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Ulcerative Colitis

Related Terms

  • Inflammatory Bowel Disease (Ulcerative Colitis, Crohn's Disease)
Ulcerative colitis is a disease of the colon that is closely related to Crohn's disease . The two are grouped in a category called inflammatory bowel disease (IBD) , because they both involve inflammation of the digestive tract.
The major symptoms of ulcerative colitis include abdominal pain and bloody diarrhea. When the disease becomes severe, individuals may develop fever, weight loss, dehydration, and anemia. Sometimes, constipation develops instead of diarrhea. Arthritis, skin sores, and liver inflammation may occur as well.
One of the most feared consequences of ulcerative colitis is dramatic dilation of the colon, which can lead to fatal perforation of the colon. Ulcerative colitis also leads to a greatly increased risk of colon cancer.
Ulcerative colitis tends to wax and wane, with periods of remission punctuated by severe flare-ups. Medical treatment aims at reducing symptoms and inducing and maintaining remission.
Sulfasalazine is one of the most common medications for ulcerative colitis. Given either orally or as an enema, it can both decrease symptoms and prevent recurrences. Corticosteroids , such as prednisone, are used similarly in more severe cases, sometimes combined with other immunosuppressive drugs, such as azathioprine and cyclosporine . Partial removal of the colon may be necessary in severe cases.

Principal Proposed Natural Treatments

People with ulcerative colitis can easily develop deficiencies in numerous nutrients. Chronic bleeding leads to iron deficiency. Malabsorption, decreased appetite, drug side effects, and increased nutrient loss through the stool may lead to mild or profound deficiencies of protein, vitamins A , B 12 , C , D , E , and K , folate , calcium , copper , magnesium , selenium , and zinc . 1-10 If you have ulcerative colitis, supplementation to restore adequate body stores of these nutrients is highly advisable and may improve specific symptoms as well as overall health. We recommend working closely with your physician to identify any nutrient deficiencies and evaluate the success of supplementation in correcting them.

Essential Fatty Acids

Fish oil and evening primrose oil contain healthy fats called essential fatty acids. According to some, though not all, of the small, double-blind, placebo-controlled trials reported, fish oil might be helpful for reducing symptoms of active ulcerative colitis. 11-15 Evening primrose oil has also shown promise. 18 However, larger studies will be necessary to discover for certain whether fish oil or evening primrose oil really help.
Regular use of fish oil alone, or in combination with gamma-linolenic acid (found in evening primrose oil), has not been found effective for preventing disease flare-ups in people whose ulcerative colitis has gone into remission. 16,17,35
For more information, including dosage and safety issues, see the Fish Oil and Evening Primrose Oil articles.

Probiotics

Friendly bacteria, or probiotics, might be helpful in ulcerative colitis.
A double-blind trial of 116 people with ulcerative colitis compared probiotic treatment against a relatively low dose of the standard drug mesalazine. 19 The results suggest that probiotic treatment might be equally effective as low-dose mesalazine for controlling symptoms and maintaining remission. Evidence of benefit was seen in other trials, as well. 20,40,45,47 For example, a 2011 review of 4 randomized trials with a total of 587 patients seemed to support the use of probiotics to reduce the relapse rates in people with ulcerative colitis. 49 The authors, though, pointed out the need for better designed trials.
Probiotics may be less useful for inducing remission; when they were added to standard medications used for induction of remission, no additional benefits were seen in a study of people with mild-to-moderate ulcerative colitis. 45
Probiotics might be useful for people with ulcerative colitis who have had part or all of the colon removed. Such individuals frequently develop a complication called "pouchitis," inflammation of part of the remaining intestine. Two double-blind, placebo-controlled studies found that probiotics can help prevent pouchitis and also reduce relapses in people who already have it. 21,38 The probiotic mixture used in these trials contained four strains of Lactobacillus , three strains of Bifidobacterium , and one strain of Streptococcus salivarius .
In addition, some evidence hints that probiotics might reduce the joint pain that commonly occurs in people with inflammatory bowel disease. 41
For more information, including dosage and safety issues, see the Probiotics article.

Aloe

In a double-blind, placebo-controlled trial, 44 people hospitalized with severe active ulcerative colitis were given oral aloe gel or placebo twice daily for 4 weeks. 39 The results showed that aloe was more effective than placebo in inducing full or partial remission of symptoms.
For more information, including dosage and safety issues, see the full Aloe article.

Other Proposed Natural Treatments

Researchers have recently become interested in the use of phosphadylcholine as a supportive treatment in severe ulcerative colitis. There may be an insufficient quantity of phosphatidylcholine in the mucus lining the colon in patients with ulcerative colitis. Taking phosphatidylcholine may correct this deficiency. A small double-blind, placebo controlled study of 60 patients whose ulcerative colitis was poorly responsive to corticosteroids were randomized to receive either phosphadylcholine (2 g per day) or placebo for 12 weeks. 31 Half of the participants taking phosphadylcholine showed a significant improvement in symptoms versus only 10% taking placebo. Moreover, 80% taking phosphadylcholine were able to completely discontinue their corticosteroids without disease flare-up compared to 10% taking placebo.
A double-blind, placebo-controlled study of 24 people with ulcerative colitis examined the effects of wheat grass juice taken at a dose of 100 cc daily for one month. 36 According to various measures of disease severity, participants given wheat grass juice improved to a greater extent than those given placebo. However, wheat grass juice is rather bitter, and it seems unlikely that the study could truly be blind, meaning that participants and doctors didn’t know who was getting the wheat grass juice and who was getting the placebo. Indeed, when researchers polled the participants, a majority of those given wheat grass juice correctly identified it. For this reason, as well as its small size, the results of the study are not convincing.
The substance curcumin (from the spice turmeric) has shown some promise for helping to maintain remission. In a double-blind, placebo-controlled study, 89 people with quiescent ulcerative colitis were given either placebo or curcumin (one gram twice daily) along with standard treatment. 43 Over the 6-month treatment period, relapse rate was significantly lower in the treatment group as compared to the placebo group.
Glutamine , 22-25boswellia , 26bromelain , 27blue-green algae , 28colostrum , 37 and mesoglycan (glycosaminoglycans), and an an extract of soy called Bowman-Birk inhibitor concentrate (BBI) 44 have been suggested for the treatment of ulcerative colitis, but the evidence that they work remains preliminary at best.
Researchers have also studied the herb andrographis as a potential treatment for ulcerative colitis. In one trial, 120 people with ulcerative colitis were randomized to andrographis extract (400 mg, 3 times daily) or the medication mesalazine (1,500 mg, 3 times daily). 48 After 8 weeks of treatment, the two groups had similar results.
In a randomized trial of 224 patients with ulcerative colitis, patients were randomized to 1,200 mg or 1,800 mg of andrographis a day, divided into three doses, compared to placebo. Significantly more patients taking the higher dose showed a clinical response, but not a clinical remission, compared to patients taking the placebo. Patients on the lower dose of andrographis showed no significant benefit.50
There are also weak indications that allergies to foods, such as milk, may play a role in ulcerative colitis. 29-34
One study failed to find real acupuncture more effective than fake acupuncture for this condition. 42

Herbs and Supplements to Use Only With Caution

Various herbs and supplements may interact adversely with drugs used to treat ulcerative colitis. For more information on this potential risk, see the individual drug article in the Drug Interactions section of this database.

References

1 Striola GC, Restrainer C, Lecis PE, et al. Altered plasma and mucosal concentrations of trace elements and antioxidants in active ulcerative colitis. Scand J Gastroenterol. 1998;33:644-649.

2 Mortensen PB, Abildgaard K, Fallingborg J. Serum selenium concentration in patients with ulcerative colitis. Dan Med Bull. 1989;36:568-570.

3 Dronfield MW, Malone JD, Langman MJ. Zinc in ulcerative colitis: a therapeutic trial and report on plasma levels. Gut. 1977;18:33-36.

4 Elsborg L, Larsen L. Folate deficiency in chronic inflammatory bowel disease. Scand J Gastroenterol. 1979;14:1019-1024.

5 Krasinski SD, Russell RM, Furie BC, et al. The prevalence of vitamin K deficiency in chronic gastrointestinal disorders. Am J Clin Nutr. 1985;41:639-643.

6 Bischoff SC, Herrmann A, Goke M, et al. Altered bone metabolism in inflammatory bowel disease. Am J Gastroenterol. 1997;92:1157-1163.

7 Dibble JB, Sheridan P, Losowsky MS. A survey of vitamin D deficiency in gastrointestinal and liver disorders. Q J Med. 1984;53:119-134.

8 Mulder TP, van der Sluys Veer A, Verspaget HW, et al. Effect of oral zinc supplementation on metallothionein and superoxide dismutase concentrations in patients with inflammatory bowel disease. J Gastroenterol Hepatol. 1994;9:472-477.

9 Ainley CC, Cason J, Carlsson LK, et al. Zinc status in inflammatory bowel disease. Clin Sci (Colch). 1988;75:277-283.

10 Halsted CH, Ghandi G, Tamura T. Sulfasalazine inhibits the absorption of folates in ulcerative colitis. N Engl J Med. 1981;305:1513-1517.

11 Aslan A, Triadafilopoulos G. Fish oil fatty acid supplementation in active ulcerative colitis: a double-blind, placebo-controlled, crossover study. Am J Gastroenterol. 1992;87:432-437.

12 Almallah YZ, El-Tahir A, Heys SD, et al. Distal procto-colitis and n-3 polyunsaturated fatty acids: the mechanism(s) of natural cytotoxicity inhibition. Eur J Clin Invest. 2000;30:58-65.

13 Stenson WF, Cort D, Rodgers J, et al. Dietary supplementation with fish oil in ulcerative colitis. Ann Intern Med. 1992;116:609-614.

14 Hawthorne AB, Daneshmend TK, Hawkey CJ, et al. Treatment of ulcerative colitis with fish oil supplementation: a prospective 12-month randomised controlled trial. Gut. 1992;33:922-928.

15 Greenfield SM, Green AT, Teare JP, et al. A randomized controlled study of evening primrose oil and fish oil in ulcerative colitis. Aliment Pharmacol Ther. 1993;7:159-166.

16 Hawthorn AB, Daneshmend TK, Hawkey CJ, et al. Treatment of ulcerative colitis with fish oil supplementation: a prospective 12-month randomised controlled trial. Gut. 1992;33:922-928.

17 Loeschke K, Ueberschaer B, Pietsch A, et al.n-3 fatty acids only delay early relapse of ulcerative colitis in remission. Dig Dis Sci. 1996;41:2087-2094.

18 Greenfield SM, Green AT, Teare JP, et al. A randomized controlled study of evening primrose oil and fish oil in ulcerative colitis. Aliment Pharmacol Ther. 1993;7:159-166.

19 Rembacken BJ, Snelling AM, Hawkey PM, et al. Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomised trial. Lancet. 1999;354:635-639.

20 Faubion WA, Sandborn WJ. Probiotic therapy with E. coli for ulcerative colitis: take the good with the bad. Gastroenterology. 2000;118:630-631.

21 Gionchetti P, Rizzello F, Venturi A, et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology. 2000;119:305-309.

22 Alverdy JC. Effects of glutamine-supplemented diets on immunology of the gut. JPEN J Parenter Enteral Nutr. 1990;14(suppl 4):109S-113S.

23 Fox AD, Kripke SA, Berman JR, et al. Reduction of the severity of enterocolitis by glutamine-supplemented enteral diets. Surg Forum. 1987;38:43-44.

24 Fujita T, Sakurai K. Efficacy of glutamine-enriched enteral nutrition in an experimental model of mucosal ulcerative colitis. Br J Surg. 1995;82:749-751.

25 van der Hulst RR, van Kreel BK, von Meyenfeldt MF, et al. Glutamine and the preservation of gut integrity. Lancet. 1993;341:1363-1365.

26 Gupta I, Parihar A, Malhotra P, et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res. 1997;2:37-43.

27 Kane S, Goldberg MJ. Use of bromelain for mild ulcerative colitis [letter]. Ann Intern Med. 2000;132:680.

28 Merchant RE, Andre CA. A review of recent clinical trials of the nutritional supplement Chlorella pyrenoidosa in the treatment of fibromyalgia, hypertension, and ulcerative colitis. Altern Ther Health Med. 2001;7:79-80,82-91.

29 Andresen AFR. Ulcerative colitis—an allergic phenomenon. Am J Dig Dis. 1942;9:91-98.

30 Bernstein CN, Ament M, Artinian L, et al. Milk tolerance in adults with ulcerative colitis. Am J Gastroenterol. 1994;89:872-877.

31 Candy S, Borok G, Wright JP, et al. The value of an elimination diet in the management of patients with ulcerative colitis. S Afr Med J. 1995;85:1176-1179.

32 Knoflach P, Park BH, Cunningham R, et al. Serum antibodies to cow's milk proteins in ulcerative colitis and Crohn's disease. Gastroenterology. 1987;92:479-485.

33 Ballegaard M, Bjergstrom A, Brondum S, et al. Self-reported food intolerance in chronic inflammatory bowel disease. Scand J Gastroenterol. 1997;32:569-571.

34 Dainese R, Galliani EA, De Lazzari F, et al. Discrepancies between reported food intolerance and sensitization test findings in irritable bowel syndrome patients. Am J Gastroenterol. 1999;94:1892-1897.

35 Middleton SJ, Naylor S, Woolner J, et al. A double-blind, randomized, placebo-controlled trial of essential fatty acid supplementation in the maintenance of remission of ulcerative colitis. Aliment Pharmacol Ther. 2002;16:1131-1135.

36 Ben-Arye E, Goldin E, Wengrower D, et al. Wheat grass juice in the treatment of active distal ulcerative colitis: a randomized, double-blind, placebo-controlled trial. Scand J Gastroenterol. 2002;37:444-449.

37 Khan Z, Macdonald C, Wicks AC, et al. Use of the 'nutriceutical', bovine colostrum, for the treatment of distal colitis: results from an initial study. Aliment Pharmacol Ther. 2002;16:1917-1922.

38 Gionchetti P, Rizzello F, Helwig U, et al. Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial. Gastroenterology. 2003;124:1202-1209.

39 Langmead L, Feakins RM, Goldthorpe S, et al. Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther. 2004;19:739-748.

40 Kato K, Mizuno S, Umesaki Y, et al. Randomized placebo-controlled trial assessing the effect of bifidobacteria-fermented milk on active ulcerative colitis. Aliment Pharmacol Ther. 2004;20:1133-1141.

41 Karimi O, Pena AS, van Bodegraven AA, et al. Probiotics (VSL#3) in arthralgia in patients with ulcerative colitis and Crohn's disease: A pilot study. Drugs Today (Barc). 2005;41:453-459.

42 Joos S, Wildau N, Kohnen R, et al. Acupuncture and moxibustion in the treatment of ulcerative colitis: A randomized controlled study. Scand J Gastroenterol. 2006;41:1056-1063.

43 Hanai H, Iida T, Takeuchi K, et al. Curcumin maintenance therapy for ulcerative colitis: randomized, multicenter, double-blind, placebo-controlled trial. Clin Gastroenterol Hepatol. 2006 Nov 10. [Epub ahead of print]

44 Lichtenstein GR, Deren JJ, Katz S, et al. Bowman-Birk Inhibitor concentrate: a novel therapeutic agent for patients with active ulcerative colitis. Dig Dis Sci. 2007 Jun 6. [Epub ahead of print]

45 Mallon P, McKay D, Kirk S, et al. Probiotics for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2007 Oct 17;CD005573.

46 Stremmel W, Ehehalt R, Autschbach F, et al. Phosphatidylcholine for steroid-refractory chronic ulcerative colitis: a randomized trial. Ann Intern Med. 2007;147:603-610.

47 Do VT, Baird BG, Kockler DR. Probiotics for maintaining remission of ulcerative colitis in adults. Ann Pharmacother. 2010 Mar;44(3):565.

48 Tang T, Targan SR, Li ZS, Xu C, Byers VS, Sandborn WJ. Randomised clinical trial: herbal extract HMPL-004 in active ulcerative colitis—a double-blind comparison with sustained release mesalazine. Aliment Pharmacol Ther. 2011;33(2):194-202.

49 Naidoo K, Gordon M, Fagbemi AO, Thomas AG, Akobeng AK. Probiotics for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2011;12:CD007443.

50 Sandborn WJ, Targan SR, Byers VS, et al. Andrographis paniculata extract (HMPL-004) for active ulcerative colitis. Am J Gastroenterol. 2013;108(1):90-98.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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