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Ulcerative Colitis

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Colon Cancer

Although most patients with ulcerative colitis will not develop colon cancer, patients with ulcerative colitis are at a 2 to 5 fold increased risk of developing colon cancer compared to persons without ulcerative colitis. Researchers believe the increased risk of colon cancer is related to chronic inflammation in the colon. In order to detect colon cancer at an early stage, most patients with ulcerative colitis will need to undergo colonoscopies on a regular interval that is more frequent than for patients without ulcerative colitis. The risk of colon cancer may be even higher in individuals who have a condition of the liver called primary sclerosing cholangitis (PSC) or with family members who have had colon cancer. All patients with ulcerative colitis should discuss the timing and frequency of colonoscopy with their gastroenterologist.

Surgery

Most patients with ulcerative colitis will not require surgery. However, some patients may not respond to medications or have other severe symptoms that require removal of the colon. Removal of the colon is the closest thing to a "cure" for ulcerative colitis because unlike Crohn's disease, ulcerative colitis does not affect other parts of the digestive system and should not recur after complete removal of the colon. After removal of the colon, patients may require either an ostomy (bag) or reconstructive surgery, referred to as a "J-pouch" or ileal pouch-anal anastomosis (IPAA). The choice of these options is between the patient and the surgeon as each option has its' advantages and disadvantages.

Patients with ulcerative colitis may have symptoms in parts of their bodies outside of the digestive system.

Joints

There are forms of arthritis and back pain that are related to ulcerative colitis. Some of these conditions improve with medications for the digestive symptoms of ulcerative colitis. The use of over-the-counter pain medications such as ibuprofen, naproxen, and aspirin may increase the symptoms of ulcerative colitis. Patients with ulcerative colitis should speak with their gastroenterologist before using these medications.

Eyes

Some patients with ulcerative colitis develop inflammation in the eyes, called iritis or uveitis. Iritis may result in redness or eye pain and may fluctuate with the severity of the digestive symptoms of ulcerative colitis. Uveitis may result in severe eye pain and loss of vision. Patients with ulcerative colitis should see an eye doctor on a regular basis and report any changes in their vision to their doctor immediately.

Skin

There are two conditions related to ulcerative colitis, erythema nodosum and pyoderma gangrenosum. Erythema nodosum consists of painful red bumps under the skin that may develop when the ulcerative colitis flares; these lesions will often respond to the medication for ulcerative colitis. Pyoderma gangrenosum consists of skin ulcers that may form either with or without a flare of ulcerative colitis digestive symptoms.

Other Complications

Other complications of ulcerative colitis disease include kidney stones, a liver condition called primary sclerosing cholangitis (PSC), and malabsorption of vitamins and nutrients.

Ulcerative Colitis Can Raise Your Risk Of Cancer. Here's What To Know — And Do — About It

If you have ulcerative colitis (UC), you're probably aware that inflammation is to blame for many of your symptoms. But, what's less commonly known is that inflammation is also the likely culprit behind an increased risk of colorectal cancer.

People with inflammatory bowel disease, including ulcerative colitis, are about twice as likely to develop colorectal cancer compared to those without the disease, according to a study published in 2020 in the journal Gastroenterology.

Here's what happens in the body: When you have UC, your immune system mistakes the lining of your colon for a foreign body and attacks it, causing damage. As your body works overtime, trying to repair the damage, a mutation can occur, increasing your risk for colon or rectal cancer, according to MD Anderson Cancer Center.

"The greater the inflammatory burden, and perhaps the longer that a person with UC has ongoing inflammation, the greater the risk for developing colorectal cancer," says Edward L. Barnes, MD, a gastroenterologist and an assistant professor of medicine at the University of North Carolina in Chapel Hill.

What's more, if you're among the subset of people with UC who also develop primary sclerosing cholangitis — a rare condition that causes scarring in the bile ducts of the liver — your risk of colorectal cancer may be significantly higher.

In a study published in June 2023 in the International Journal of Colorectal Disease, just under 4 percent of people with UC developed primary sclerosing cholangitis. Those 4 percent were up to three times more likely to develop colorectal cancer and more than 36 times more likely to develop biliary tract or bile duct cancer (also called cholangiocarcinoma) than the general population, the researchers found.

Here's what else to know about colorectal cancer risk and what you can do about it.

There are steps you can take to reduce your risk of colorectal cancer. Among them:

Find a UC treatment that works. Newer medications for UC are enabling some people to achieve remission, Dr. Barnes notes. If your current treatment regimen isn't controlling your symptoms, talk to your doctor about exploring new options, he advises, both for "better symptom control and improved quality of life."

"We believe that treating inflammation in UC is very important," Barnes adds, citing research that shows greater inflammation may make it more likely that you'll develop the genetic mutation that causes colon cancer.

If you don't respond to medication, surgery is also an option. A procedure called a proctocolectomy involves removing your entire colon and rectum to eliminate UC.

In most cases, the surgeon will perform ileoanal anastomosis (J-pouch) surgery, in which they construct a pouch from the end of your small intestine and attached directly to your anus, allowing you to expel waste in the usual way, without a colostomy bag, according to Mayo Clinic.

Once you find an effective treatment, stick with it. Again, the objective is to reduce inflammation in the colon and rectum, which can be a breeding ground for cancer cells. Taking your medications as directed, whether they be anti-inflammatories for mild-to-moderate UC or immunosuppressants and/or biologics for more severe forms of the condition, is the best way to avoid "cumulative inflammation," or inflammation that builds up, damaging the health of the colon and rectum, Barnes says.

"The major way that we try to reduce the risk of colorectal cancer in patients with UC is better control of inflammation," he adds. "We hope that better control of UC will reduce their risk of developing colorectal cancer."

Maintain a healthy diet. A healthy diet can help you maintain your overall health, and it can help keep your UC symptoms — including inflammation — in check. Avoid foods that are high in fat or refined sugars, as well as dairy products, caffeine, alcohol, and raw fruits and vegetables, as these can trigger UC symptoms, according to the Crohn's & Colitis Foundation.

Exercise regularly. Exercise can help you manage many of the complications of UC, including reduced bone density and a weakened immune system, the latter of which can hinder your body's ability to stave off inflammation. If you have UC, try moderately intense exercise, such as swimming or biking, three or four days per week, the Foundation advises.

Get screened for cancer. Colorectal cancer can develop earlier in people who have IBD than in people without IBD, says Amosy Ephreim M'Koma, MD, a colon and rectal surgeon at Vanderbilt-Ingram Cancer Center in Nashville.

Essentially, this is because the cumulative inflammation in the colon seen with UC likely speeds up the development of the genetic mutations that cause cancer, Dr. Ephreim M'Koma says.

If you have UC, you should get a colonoscopy eight years after you were diagnosed with IBD, according to the ACS. You may need a follow-up colonoscopy every 1 to 3 years, depending on your risk factors and what the test finds.

If you have UC and are diagnosed with primary sclerosing cholangitis, get a colonoscopy as soon as possible and then every one to two years thereafter, MD Anderson Cancer Center advises.

This is called "surveillance colonoscopy," and your doctor will be "looking for any early signs of dysplasia or precancerous changes," Barnes explains. "The presence of dysplasia will often trigger changes in how we manage the patient's condition. Making sure that the patient is getting colonoscopies to try and identify these changes early, before they develop colorectal cancer, is a key point of managing the risk."

What To Know About Crypt Abscess In Ulcerative Colitis

Ulcerative colitis (UC) may cause crypt abscesses to form. Crypt abscesses occur when inflammatory cells accumulate in crypts, or pouches, inside the gastrointestinal system.

Ulcerative colitis is a form of inflammatory bowel disease (IBD). It occurs due to the immune system having an abnormal reaction that leads to inflammation and ulcers of the large intestine's inner lining.

UC can cause a person to experience diarrhea, blood in their stool, and abdominal pain.

This article will explore what crypt abscesses are and the type of crypt abscesses that may occur. It will also explore how crypt abscesses may occur in UC and other causes of crypt abscesses and their treatments.

The epithelial layer is the layer of cells that lines the organs, such as the large intestine and small intestine in the gastrointestinal (GI) tract. This layer folds back on itself to form a cavity or pouch, known as the crypt, which acts as a gland.

Crypt abscesses occur when there is a buildup of inflammatory cells within the crypts. The inflammatory cell accumulation can harm the surrounding cells and prevent the crypts from secreting substances and functioning effectively.

Small crypt abscesses may resolve less frequently on their own, while other types may require medication or surgical intervention.

Types of crypt abscesses

Two types of crypt abscesses may occur: neutrophilic and apoptotic.

Neutrophilic crypt abscesses contain white blood cells — neutrophils — that help the body fight infection. Apoptotic abscesses contain apoptotic cells that get rid of unneeded or abnormal cells, which is also known as programmed cell death.

In UC, inflammation normally begins in the rectum and progresses to the colon. Crypt abscesses form as a response to active inflammation. The abscesses are commonly neutrophilic in UC.

The destruction of the crypts can also cause the loss of the mucosal architecture, which leads to the colon becoming more rigid and short. It may take on a "lead-pipe" appearance.

When inflammation occurs with IBD, the crypts fill up with inflammatory white blood cells, including:

macrophages to remove dead and dying cells

neutrophils that attack bacteria

dendritic cells to produce immune responses against pathogens

natural killer T lymphocytes to destroy compromised cells

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