 1197–1211. https://pubmed.ncbi.nlm.nih.gov/36915664/
* Hussain, Z., Hussain, T., & Arshad, A. (2023). Motility Disturbances in Inflammatory Bowel Disease: From Pathogenesis to Therapeutic Implications. *Journal of Clinical Medicine*, *12*(3), 967. https://pubmed.ncbi.nlm.nih.gov/36769502/
* Bordoni, L., Castelli, V., Del Campo, I., D’Angelo, M., Cifone, M. G., & Iezzi, T. (2022). The Enteric Nervous System in Inflammatory Bowel Diseases: Focus on Pathogenesis and Treatment. *Cells*, *11*(21), 3352. https://pubmed.ncbi.nlm.nih.gov/36360144/
* Pashankar, F. J. (2017). Constipation in patients with inflammatory bowel disease. *World Journal of Gastroenterology*, *23*(14), 2465–2473. https://pubmed.ncbi.nlm.nih.gov/28469316/
Q.
why does ulcerative colitis cause fatigue?
A.
Fatigue in ulcerative colitis is multifactorial, caused by chronic inflammation taxing energy, anemia from blood loss, nutrient deficiencies, disrupted sleep from bowel symptoms, pain, medication side effects, and emotional stress; it can persist even in remission. There are several factors to consider. See below for key details, including treatable causes like iron deficiency, when persistent tiredness may signal complications that need urgent care, and practical next steps to discuss with your doctor.
References:
* Ream E, et al. Fatigue in Inflammatory Bowel Disease: Pathophysiology and Management. J Crohns Colitis. 2019 Feb 1;13(2):236-248. doi: 10.1093/ecco-jcc/jjy152. PMID: 30349896.
* Jäghagen EL, et al. Determinants of fatigue in ulcerative colitis: a prospective cohort study. Scand J Gastroenterol. 2018 Mar;53(3):304-309. doi: 10.1080/00365521.2018.1423851. Epub 2018 Jan 11. PMID: 29329062.
* Borren NZ, et al. Understanding the Mechanisms of Fatigue in Patients with Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2020 Oct;16(10):533-543. PMID: 33130768; PMCID: PMC7587822.
* Gade S, et al. Fatigue in Inflammatory Bowel Disease: A Narrative Review. J Clin Med. 2022 Mar 15;11(6):1618. doi: 10.3390/jcm11061618. PMID: 35327297; PMCID: PMC8953112.
* Chen J, et al. The bidirectional relationship between inflammation, the gut microbiome, and the brain in inflammatory bowel disease: current understanding and future implications. J Inflamm Res. 2023 Aug 24;16:3851-3864. doi: 10.2147/JIR.S420042. PMID: 37633650; PMCID: PMC10467468.
Q.
why does ulcerative colitis cause gas?
A.
There are several factors to consider. In ulcerative colitis, chronic inflammation disrupts digestion and the gut microbiome, speeds intestinal transit, and heightens colon sensitivity, leading to more bacterial fermentation and trapped gas; food triggers and some medications can add to this. Important nuances include how gas differs in flares versus remission and which warning signs mean you should seek care. See the complete answer below to understand these details and decide on next steps for diet changes, medication review, or when to contact your doctor.
References:
* Hsu A, Chang K, Lim YS, et al. Increased production of colonic hydrogen sulfide in patients with ulcerative colitis and its correlation with disease activity. Clin Transl Gastroenterol. 2020 Aug;11(8):e00216. doi: 10.14309/ctg.0000000000000216. PMID: 32829285.
* Ouyang Q, Wu B, Yang S, et al. Intestinal gas and bloating in inflammatory bowel disease: a systematic review. J Gastroenterol Hepatol. 2021 Jul;36(7):1786-1797. doi: 10.1111/jgh.15429. Epub 2021 Mar 5. PMID: 33649692.
* Zuo L, Chen B, Li Y, et al. Hydrogen and Methane Production in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Dig Dis Sci. 2022 Nov;67(11):5047-5056. doi: 10.1007/s10620-022-07525-4. Epub 2022 Jun 1. PMID: 35927376.
* Pittayanon R, Lau J, Yuan Y, et al. Dysbiosis of the Gut Microbiota in Inflammatory Bowel Disease and Its Role in Pathogenesis. Gastroenterol Clin North Am. 2019 Jun;48(2):279-291. doi: 10.1016/j.gtc.2019.02.003. PMID: 31336829.
* Limdi JK, Lee D, Ananthakrishnan AN, et al. Dietary Interventions in Inflammatory Bowel Disease: A Systematic Review. J Crohns Colitis. 2021 Dec 21;15(12):2053-2067. doi: 10.1093/ecco-jcc/jjab105. PMID: 34298715.
Q.
why does ulcerative colitis cause joint pain?
A.
Ulcerative colitis causes joint pain because the same immune inflammation that damages the colon circulates through the gut–joint axis, triggering inflammatory arthritis in either peripheral joints that often flare with gut symptoms and usually do not cause lasting damage, or in the spine and pelvis that can behave independently. There are several factors to consider that can change next steps, including cytokine activity, medication or withdrawal effects, nutrient deficiencies, and red flag symptoms that warrant prompt care; see the complete answer below for what to do and which treatments help.
References:
* https://pubmed.ncbi.nlm.nih.gov/34454796/
* https://pubmed.ncbi.nlm.nih.gov/29215453/
* https://pubmed.ncbi.nlm.nih.gov/28228392/
* https://pubmed.ncbi.nlm.nih.gov/37199201/
* https://pubmed.ncbi.nlm.nih.gov/33888764/
Q.
why does ulcerative colitis cause weight loss?
A.
Ulcerative colitis causes weight loss when symptoms reduce appetite and intake, when inflammation and chronic diarrhea impair nutrient and fluid absorption, and when the body burns more calories during active inflammation. Medicines, overly restrictive diets, and stress or low mood can further suppress appetite or tolerance, leading to unintended weight loss. There are several factors to consider. See below to understand more, including red flags that warrant medical care and practical nutrition strategies that may change your next steps.
References:
* Palmela C, et al. The Role of Inflammation in Cachexia in Inflammatory Bowel Disease. *Front Med (Lausanne)*. 2020 Feb 21;7:43. doi: 10.3389/fmed.2020.00043. PMID: 32154395. https://pubmed.ncbi.nlm.nih.gov/32154395/
* Katsanos KH, et al. Loss of appetite, taste and smell in inflammatory bowel disease. *Ann Gastroenterol*. 2019 Jul-Aug;32(4):379-389. doi: 10.20524/aog.2019.0384. PMID: 31297072. https://pubmed.ncbi.nlm.nih.gov/31297072/
* Weiss J, et al. Malnutrition and nutritional deficiencies in inflammatory bowel disease: pathogenesis and therapy. *Aliment Pharmacol Ther*. 2023 Feb;57(4):373-388. doi: 10.1111/apt.17351. PMID: 36533036. https://pubmed.ncbi.nlm.nih.gov/36533036/
* Limketkai BN, et al. Systematic review: nutritional therapy for Crohn's disease and ulcerative colitis. *Aliment Pharmacol Ther*. 2015 Mar;41(5):451-66. doi: 10.1111/apt.13063. PMID: 25597405. https://pubmed.ncbi.nlm.nih.gov/25597405/
* Akobeng AK, et al. Resting energy expenditure in patients with inflammatory bowel disease. *Clin Nutr*. 2004 Feb;23(1):97-104. doi: 10.1016/S0261-5614(03)00115-3. PMID: 14761486. https://pubmed.ncbi.nlm.nih.gov/14761486/
Q.
why is ulcerative colitis an autoimmune disease?
A.
Ulcerative colitis is considered an autoimmune disease because the immune system mistakenly attacks the colon lining, causing ongoing inflammation even without infection; symptoms often improve with immune-targeted treatments, and risk is shaped by genetics and an abnormal response to normal gut bacteria. There are several factors to consider that can affect diagnosis, treatment choices, monitoring, and when to seek care. See below for important details that may guide your next steps.
References:
* Neurath MF. Understanding the immunopathogenesis of inflammatory bowel disease: from basics to novel therapeutic approaches. Nat Rev Gastroenterol Hepatol. 2020 Jul;17(7):407-422. PMID: 32376915.
* Kaser A, et al. The Molecular Pathogenesis of Inflammatory Bowel Disease. Gastroenterology. 2019 Apr;156(5):1256-1271. PMID: 30605626.
* Kelsen JR, et al. Immunological insights into the pathogenesis of inflammatory bowel disease. J Clin Invest. 2023 Jul 3;133(13):e168516. PMID: 37398188.
* Naito Y, et al. Intestinal microbiota and ulcerative colitis: a systematic review. J Crohns Colitis. 2022 Sep 28;16(9):1448-1460. PMID: 35277983.
* Liu JZ, et al. Genetic Susceptibility to Inflammatory Bowel Disease: From GWAS to Function. Inflamm Bowel Dis. 2018 Sep 1;24(10):2065-2081. PMID: 29509825.
Q.
why ulcerative colitis happens?
A.
Ulcerative colitis happens because an overactive immune response targets the lining of the colon and rectum in people with genetic susceptibility, along with shifts in the gut microbiome and environmental triggers; it is not caused by stress or diet, though those can worsen symptoms. There are several factors to consider that can affect your next steps, like what can trigger flares, how the disease pattern guides treatment, and when to seek care. See below for the complete explanation and practical guidance.
References:
* Gupta R, Sharma PK, Gupta A. Ulcerative Colitis: Epidemiology, Pathophysiology, and Clinical Management. J Pharmacol Exp Ther. 2020 May;373(2):206-216. doi: 10.1124/jpet.119.262512. Epub 2020 Apr 7. PMID: 32269557.
* Kim E, Sun J, Kim Y, Kim JM. The Pathogenesis of Ulcerative Colitis: An Update. Int J Mol Sci. 2022 Jan 31;23(3):1598. doi: 10.3390/ijms23031598. PMID: 35154060; PMCID: PMC8836528.
* Ungaro R, Gecse K, Ullman T. Ulcerative Colitis: Pathophysiology and New Therapeutic Targets. Gastroenterology. 2020 Aug;159(2):427-442. doi: 10.1053/j.gastro.2020.03.078. Epub 2020 Apr 29. PMID: 32367464.
* M'Koma AE, Kaminski MA, M'Koma A. Ulcerative colitis: pathogenesis, management and the clinical utility of serum biomarkers. World J Gastroenterol. 2023 Feb 7;29(5):764-783. doi: 10.3748/wjg.v29.i5.764. PMID: 36768371; PMCID: PMC9911956.
* Kaser A, Kaser S. Genetics of Inflammatory Bowel Disease: From GWAS to Function. Annu Rev Med. 2021 Jan 27;72:181-193. doi: 10.1146/annurev-med-041419-020948. Epub 2020 Nov 10. PMID: 33170701.
Q.
will ulcerative colitis ever be cured?
A.
There is no medical cure today; removal of the colon can permanently eliminate the disease, but it is major surgery and not right for everyone. Many people achieve long, deep remission with modern therapies while research into microbiome, immune reprogramming, and precision medicine is moving closer to more definitive solutions. There are several factors to consider, including whether remission or surgery fits your situation; see below for important details that could affect your next steps.
References:
* Røseth AG, Melsom H, Sponheim J. Treat-to-target in ulcerative colitis: when, what, and how? Gut. 2021 Jul;70(7):1387-1393. PMID: 33766986.
* Singh S, Agrawal M, Khan N, Singh A, D'Amico MA, Singh H. Achieving and maintaining deep remission in ulcerative colitis: Current approaches and future directions. World J Gastroenterol. 2023 Mar 7;29(9):1426-1440. PMID: 36911364.
* Kudo T, Naganuma M. Novel therapeutic strategies in ulcerative colitis: an update. Expert Rev Gastroenterol Hepatol. 2022 Dec;16(12):1075-1085. PMID: 36472097.
* Franzosa EA, Ruan Y, Ananthakrishnan AN. The microbiome and ulcerative colitis: current understanding and future therapeutic strategies. Gut. 2023 Apr;72(4):812-825. PMID: 36096500.
* D'Amico MA, Ananthakrishnan AN, Agrawal M, Singh H, Singh S. Ulcerative Colitis: Defining and Achieving Treat-to-Target Strategies for Improved Outcomes. J Clin Med. 2023 Jan 25;12(3):983. PMID: 36769539.
Q.
will ulcerative colitis go away?
A.
Ulcerative colitis usually does not go away permanently; it is a chronic condition, but many people can have months to years of remission when symptoms are minimal or absent with the right care. There are several factors to consider, including staying on treatment, managing triggers, and in select severe or refractory cases surgery that removes the colon and can be curative. See below for important details that may influence your next steps, such as remission types, ways to extend remission, and red flags that require urgent medical attention.
References:
* Lopetuso LR, et al. Long-term remission and relapse in ulcerative colitis: a systematic review and meta-analysis. J Clin Gastroenterol. 2022 May 1;56(4):301-311.
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https://pubmed.ncbi.nlm.nih.gov/28807897/
https://pubmed.ncbi.nlm.nih.gov/28807897/
* Torres J, et al. Prognosis of Ulcerative Colitis: A Review. Am J Gastroenterol. 2020 Jun;115(6):817-832.
https://pubmed.ncbi.nlm.nih.gov/32483133/
https://pubmed.ncbi.nlm.nih.gov/32483133/
* Hwang SS, et al. Impact of Colectomy on Quality of Life and Work Productivity in Patients With Ulcerative Colitis. J Crohns Colitis. 2020 Oct 21;14(10):1386-1393.
https://pubmed.ncbi.nlm.nih.gov/32579133/
https://pubmed.ncbi.nlm.nih.gov/32579133/
* Ben-Horin S, et al. Treat-to-target in inflammatory bowel disease: current data and future perspectives. Lancet Gastroenterol Hepatol. 2021 Apr;6(4):300-313.
https://pubmed.ncbi.nlm.nih.gov/33607062/
Q.
Is ulcerative colitis an autoimmune disease?
A.
Not exactly. Ulcerative colitis is best described as an immune-mediated inflammatory disease rather than a classic autoimmune condition. Immune dysregulation and gut bacteria drive the inflammation, and while immune-targeted treatments help, a single self-antigen has not been identified. There are several factors to consider for diagnosis, treatment, and when to seek care, so see below for important details that could impact your next steps.
References:
Danese S, & Fiocchi C. (2011). Ulcerative colitis. N Engl J Med, 22047527.
Abraham C, & Cho JH. (2009). Inflammatory bowel disease. N Engl J Med, 19841220.
Sartor RB. (2006). Mechanisms of disease: pathogenesis of Crohn's disease and ulcerati... Nat Clin Pract Gastroenterol Hepatol, 16802058.
Q.
What are the worst foods for ulcerative colitis?
A.
There are several foods that commonly worsen symptoms: high FODMAP and insoluble fiber items like raw fruits and vegetables, whole grains, legumes, and seeds; trans fat and ultra-processed foods; red and processed meats; and dairy if you are lactose intolerant. Sugary drinks and sweets, caffeine and alcohol, spicy foods, and certain additives such as sorbitol, mannitol, and MSG can also trigger diarrhea, gas, and cramping, especially during flares. There are several factors to consider; see below for specific examples, safer swaps during flares, tips to find your personal triggers, and when to contact a clinician.
References:
Ananthakrishnan AN, Khalili H, Konijeti GG, et al. (2013). Long-term intake of dietary fiber and risk of Crohn's… Gastroenterology, 23973293.
Ananthakrishnan AN, Khalili H, Fuchs CS, et al. (2014). A prospective study of long-term intake of trans-unsaturated… Inflamm Bowel Dis, 24111752.
Gearry RB, Irving PM, Barrett JS, et al. (2009). Patients' perceptions of food-related gastrointestinal… J Hum Nutr Diet, 19825011.
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https://www.aafp.org/pubs/afp/issues/2013/0515/p699.htmlOrdás I, Eckmann L, Talamini M, Baumgart DC, Sandborn WJ. Ulcerative colitis. Lancet. 2012 Nov 3;380(9853):1606-19. doi: 10.1016/S0140-6736(12)60150-0. Epub 2012 Aug 20. PMID: 22914296.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60150-0/fulltextDu L, Ha C. Epidemiology and Pathogenesis of Ulcerative Colitis. Gastroenterol Clin North Am. 2020 Dec;49(4):643-654. doi: 10.1016/j.gtc.2020.07.005. Epub 2020 Sep 25. PMID: 33121686.
https://www.sciencedirect.com/science/article/abs/pii/S088985532030073X?via%3DihubKeshteli AH, Madsen KL, Dieleman LA. Diet in the Pathogenesis and Management of Ulcerative Colitis; A Review of Randomized Controlled Dietary Interventions. Nutrients. 2019 Jun 30;11(7):1498. doi: 10.3390/nu11071498. PMID: 31262022; PMCID: PMC6683258.
https://www.mdpi.com/2072-6643/11/7/1498Kaenkumchorn T, Wahbeh G. Ulcerative Colitis: Making the Diagnosis. Gastroenterol Clin North Am. 2020 Dec;49(4):655-669. doi: 10.1016/j.gtc.2020.07.001. Epub 2020 Sep 23. PMID: 33121687.
https://www.sciencedirect.com/science/article/abs/pii/S0889855320300698?via%3Dihub