Ulcerative Colitis
IBD Patient Education

Doctors Who Treat Ulcerative colitis and IBD

As ulcerative colitis is diagnosed, treated and managed, you may encounter the following team of doctors and specialists listed below in this ulcer patient education guide (link back to main overview page with anchor text “ulcer patient education guide”). Having a team of doctors or specialists with varied expertise will more accurately help diagnose and treat your condition.

• General Practitioner – typically, a general practitioner or family doctor is the first healthcare provider consulted for evaluation since there is an ongoing professional relationship.

With a display of symptoms, specialists are then recommended and a team approach includes:

• Gastroenterologist – a physician who specializes in the health and conditions of the digestive system and digestive organs.
• Nutritionist - a healthcare professional who devises diet plans to maximize the health of the individual along with the appropriate vitamins and supplements.
• Holistic Practitioner – a healthcare professional who views the body as a whole, considering physical, mental and spiritual components. Herbs and nutritional supplements are considered in addition to meditation, cleansing, diet and exercise programs.

How to Prepare for Your Doctor Visit for Ulcerative Colitis

Having made your appointment with a healthcare provider, there are certain actions that you need to take in order to maximize the benefit of your doctor visit, listed below in this ulcerative colitis patient education guide.

It is recommended to bring the following information to your first doctor visit:

• List of symptoms with date of onset and foods consumed at that time, what makes the symptoms worse, and what improves them
• Record of any personal life changes (lost job, stresses, relationship problems)
• Inventory of all medications being taken
• Record of all past medical history and family history
• Friend or family member to act as an advocate
• List of questions to ask the healthcare provider

Inform the doctor if you might be pregnant or have latex allergies.

Preparation for Barium Enema

• For 1-3 days prior to the test, follow a clear liquid diet.
• Drink large quantities of noncarbonated clear liquids.
• Laxatives will be advised for intestinal emptying. This may include suppositories or enemas.

Preparation for Barium Swallow

• Eat a low-fiber diet for 2-3 days prior.
• No food, drink, or tobacco use after midnight on day of exam.

Questions to Ask Your Doctor About Ulcerative Colitis

From your initial IBD diagnosis throughout treatment and care, you will have questions about your ulcer condition. This ulcer patient education guide lists questions to discuss with the doctor so you can make informed treatment decisions.

Questions About My Diagnosis

• Are there any other conditions causing my symptoms?
• Can this be irritable bowel syndrome? What’s the difference between IBS and IBD?
• Can my medication be causing these symptoms?
• Does this make me prone to cancer?

Questions About My Treatment

• Are there medications that I can take for relief? Are there side effects?
• How soon after starting drugs will I see relief?
• Why did you choose this particular medication?
• If I do not take the medication, what will happen to me?
• Is this condition progressive? Can it be cured?
• Will I need surgery for this in the future?
• Are there medications that I should avoid?
• Is there a clinical trial that I am eligible for?

Questions About My Lifestyle and Family

• Is this hereditary? Can my children get this?
• Are there foods that I should avoid? Is there a special diet that I should follow?
• Must I avoid drinking alcoholic beverages? Can I smoke tobacco products?
• Are there special exercises that can help me?
• Is there a support group that I can join? Is there a web forum that I can join?

Common Tests or Labs to Diagnose Ulcerative Colitis

There are several conditions that must be distinguished from ulcerative colitis which have similar symptoms, including:

• Diverticulitis
• Irritable bowel syndrome (IBS)
• Crohn’s Disease which is another form of IBD
• Colon/intestinal cancer

The following tests are listed in this patient education guide to help differentiate ulcerative colitis or IBD from other conditions:

Test	Why Test?	What Happens?	Normal Result
Stool Sample	Detects any occult blood, parasites, bacteria, or viruses in feces, as well as digestive problems like malabsorption of fats, some sugars, and nutrients	Insert plastic wrap loosely across the toilet rim, under the seat. After the stool has then been passed onto this sheet, place the sample into a clean, dry container and seal well. The container should then be brought to the laboratory or doctor’s office as soon as possible.	No blood or abnormal culture growth detected
Sigmoidoscopy	Detects inflammation, ulcers, and abnormal growths in the sigmoid colon and rectum	You are asked to lie on your left side while on an exam table. The doctor inserts a flexible, lighted tube (sigmoidoscope) into your rectum and guides it slowly to the sigmoid colon, which is filled with air for proper viewing. A video image is obtained from a camera attached to the scope, which is also transmitted to a computer. Any polyps or abnormal tissue can be biopsied through the sigmoidoscopy. After satisfactory viewing, the scope is withdrawn slowly.	Clean, pink bowel mucosa seen with no growths, ulcers, or irregularities
Colonoscopy	Views large intestine to detect polyps, ulcers, growths, strictures, bleeding, and inflammation	A colon prep is advised for 1-2 days prior to the exam to clean out the bowels involving dietary restrictions that cause frequent stools. You will change into a gown after removing all clothes. Sedation is administered (usually intravenously) while you lie on your side on the examination table in a fetal position with knees drawn to your chest. The doctor inserts a long, flexible, lighted tube into the rectum and guides it slowly to the colon, which is filled with air for proper viewing. A video image is obtained from a camera attached to the scope, which is also transmitted to a computer. Any polyps or abnormal tissue can be biopsied through the colonoscope. After satisfactory viewing, the scope is withdrawn slowly. The procedure typically takes 20-60 minutes, but an additional hour is needed for recovery from the anesthetic.	Clean, pink bowel mucosa seen with no growths, ulcers, or irregularities
Capsule endoscopy	Visualizes the small intestine and helps distinguish causes of symptoms (especially when other tests are inconclusive)	Multiple adhesive patches are applied to the abdomen. Each patch has an antenna with wires connected to a recorder that is secured on a special waist belt. You will then swallow a camera capsule (which is the size of a large pill) with a glass of water. You may then resume normal daily functions and a light lunch or snack. As the capsule moves through the intestine, images are sent to an antenna on your abdomen, which transmits data to the recorder. This device collects and stores the transmitted images. The procedure takes 8 hours or when the capsule is seen in a bowel movement. The capsule can be flushed and then patches and recorder may be removed.	No polyps, growths, bleeding, or irregularities seen in the small bowel
Double balloon endoscopy	Detects any disease of the small intestine such as bleeding, tumors, and unexplained diarrhea	After lying on your left side on the exam table, intravenous sedation and pain medication is administered. The doctor inserts a thin, flexible tube through your mouth into the gastrointestinal tract. Balloons attached to the scope are inflated or deflated to permit dilation of the bowel and complete visualization. Biopsies can be performed during this procedure if needed. When visualization is complete and any bleeding is controlled, the tube is withdrawn and you are allowed to awaken, which usually takes one hour. The entire test takes 1-3 hours.	No active bleeding or irregularities seen in the small bowel
Barium enema	Used to investigate the cause of rectal bleeding, abdominal pain, chronic diarrhea, or change in bowel habits Detects abnormal growths or polyps in the colon, as well as diverticulitis and inflammation	After removing your clothing and donning a gown, you will lie on your side on an x-ray machine table. An x-ray is taken to ensure a clean colon. A lubricated enema tube is then inserted into the rectum which is connected to a barium bag that delivers the barium solution into the colon, lining the large intestine. If an air-contrast barium enema is requested, air is also inserted through the rectum for colon dilation for better image quality. A balloon near the tube tip is inflated to ensure that the barium does not leak out. You may be asked to shift your position so that the entire colon is uniformly coated. X-ray images are then obtained. The barium is removed through the tube, which is then also removed. The procedure usually takes 30-45 minutes.	Pink, regular mucosa with no growths, polyps, strictures, outpouching or inflammation
CT scan (computerized tomography)	Non-invasive test which visualizes internal organs, bones, blood vessels, and soft tissue Growths, strictures, bleeding, and irregularities are visualized	After lying flat on your back on the CT exam table, straps and pillows may be applied to maintain position. The table then moves through the scanner as images are obtained. The table may make several passes. The procedure takes approximately 30 minutes and is usually painless.	No abnormal growths or irregularities
MRI (magnetic resonance imaging)	Detects any masses, growths, strictures, or irregularities of soft tissue, internal organs, bones, and blood vessels	You lie on your back on a moveable table after removing your clothes and donning a gown. The table then glides into a tunnel-like machine. The magnet makes repetitive banging, tapping or thumping noises. To block this noise, earplugs or music is often provided. A microphone is also provided so that you can talk to the technician who is monitoring you from outside the room. Contrast medium may also be injected into your vein to highlight certain tissues. Light sedation may be given.	No tumors, growths, polyps, strictures, or irregularities seen

Common Medications and Treatments for Ulcerative Colitis

Treating ulcerative colitis depends on the extent and severity of the condition and involves management of symptoms and prevention of new episodes. If one is in remission (symptom-free), treatment other than diet modification may not be necessary.

Because there is not one diet that works for everyone, it is important to see which foods trigger your symptoms. Keeping a food diary will help pinpoint which foods are problematic so that they may be avoided.

Typically, foods associated with triggering symptoms of ulcerative colitis that should therefore be avoided include:

• Spicy foods
• Raw fruits and vegetables (high fiber content)
• Seeds and nuts
• Fried foods
• Fatty foods and red meat
• Caffeine (including chocolate)
• Alcoholic or carbonated beverages
• Milk products for those with lactose-intolerance

Nutritional supplements are given to improve normal growth development in children.

Treatment for mild to moderate symptoms

Treatment	How it Works
Antidiarrheal drugs	Treat frequent, loose, and watery stools by slowing the passage of stools through the bowels and absorbing substances that the body needs; also lessen fluid secretion into the intestine and inhibit bacterial action
Aminosalicylates	Relieve inflammation of the intestine
Corticosteroids	Decrease intestinal inflammation

Treatment for moderate to severe symptoms

Treatment	How it Works
Corticosteroids (higher dose)	Decrease intestinal inflammation
Immunomodulators	Prevent inflammation by suppression of the immune system and decrease the long-term need for corticosteroids
Biologics	Heal the intestinal lining

If severe, persistent intestinal symptoms linger despite treatment, other symptoms may occur such as fever and fluid depletion. Fluids and electrolyte replacement are given intravenously in the hospital.

If symptoms spiral out of control despite all treatment, bleeding and bowel perforation may occur, necessitating surgery. Fortunately, this is not common.

Written by Barbara Hales, M.D.