Can Ulcerative Colitis Cause Colon Cancer?

Cancer is a scary thing to think about when you’re attempting to maintain a healthy lifestyle with IBD. You may have heard that continuous inflammation in the gastrointestinal tract can lead to more serious complications, such as colon cancer. Ulcerative colitis does not necessarily “cause” colon cancer, however, the risk of being diagnosed with colon cancer does increase over time. Let’s take a deeper look at how and why this happens

Ulcerative colitis can increase the risk of colon cancer based on two factors:

1. Disease Duration
2. Area and Extent of Colon Affected

Disease Duration

If you have lived with ulcerative colitis for 8 to 10 years, the risk of developing colon cancer will begin to increase. The longer a patient lives with ulcerative colitis, the higher their chances of developing malignant tumors in the colon. Other factors, such as family history, can significantly increase these chances as well.

How Much of the Colon Is Affected

A patient suffering from ulcerative colitis will have an increased chance of colon cancer when the entire colon is affected. Risks are reduced when the disease impacts fewer areas of the large intestine. For instance, if only the lower colon and rectum are affected, the risk of cancer is no different from that of a person without ulcerative colitis.

Although most people with ulcerative colitis never develop colon cancer, it is important to recognize that if you fit the descriptions above, you should consult your doctor about appropriate prevention methods. Annual colonoscopies and screenings are essential for catching early signs of cancer. They also offer a greater chance for recovery if your gastroenterology team finds cancerous tumors or cells. If you have lived with the disease for eight or more years, then it is vital that you ask for a precautionary examination during your next doctor visit.

Steroids and IBD: Not Recommended For Long-Term Treatment

IBD is a chronic condition with a relapsing and remitting course. It often requires long-term immune suppressive or anti-inflammatory medications to keep the disease in check. Despite the widespread use of newer and better medications that keep the disease at bay, disease flares still occur. These flares are often treated with steroids, such as prednisone. These steroids are not the same as anabolic steroids, which are typically used by athletes. Even though steroids work well at suppressing inflammation in the short term, they have a lot of side effects and are not recommended for long-term use. Steroids and IBD are not the perfect mix; they can cause a great number of side effects, which, if used long-term, could cause a patient severe trauma and complications. Some of these side effects that may occur are:

• Insomnia
• Acne
• Mood fluctuations
• Elevated blood sugar levels
• Joint pain
• Bone loss
• Stretch marks
• “Buffalo Hump” forming on back
• Weight gain
• Fragile skin

In addition to these side effects, they carry an increased risk of infections, particularly gastrointestinal infections, such as clostridium difficile (CDF) and cytomegalovirus (CMV), among others.  These infections may mimic symptoms of an IBD flare and the flu. Prompt recognition of these infections is important for timely symptom control.

If you are wondering what options are available to help reduce flares and promote a healthy lifestyle with IBD, consider asking your doctor about these natural alternative treatments. 

Crohn's Disease and Pregnancy: Some Important FAQs

You may be wondering if IBD can impact your ability to get pregnant and start a family. There are several facts to consider when it comes to making such an important decision with your spouse,, particularly when it comes to Crohn's disease and pregnancy. Here you will find a compiled list of frequently asked questions regarding pregnancy and Crohn’s disease. Keep in mind: everyone is different, so it is important to talk with your gastroenterologist and obstetrician about this information or any additional questions you may have. “Will I be able to get pregnant?”

In order to answer this question, you need to ask yourself if your IBD is currently active. Recognizing whether you are in remission or experiencing active flare-ups can help further determine the complexity of becoming pregnant. Women with IBD in remission can get pregnant as easily as any other woman their age. However, women with active IBD or who have had surgery previously in their pelvis, may struggle.

“What if my significant other has IBD?”

If your male spouse has IBD, his fertility level will not be impacted. However, your spouse should be cautious about taking certain medications. Sulfasalazine (Azulfidine®) has been reported to reduce sperm count and quality. Seek a doctor’s approval before switching to another 5-ASA compound treatment.

“Will my child be born with IBD?”

No, not necessarily. If both parents have IBD, a baby has a 1 in 3 chance of developing IBD. On the other hand, chances significantly change if only one parent has Crohn’s disease. In this case, there is a 9% chance of a baby adopting the condition.

“How will pregnancy affect my IBD symptoms?”

Perhaps surprisingly, pregnancy often has a positive effect on Crohn’s disease. Since pregnancy naturally calms the immune system to protect the fetus, it reduces IBD symptoms. Also, pregnant women release the hormone relaxin, which stops premature contractions of the uterus. This aspect of pregnancy may reduce the need for surgery in the future, as well as future flare-ups.

“Are my medications harmful to my baby?”

There are particular medications that pregnant women should be mindful of. The drug methotrexate is extremely harmful to fetuses and newborns. Men should avoid taking methotrexate at least three months prior to conception. Women should also not take methotrexate within three to six months before getting pregnant. Women should continue to not take methotrexate during pregnancy or while breastfeeding.

IBD In Children Is On the Rise

IBD is commonly known as an “adult condition.” So why has there been a significant increase in the number of children diagnosed with IBD? According to the Crohn’s & Colitis Foundation of America (CCFA), about 100,000 children under the age of 18 have been diagnosed with this lifelong disease in the United States. This rate has approximately doubled over the past 10 years. Pediatricians have now, more then ever, become more attentive to properly identifying IBD in young patients. Does IBD affect a child’s life?

Simply put, yes. Along with the burden of symptoms that stem from IBD, children are affected in other ways as well. A child’s education can be impacted as a young person suffering from severe symptoms could miss a significant amount of school days. Serial absences could lead to questions from teachers and classmates, who may not understand IBD or may be unsympathetic to your child’s health issues. These reactions could negatively affect your child’s self-esteem and reduce their desire to return to school.

IBD also affects a child’s growth pattern. Growth impairment and poor linear growth is frequently observed among IBD patients under the age of 16 with Crohn’s disease and ulcerative colitis. According to the CCFA, approximately one-third of children with Crohn’s disease and one-tenth of children with ulcerative colitis have a less than average adult height because of their IBD. Some children also experience difficulties in gaining weight while others tend to be overweight and obese.

How can the effects of IBD be minimized?

Proper nutrition is key. Paying close attention to nutritional intake is essential to staying healthy. It is important that your child eats foods that are beneficial for growth, while avoiding items that may cause IBD symptoms to act up. In addition, growth hormones are an option for children who experience slow maturity. Anti-inflammatory medications are another alternative that can help reduce symptoms. If a child and their parents work hard to properly manage an IBD diagnosis, they will have the best opportunity to live a regular lifestyle.

IBD Research and How You Can Get Involved

As troubling as IBD is for more than 1.4 million patients in America, it is a disease that continues to stump scientists and researchers. What causes inflammatory bowel disease? Is it heredity or viral?  What are the most beneficial treatments? These are a few of the questions that medical professionals continue to seek evidence and answers for. Fortunately, for doctors and patients, research has come a long way. Here’s what we do know:

• A reaction occurs between the genes in people suffering from Crohn’s and colitis.
• When in contact with an unidentified environmental agent, such as bacteria, an abnormal immune response results.
• Genetics, the environment, and the immune system are factors that play a role in the longevity of IBD.

Although medications exist to help treat the effects of IBD, doctors have yet to discover a cure. If you are suffering from IBD, do not worry! You are definitely not alone. There are several organizations that connect patients with leading medical professionals, provide a supportive community, and work tirelessly to aggregate new information about IBD. To learn more about inflammatory bowel disease, the newest research advancements, and how you can get involved in finding a cure, check out the organizations below:

Crohn’s & Colitis Foundation of America, CCFA, is a not-for-profit organization focused on finding cures for Crohn’s Disease and Ulcerative Colitis. With over 50,000 members based in 40 chapters nationwide, there is plenty of hope for the future of IBD. As hosts of the 2013 “Advances in IBD: Crohn's & Colitis Foundation's Clinical and Research Conference," CCFA gathers together healthcare professionals and researchers who study and manage patients with inflammatory bowel diseases. You can support IBD research by making a donation to the organization or volunteering with a local chapter.

The American Gastroenterological Association is an organization that acts as the “voice of the GI community.” This national association of over 16,000 members is a resource filled with valuable knowledge on the advancements of gastroenterology. During each annual meeting, researchers and physicians gather to discuss important issues and new discoveries on digestive disease research. Support the organization by becoming a member and making a donation to the AGA Research Foundation or political action committee.

3 Natural IBD Treatments You Should Know About

Many patients often overlook the benefits that natural remedies can provide. There are several items that can be purchased from natural food stores that aid in reducing the ailments caused by inflammatory bowel diseases. In the list below we have identified and demystified three alternative medicines that have been tested to treat IBD. Read on to find out whether or not these natural IBD treatments are a good fit for you. Probiotics: Ulcerative colitis consists of an imbalance of bacteria in the digestive system; scientists believe that the use of probiotics can help balance out the amount of bacteria present in the intestines. Probiotics act as “good” bacteria that can potentially fight the disease, ultimately maintaining stability and restoring intestinal balance. Probiotics are found in foods, especially yogurt and milk, and come in several forms including powders, capsules, and tablets.

Fish Oil: Filled with high doses of omega-3 fatty acids, fish oil acts as an anti-inflammatory agent that can benefit patients suffering from Crohn's disease. While fish oil capsules are an option, you can also try incorporating cold-water fish, such as salmon or herring, into your diet 2-3 times per week. Not a fish lover? Fish oil can also be found in some nuts and green vegetables. Unfortunately, fish oil studies have been unsuccessful in proving beneficial results for people with ulcerative colitis.

Aloe Vera: Known for having anti-inflammatory properties, aloe vera juice has been proven to reduce symptoms in some patients with mild-to-moderate ulcerative colitis. On the other hand, scientists are struggling to support this claim with a sufficient amount of strong evidence to say aloe vera is purely beneficial. The laxative effect of aloe vera juice is something patients should be aware of when ingesting; aloe vera also possesses some “immune booster” qualities that may cause painful abdominal cramps or disrupt an already overactive immune system.

Remember, natural treatments can have side effects too, so it is important that you discuss these alternatives with your doctor before testing them out.

Becker's ASC Review Article: Creating an IBD Collaborative System of Care

Our very own Dr. Denmark was recently interviewed by Becker's ASC Review on the topic of establishing a IBD collaborative system of care. Discussing topics like research, patient transition, and shared decision-making, Dr. Denmark shares in this article the six key elements for creating a multidisciplinary approach to treating IBD. You can view the full article here.

beckers asc review of gastroenterologist vera denmark discussing IBD collaborative system of care

10 Foods to Ditch From Your Diet If You Have IBD

Though eating certain types of foods does not cause Inflammatory Bowel Disease (IBD), there are some delectables that can exaggerate symptoms, ultimately making pains and flare-ups even worse. Certain foods in your diet and IBD just don't mix. These are usually foods that are hard to digest, high in fiber (e.g. beans), or have rough exteriors (e.g. unpeeled apples). Each individual will react differently to the foods we have listed. Below is a list of foods to consider steering clear of. It is important that you understand what personally works for your body and which foods on our list are acceptable for you.

Foods to Avoid for Crohn’s disease

1. Nuts
2. Fruit with skin
3. Popcorn
4. Fried Foods
5. Seeds
6. Tomatoes
7. Chocolate
8. Coffee & Carbonated Beverages
9. Alcohol
10. Dairy

Foods to Avoid for Ulcerative Colitis

1. Beans
2. Coffee and Tea
3. Dairy
4. Broccoli
5. Seeds
6. Corn and Mushrooms
7. Fatty Meats
8. Chocolate
9. Alcohol
10. Nuts

Treating IBD the Right Way

For patients suffering from these symptoms, IBD treatment is of the utmost importance. Several options exist to help reduce intestinal inflammation and minimize symptoms. We have provided some helpful tips that can be implemented into a treatment regimen.

Analyze your personal situation for proper IBD management. How a patient chooses to treat IBD should be based on personal diagnosis. Each condition is different and requires an individualized treatment plan. Guidelines will depend on severity, disease location, condition, and symptoms.

Review and consider dietary changes to incorporate into your diet. In order to minimize IBD symptoms, dietary modifications are often recommended. Eating less fiber rich foods can help reduce symptoms because they are easier to digest. Like any other diet, but especially one with IBD, vitamins and fluids are essential to nourishing the body. For more dietary tips on minimizing symptoms, refer to these guidelines.

Know that different medications offer various solutions. There are quite a few oral medications that exist that can help modulate symptoms, however some are disease-specific. Aminosalicylates are defined as anti-inflammatory agents whereas antibiotics only work for Crohn’s disease patients. For more information on other medications that are used to treat IBD, please read our resources page.

These options are only a few of the various treatment alternatives that exist. Although every case is unique, the treatment goals remain the same: to improve and maintain the well-being of patients while reducing dependence on steroids.

IBD vs IBS: What's the Difference?

IBD vs IBS. Are they really one in the same? Although they start with the same letters, IBD and IBS are actually two different conditions. Irritable Bowel Syndrome (IBS) is classified as a functional gastrointestinal disorder or syndrome, while Inflammatory Bowel Disease (IBD) is actually classified as a disease.

Reading the Right Signs

The reason why many people confuse IBD and IBS is because both conditions have similar warning signs and symptoms. However, it is important to recognize what the differences are in order to find an appropriate treatment.

IBS: The symptoms of IBS include abdominal pain, diarrhea, constipation, cramping, bloating and gas. Although these are symptoms anyone might experience on occasion, a person with IBS can experience an exceptional amount of discomfort and distress, hindering their daily life.

IBD: The symptoms of IBD can be a bit more serious. For starters, rectal bleeding is an indicator of IBD. Unlike IBS, bleeding and weight loss may occur in addition to the abdominal pains and diarrhea. Permanent harm and damage on the intestines are the risks at stake. IBD has also been connected to iron deficiency due to blood loss.

One of the most obvious differences between the two conditions is noticeable when examining the colon. The colon of a patient with IBS shows no abnormalities. Although the digestive tract appears normal, it actually fails to function properly. A person suffering from IBD, however, suffers from a more damaged digestive system. The intestines are in fact inflamed in IBD, hence the term “inflammatory,” and abnormalities are present in a colonoscopy or x-ray.

Also Know As…AKA

IBS is also known as spastic colon (spastic colitis), spastic bowel, or mucous colitis. These names are related to the way the intestines “act up”, “become spastic” and digest substances improperly.

IBD, on the other hand, consists of two different conditions: Ulcerative Colitis (UC) and Crohn’s Disease (CD). Ulcerative Colitis is a chronic disease of the large intestine, identified when inflammation occurs and tiny open sores, or ulcers, form on the surface of the colon. This results in bleeding and mucus.  Crohn’s disease is also an ongoing condition that causes inflammation of the digestive tract, involving any area of the gastrointestinal tract, but most commonly the small intestine and the colon. The key differences between the two IBD disorders are location and the severity of inflammation.

Unfortunately, there are mixed views on what causes IBD, and the causes of IBS are still not fully understood. Some blame IBD on genetics, while others believe stress is the cause for IBS. Nonetheless, a definitive cure does not exist for either condition.

Inflammatory Bowel Disease Medication Options

Fortunately for those who have IBD, there are a variety of treatment options available that help reduce and sometimes even completely repress IBD symptoms. In additional to nutritional guidance and emotional support, there are many inflammatory bowel disease medications available, depending on how severe the inflammation is in each patient. These IBD medications can be grouped into the following four categories.

1. Anti-Inflammatory IBD Medications

These kinds of drugs tend to be the first step in the IBD treatment process. They can be greatly effective in reducing IBD symptoms, but some have been known to cause unpleasant - though generally mild - side effects. Mesalamine (an anti-inflammatory compound), however, tends to be very well tolerated, and is available in both oral and rectal (enemas and suppositories) forms. While both are considered effective in the treatment of mild to moderate ulcerative colitis, some have questioned its efficacy in treating Crohn's disease.

2. Steroids

Steroids are often used as an IBD medication for the short-term treatment of inflammation in patients with both ulcerative colitis and Crohn's disease. When used long-term for IBD treatment, steroids can result in elevated blood sugars, mood swings, and insomnia (among other things), so this is usually only recommended for treatment in those with especially severe inflammatory bowel disease who aren't responding to other medications. Though previously more widely-used, steroid alternatives that keep patients symptom-free without the side effects have been introduced over the past 10 years.

3. Immunomodulators

This type of IBD medication works by inhibiting the division of white blood cells that are the cause of uncontrolled inflammation, targeting the immune system rather than directly treating the inflammation itself (as anti-inflammatory drugs do). Immunomodulators are proven to work well in patients with Crohn's disease (efficacy is less clear in treating ulcerative colitis), especially those who are trying to transition out of short-term steroid therapy. However because of some of the more serious potential side effects, IBD treatment with immunomodulators requires frequent monitoring of liver function and white blood cell count.

4. Anti-TNFα Agents

This IBD medication works differently from the other drugs mentioned here, and is considered one of the most effective treatment options for controlling IBD symptoms. Anti-TNFα drugs are chemically engineered antibodies that allow for attacking TNFα, a chemical produced by activated white blood cells in the intestine of patients with IBD. This treatment goes directly to the source to reduce inflammation.

So which IBD medication is right for you? The answer depends on a variety of factors. Your symptoms, the severity of your symptoms, personal patient preferences, and past medical history all come into play. There are even a variety of new drugs available that use completely different approaches to attack IBD symptoms - Vedolizumab, for example, selectively blocks the movement of disease-causing T cells into the gut - so determining the best medical therapy for an individual patient comes down to a series of in-depth discussions with your doctor.

Pay Attention To These IBD Symptoms

Inflammatory Bowel Disease (IBD) is a broad term used to describe several conditions, and as such, IBD symptoms can vary depending on the specific condition a person has. While IBD isn't usually life-threatening, its various conditions can cause some unpleasant complications; bowel obstruction, ulcers, anal fissure, and colon cancer, just to name a few. Therefore, its extremely important that anyone with unexplained gastrointestinal issues pay close attention to their symptoms so that diagnosis and effective treatment can take place.

Ulcerative Colitis Symptoms

The two main conditions which fall under the IBD umbrella are ulcerative colitis and Crohn's disease. IBD symptoms that can indicate the former include:

• Rectal bleeding
• Rectal pain
• Frequent, small bowel movements
• Bloody diarrhea
• Abdominal cramps and pain
• Unintended weight loss
• Tenesmus
• Fatigue

Additionally, there is a rare form of ulcerative colitis that can be associated with much more severe symptoms. Known as Fulminant colitis, symptoms of this condition include severe pain, profuse diarrhea and, sometimes, dehydration and shock.

Crohn's Disease Symptoms

Although Crohn's disease involves a different part of the digestive tract, many Crohn's disease symptoms are similar to the symptoms of ulcerative colitis:

• Diarrhea
• Abdominal pain and cramping
• Blood in your stool
• Reduced appetite and weight loss
• Fever
• Fatigue

ibd symptoms

Tracking Your IBD Symptoms

If you're experiencing any of these symptoms, know that knowledge is power, and the more detail you know about your IBD symptoms, the better. Both for yourself and your doctor, keeping track of the following can be incredibly beneficial for IBD treatment:

1. Observe the characteristics of your bowel movements It's not always the most comfortable of conversations to have, but it will come up when you visit a gastroenterologist. For some, it can be helpful to refer to the Bristol stool chart when beginning this process.

2. Pay close attention to aches, pains, and any other irregular health symptoms Even mild aches and pains that you may normally shrug off can provide helpful clues into your IBD diagnosis. Since it can be hard to remember every detail, writing down any and all symptoms, including the date, time of day, and length of time can be tremendously helpful. Because IBD can cause joint pain and skin problems, its important to keep track of anything you notice, even if it doesn't seem like an IBD-related symptom.

3. Keep a food and appetite diary Writing down what you eat not only helps you and your doctor learn which foods ease your symptoms, but can also help distinguish between Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD). Tracking your appetite is important also, since unexplained appetite loss can be an important signal in the IBD diagnosis process.

More than 1 million people in the US alone are reported to have IBD, but with an effective diagnosis and treatment program, many live normal, active lives. However paying attention to potential IBD symptoms is the first step.

Your Body and IBD

When you’re living with IBD, eating can be a constant struggle. Dairy products and high-fat foods are the most common triggers, but even certain fruits and vegetables can irritate your IBD. With such sensitivity to everyday foods, it can be difficult to get the proper nutrition that your body needs. Some people try to find a “one-size-fits-all” diet plan for living with IBD, but the fact is – there’s no such thing. Two people that both have IBD can experience very different symptoms and triggers. To figure out an IBD nutrition plan that’s right for you, start with these three easy steps:

1. Keep a Food Diary

Write down what you ate, how much you ate, and what time you ate. Note any symptoms you felt after eating, and the time they occurred. If you notice that certain foods are making your symptoms worse, adjust your portions. If the symptoms persist, talk to your doctor about these foods.

2. Choose Healthy Substitutes

If you’re having a flare-up, your first instinct may be to avoid any food that you think might irritate your IBD. But instead of cutting out whole food groups, try making some simple substitutions, and notice how this affects your symptoms. Opt for lactose-reduced milk instead of whole milk. Eat meats that are low in fats. Try to cook your vegetables a different way.

3. Get the Nutrients You Need

Having IBD can make it difficult to get all of the nutrients your body needs from the food you’re eating, so adding vitamin and mineral supplements to your diet can be a big help. If your IBD is making it difficult to stay at a healthy weight, try drinking high-calorie liquid supplements. If your diet feels too limited, talk with a dietician.

Living with IBD isn’t always easy, and even though many people suffer from this illness, everyone’s body reacts differently. These tips will help you figure out the best IBD diet plan for you.