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Research update: The latest findings on ulcerative colitis

Ulcerative colitis is a condition involving chronic inflammation of the lining of the large intestine. It leads to the formation of small sores called ulcers that cause digestive symptoms and sometimes complications such as malnutrition.

Recent studies have helped scientists develop a better understanding of ulcerative colitis, including its potential causes and treatments.

Ongoing research may help them develop new strategies for preventing, diagnosing, and managing the condition.

Read on to learn about the latest research findings.

Gut microbes

The gastrointestinal tract contains more than 100 trillion microbial cells. Many microbes in this gut microbiome are “friendly” bacteria that help keep the body healthy. They influence metabolism, nutrition, immune function, and more.

Scientists have linked microbial disruption in the gut to several chronic conditions, including ulcerative colitis and other types of inflammatory bowel disease (IBD).

The authors of one 2020 study from the Stanford University School of Medicine looked at the effect of colectomy with ileal pouch-anal anastomosis on gut microbes. Some people with ulcerative colitis undergo this operation to remove the damaged intestine.

The researchers found that people with ulcerative colitis who developed pouchitis after surgery had low levels of Ruminococcaceae bacteria in their digestive systems.

Pouchitis is ongoing intestinal inflammation that can occur after IBD surgery. According to the study authors, about 50% of people who undergo this procedure experience pouchitis.

People with pouchitis also had low levels of secondary bile acids (SBAs), anti-inflammatory substances that Ruminococcaceae bacteria produce.

The authors of the Stanford study hypothesized that low levels of Ruminococcaceae bacteria and SBAs in people with IBD may lead to increased inflammation that drives both IBD and pouchitis.

Past research has also found that people with IBD tend to have lower levels of SBAs than people without IBD.

The Stanford research team has an ongoing clinical trial to learn whether taking SBA supplements can reduce inflammation after surgery in people with ulcerative colitis. The estimated primary completion of this trial is December 2025, with an estimated study completion of December 2050.

Scientists have not identified any single food or specific diet that causes, prevents, or treats ulcerative colitis.

However, some people with ulcerative colitis find that their symptoms improve when they eat or avoid certain foods. Different people may benefit from different diets.

Scientists have studied the effects of several diets on IBD, including:

the Mediterranean diet, which is low in red meat and high in whole grains, vegetables, fruits, nuts, and monounsaturated fats
the specific carbohydrate diet (SCD), which cuts out all grains
the low FODMAP diet, which limits certain types of carbs
a gluten-free diet, which eliminates wheat and other grains that contain gluten

The authors of a 2024 review of studies found some evidence that linked the Mediterranean diet to higher quality of life and lower disease activity in people with IBD. However, research findings on this diet were mixed.

According to the review, the SCD and modified SCD also show promise for reducing symptoms and disease activity in IBD. Most of the research into this diet has focused on children.

The review found that a low FODMAP diet does not appear to reduce disease activity in IBD. However, some evidence suggests that it might ease digestive systems in some people.

The review also found that some people with IBD report improved symptoms with the Crohn’s disease exclusion diet. This diet involves avoiding certain foods, such as gluten and dairy products. However, the studies were small, and more research is needed.

The researchers explained that some foods help support a diverse and healthy gut microbiome. They speculated that certain diets may help control inflammation in the gut to potentially prevent or help treat IBD.

The Mediterranean diet is filled with antioxidant-rich foods that research suggests may help boost the gut microbiome and lower inflammation to reduce the risk of some chronic conditions. However, adherence to this diet is low.

The available research into diet for IBD is limited. More research is necessary to learn how various eating plans affect people with ulcerative colitis.

New and upcoming treatments

In 2023, the Food and Drug Administration (FDA) approved the subcutaneous administration of vedolizumab (Entyvio) for maintenance therapy of moderate to severe ulcerative colitis after intravenous injections. This is the only FDA-approved biologic for maintenance therapy in ulcerative colitis that is available in intravenous (IV) and subcutaneous injections.

Entyvio is an integrin receptor antagonist that blocks the alpha4beta7 integrin, a specific type of receptor present in the gut. It is safe and effective for treating IBD, including ulcerative colitis, according to a 2022 review .

A 2020 study found that subcutaneous Entyvio is safe and effective as maintenance therapy for moderate to severe ulcerative colitis.

Scientists are also studying the treatment of ulcerative colitis with:

JAK inhibitors
interleukin-23 inhibitors, which are a type of biologic
sphingosine 1 phosphate receptor modulators
apremilast (Otezla)
stem cell transplant
fecal microbiota transplant

Some of these treatments may be effective for ulcerative colitis that does not respond well to current treatment options.

Researchers are continuing to study these treatments to learn how safe and effective they are for treating ulcerative colitis.

Healthcare professionals can better understand how active a person’s ulcerative colitis is by monitoring inflammation in their body. This information can help healthcare professionals determine whether it is necessary to adjust someone’s treatment plan.

To continuously monitor inflammation, scientists are developing and testing novel biosensors. These sensors use enzymes, antibodies, or other biological molecules to detect certain chemicals in the body.

For example, researchers from the University of Texas at Dallas have designed a wearable wrist device that monitors sweat for biomarkers of inflammation.

Scientists are also designing and testing ingestible biosensors. These are tiny detectors and transmitters that people swallow in capsules. Some ingestible biosensors detect gases or other chemicals that provide information about the health of the person’s digestive system.

Biosensors may eventually help people with ulcerative colitis get treatment earlier when inflammation increases or complications develop.

Scientists are also making progress in understanding the genetics of ulcerative colitis.

Most experts agree that the condition results from complex interactions among genetics, environmental factors, microbes, and immune responses.

Scientists have linked ulcerative colitis to more than 240 genetic variants , most of which are involved in the immune response.

Learning about the role that specific genes play may help scientists identify new treatment targets for ulcerative colitis. It may also help experts target the most beneficial available treatments to people based on their genetic makeup.

The takeaway

Researchers continue to study the underlying causes of ulcerative colitis, as well as novel strategies for diagnosing, monitoring, and treating the condition.

Ongoing studies may help experts develop new medications and tools for managing ulcerative colitis and learn which people are most likely to benefit from specific treatments.

People with ulcerative colitis can speak with a doctor to learn more about the new and experimental treatments for the condition.

Last medically reviewed on March 19, 2024

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How we reviewed this article:

Guinane CM, et al. (2013). Role of the gut microbiota in health and chronic gastrointestinal disease: Understanding a hidden metabolic organ. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3667473/
Hazel K, et al. (2020). Emerging treatments for inflammatory bowel disease. https://journals.sagepub.com/doi/full/10.1177/2040622319899297
Hirten RP, et al. (2021). New therapeutics for ulcerative colitis. https://www.annualreviews.org/doi/10.1146/annurev-med-052919-120048?
Hu W, et al. (2023). Identification of hub genes and immune infiltration in ulcerative colitis using bioinformatics. https://www.nature.com/articles/s41598-023-33292-y
Jagannath B, et al. (2023). An observational study demonstrating the measurement, characterization, and validation of expression of calprotectin in human sweat through a sweat wearable. https://www.sciencedirect.com/science/article/pii/S2590137023000110
Li N, et al. (2021). Alterations in bile acid metabolism associated with inflammatory bowel disease. https://academic.oup.com/ibdjournal/article/27/9/1525/6063290?login=false
Manski S, et al. (2024). Diet and nutrition in inflammatory bowel disease: A review of the literature. https://academic.oup.com/crohnscolitis360/article/6/1/otad077/7465200
Overview of ulcerative colitis. (n.d.). https://www.crohnscolitisfoundation.org/what-is-ulcerative-colitis/overview
Qiu B, et al. (2022). Efficacy and safety of vedolizumab for inflammatory bowel diseases: A systematic review and meta-analysis of randomized controlled trials. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9543089/
Ratajczak AE, et al. (2022). Should the Mediterranean diet be recommended for inflammatory bowel diseases patients? A narrative review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9871561/
Sandborn WJ, et al. (2020). Efficacy and safety of vedolizumab subcutaneous formulation in a randomized trial of patients with ulcerative colitis. https://www.gastrojournal.org/article/S0016-5085(19)41247-X/fulltext?
Sinha SR, et al. (2020). Dysbiosis-induced secondary bile acid deficiency promotes intestinal inflammation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172352/
The role of secondary bile acids in intestinal inflammation. (2023). https://clinicaltrials.gov/ct2/show/NCT03724175
U.S. FDA approves subcutaneous administration of Takeda’s Entyvio® (vedolizumab) for maintenance therapy in moderately to severely active ulcerative colitis [Press release]. (2023). https://www.takeda.com/newsroom/newsreleases/2023/US-FDA-Approves-Subcutaneous-Administration-of-Takeda-ENTYVIO-vedolizumab-for-Maintenance-Therapy-in-Moderately-to-Severely-Active-Ulcerative-Colitis/
Velikova T, et al. (2023). Editorial: Recent advances and new biomarkers in ulcerative colitis. https://www.frontiersin.org/articles/10.3389/fmed.2023.1214882/full
Xu X, et al. (2022). The gut metagenomics and metabolomics signature in patients with inflammatory bowel disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9215062/

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Ulcerative colitis (UC) increases the risk of heart disease, stroke, and heart attack. New research suggests some UC medications may lower the risk.

Ulcerative colitis is a widely misunderstood type of inflammatory bowel disease. Getting the common facts about this condition straight can help…

What are biologics for ulcerative colitis? Get answers to common questions about biologics, including how effective they are and the safest options…

Edward Roberts, PhD, (left) and fellow Scripps Research professor Hugh Rosen, MD, PhD, invented ozanimod (marketed as Zeposia), which addresses overactive immune responses. The novel drug was approved for multiple sclerosis in 2020 and now is approved for ulcerative colitis.

A new indication of success: fda approves ozanimod for ulcerative colitis.

The novel drug created at Scripps Research has achieved a second FDA approval, this time for ulcerative colitis, as clinical trials continue for Crohn’s disease.

May 27, 2021

LA JOLLA, CA— Ozanimod, the drug invented at Scripps Research that won FDA approval last year for relapsing forms of multiple sclerosis , has been approved in the United States for a second high-need medical condition, ulcerative colitis.

The once-daily oral drug, sold by Bristol Myers Squibb under the name Zeposia, can now be prescribed to treat adults with moderate to severe forms of the inflammatory bowel disease. Notably, it’s the first drug in a novel class of immune-modulating compounds to be approved for ulcerative colitis, which affects about 1 million people in the United States.

“For patients with ulcerative colitis, this oral drug offers a better and more convenient option to control disease progression and improve quality of life,” says Hugh Rosen, MD, PhD , who invented ozanimod along with fellow Scripps Research professor Edward Roberts, PhD , and their laboratory colleagues. “The hope is that this will lead to fewer dangerous complications or serious infections than current treatment options, providing a steadier path for newly diagnosed patients as well as those failing other treatments.”

Ulcerative colitis is a relapsing, chronic autoimmune disease of the large intestine and rectum, in which the lining of the colon becomes inflamed and develops tiny open sores, or ulcers. The condition, as with other inflammatory bowel diseases, is driven in large part by an overactive immune response.

The need for a new treatment option is great, as many patients with ulcerative colitis have an inadequate response or do not respond at all to currently available therapies. Existing therapies also come with a significant risk of serious infections including tuberculosis and blood clotting.

In a randomized and blinded phase 3 clinical study that led up to the expedited FDA approval, more than 600 ulcerative colitis patients taking ozanimod were compared with more than 300 patients on placebo. A far higher share of patients who took ozanimod for 10 weeks experienced remission, meaning that symptoms decreased to the point that they were mostly absent or gone. The onset of improvement was rapid, with many patients reporting decreased symptoms and rectal bleeding starting in the second week of therapy, and the percentage responses increasing with time on therapy.

At week 52 of the clinical trial, patients on the drug also maintained their remission at a high rate. In addition, the study met secondary endpoints for clinical response—noting a marked decrease in disease activity—and endoscopic improvement, which refers to healing of the mucosal tissue in the colon and rectum.

Taken daily as a capsule, ozanimod is the first in a class of drugs known as “sphingosine 1-phosphate receptor modulators” to be approved for ulcerative colitis. The drug works by acting on certain types of immune cells called lymphocytes that are centrally involved in the autoimmune attack on the large intestine. It binds to receptors on the cells’ surface, diminishing the immune system’s ability to inflict damage.

Ozanimod is also in late-stage clinical trials for the treatment of Crohn’s disease, another type of inflammatory bowel disease. While ulcerative colitis affects the colon and rectum, Crohn’s disease may act on any part of the gastrointestinal tract and also affect the entire thickness of the bowel wall.

“It has been tremendously emotionally and intellectually satisfying for us to see this drug advance from discovery and early lab studies to regulatory approvals for multiple sclerosis, ulcerative colitis and hopefully Crohn’s disease in the future,” Rosen says. “The impact of these diseases on patients and their families cannot be overstated. Through our work, we continue to strive for each and every person around the world who is living with these and other diseases.”

Additional molecules developed by Rosen and Roberts at Scripps Research are currently in phase 2 clinical trials for major depressive disease and anxiety, and phase 1 studies for treatment of autism.

The fundamental discoveries that led to ozanimod were reported by Rosen, Roberts and their Scripps Research colleagues in a series of papers from 2002 to 2008. In 2009, Scripps Research licensed ozanimod to biotechnology startup Receptos, which Celgene purchased in 2015 for $7.2 billion. Celgene was acquired by Bristol Myers Squibb in 2019.

For more information, contact [email protected] See More News

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Stanford scientists link ulcerative colitis to missing gut microbes

Bacteria normally inhabiting healthy people’s intestines — and the anti-inflammatory metabolites these bacteria produce — are depleted in ulcerative colitis patients, a Stanford study shows.

February 25, 2020 - By Bruce Goldman

Aida Habtezion is the senior author of a study that describes how people with ulcerative colitis have insufficient amounts of a metabolite produced by a family of gut-dwelling bacteria. Steve Castillo

About 1 million people in the United States have ulcerative colitis, a serious disease of the colon that has no cure and whose cause is obscure. Now, a study by Stanford University School of Medicine investigators has tied the condition to a missing microbe.

The microbe makes metabolites that help keep the gut healthy.

“This study helps us to better understand the disease,” said Aida Habtezion , MD, associate professor of gastroenterology and hepatology. “We hope it also leads to our being able to treat it with a naturally produced metabolite that’s already present in high amounts in a healthy gut.”

When the researchers compared two groups of patients — one group with ulcerative colitis, the other group with a rare noninflammatory condition — who had undergone an identical corrective surgical procedure, they discovered that a particular family of bacteria was depleted in patients with ulcerative colitis. These patients also were deficient in a set of anti-inflammatory substances that the bacteria make, the scientists report.

A paper describing the research findings was published online Feb. 25 in Cell Host & Microbe . Habtezion is the senior author. Lead authorship is shared by Sidhartha Sinha , MD, assistant professor of gastroenterology and hepatology, and postdoctoral scholar Yeneneh Haileselassie, PhD.

The discoveries raise the prospect that supplementing ulcerative colitis patients with those missing metabolites — or perhaps someday restoring the gut-dwelling bacteria that produce them — could effectively treat intestinal inflammation in these patients and perhaps those with a related condition called Crohn’s disease, Habtezion said.

A clinical trial to determine whether those metabolites, called secondary bile acids, are effective in treating the disease is now underway at Stanford. Sinha is the trial’s principal investigator, and Habtezion is the co-principal investigator.

Surgery often required

Ulcerative colitis is an inflammatory condition in which the immune system attacks tissue in the rectum or colon. Patients can suffer from heavy bleeding, diarrhea, weight loss and, if the colon becomes sufficiently perforated, life-threatening sepsis.

There is no known cure. While immunosuppressant drugs can keep ulcerative colitis at bay, they put patients at increased risk for cancer and infection. Moreover, not all patients respond, and even when an immunosuppressant drug works initially, its effectiveness can fade with time. About one in five ulcerative colitis patients progress to the point where they require total colectomy, the surgical removal of the colon and rectum, followed by the repositioning of the lower end of the small intestine to form a J-shaped pouch that serves as a rectum.

These “pouch patients” can lead quite normal lives. However, as many as half will develop pouchitis, a return of the inflammation and symptoms they experienced in their initial condition.

The new study began with a clinical observation. “Patients with a rare genetic condition called familial adenomatous polyposis, or FAP, are at extremely high risk for colon cancer,” Habtezion said. “To prevent this, they undergo the exact same surgical procedure patients with refractory ulcerative colitis do.” Yet FAP pouch patients rarely if ever experience the inflammatory attacks on their remaining lower digestive tract that ulcerative-colitis patients with a pouch do, she said.

The Stanford scientists decided to find out why. Their first clue lay in a large difference in levels of a group of substances called secondary bile acids in the intestines of seven FAP patients compared with 17 patients with ulcerative colitis who had undergone the pouch surgery. The investigators measured these metabolite levels by examining the participants’ stool samples.

Primary bile acids are produced in the liver, stored in the gallbladder and released into the digestive tract to help emulsify fats. The vast majority of secreted primary bile acids are taken up in the intestine, where resident bacteria perform a series of enzymatic operations to convert them to secondary bile acids.

Prior research has suggested, without much elaboration or follow-up, that secondary bile acids are depleted in ulcerative colitis patients and in those with a related condition, Crohn’s disease, in which tissue-destroying inflammation can occur in both the colon and the small intestine.

The researchers confirmed that levels of the two most prominent secondary bile acids, deoxycholic acid and lithocholic acid, were much lower in stool specimens taken from the ulcerative colitis pouch patients than from FAP pouch patients. Clearly, the surgical procedure hadn’t caused the depletion.

Diminished microbial diversity

These findings were mirrored by the scientists’ observation that microbial diversity in the specimens from ulcerative colitis pouch patients was diminished. Moreover, the investigators showed that a single bacterial family — Ruminococcaceae — was markedly underrepresented in ulcerative colitis pouch patients compared with FAP pouch patients. A genomic analysis of all the gut bacteria in the participants showed that the genes for making enzymes that convert primary bile acids to secondary bile acids were underrepresented, too. Ruminococcaceae, but few other gut bacteria, carry those genes.

“All healthy people have Ruminococcaceae in their intestines,” Habtezion said. “But in the UC pouch patients, members of this family were significantly depleted.”

Incubating primary bile acids with stool samples from FAP pouch patients, but not from ulcerative colitis pouch patients, resulted in those substances’ effective conversion to secondary bile acids.

In three different mouse models of colitis, supplementation with lithocholic acid and deoxycholic acid reduced infiltration by inflammatory immune cells and levels of several inflammatory signaling proteins and chemicals in the mice’s intestines, the researchers showed. The supplements also mitigated the classic symptoms of colitis in the mice, such as weight loss or signs of colon pathology.

All three mouse models are considered representative of not just ulcerative colitis but inflammatory bowel disease in general, a category that also includes Crohn’s disease. So the findings may apply to Crohn’s disease patients, as well, Habtezion said.

In an ongoing Phase 2 trial at Stanford, Sinha, Habtezion and their colleagues are investigating the anti-inflammatory effects, in 18- to 70-year-old ulcerative colitis pouch patients, of oral supplementation with ursodeoxycholic acid, a naturally occurring secondary bile acid approved by the Food and Drug Administration for treatment of primary biliary sclerosis and for management of gall stones. Information about the trial, which is still recruiting people, is available at https://clinicaltrials.gov/ct2/show/NCT03724175 .

Habtezion is associate dean for academic affairs in the School of Medicine, a faculty fellow of Stanford ChEM-H and a member of Stanford Bio-X , the Stanford Cancer Institute , the Stanford Pancreas Cancer Research Group and the Wu Tsai Neurosciences Institute at Stanford .

Other Stanford co-authors of the study are postdoctoral scholars Min Wang, PhD, Estelle Spear, PhD, Gulshan Singh, PhD, and Hong Namkoong, PhD; former research scientist Linh Nguyen, PhD; former postdoctoral scholar Carolina Tropini, PhD; former gastroenterology medical fellow Davis Sim, MD; research assistant Karolin Jarr; Laren Becker , MD, instructor of gastroenterology and hepatology; Michael Fischbach, PhD, associate professor of bioengineering; and Justin Sonnenburg , PhD, associate professor of microbiology and immunology.

Researchers from the Children’s Hospital of Philadelphia also contributed to the work.

The work was funded by the National Institutes of Health (grants R01DK101119, KL2TR001083 and UL1TR001085), the Ann and Bill Swindells Charitable Trust, the Kenneth Rainin Foundation, and Leslie and Douglas Ballinger.

Stanford’s Department of Medicine also supported the work.

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu .

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Ulcerative colitis: Recent advances in the understanding of disease pathogenesis

Affiliation.

1 Edinburgh IBD Science Unit, Centre for Inflammation Research, Queens Medical Research Unit, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
PMID: 32399194
PMCID: PMC7194476
DOI: 10.12688/f1000research.20805.1

Inflammatory bowel diseases are common, complex, immune-mediated conditions with a sharply rising global prevalence. While major advances since 2000 have provided strong mechanistic clues implicating a de-regulation in the normal interaction among host genetics, immunity, microbiome, and the environment, more recent progress has generated entirely new hypotheses and also further refined older disease concepts. In this review, we focus specifically on these novel developments in the pathogenesis of ulcerative colitis.

Keywords: Inflammation; Inflammatory Bowel Disease; Mucosal Immunology; Pathogenesis; Ulcerative colitis.

Publication types

Research Support, Non-U.S. Gov't
Colitis, Ulcerative / genetics
Colitis, Ulcerative / physiopathology*

Grants and funding

STEPHEN M. ADAMS, MD, ELIZABETH D. CLOSE, MD, AND APARNA P. SHREENATH, MD, PhD

Am Fam Physician. 2022;105(4):406-411

Related Letter to the Editor: New-Onset Ulcerative Colitis in Patients With COVID-19

Author disclosure: No relevant financial relationships.

Ulcerative colitis is a relapsing and remitting inflammatory bowel disease of the large intestine. Risk factors include recent Salmonella or Campylobacter infection and a family history of ulcerative colitis. Diagnosis is suspected based on symptoms of urgency, tenesmus, and hematochezia and is confirmed with endoscopic findings of continuous inflammation from the rectum to more proximal colon, depending on the extent of disease. Fecal calprotectin may be used to assess disease activity and relapse. Medications available to treat the inflammation include 5-aminosalicylic acid, corticosteroids, tumor necrosis factor–alpha antibodies, anti-integrin antibodies, anti-interleukin-12 and -23 antibodies, and Janus kinase inhibitors. Choice of medication and method of delivery depend on the location and severity of mucosal inflammation. Other treatments such as fecal microbiota transplantation are considered experimental, and complementary therapies such as probiotics and curcumin have mixed data. Surgical treatment may be needed for fulminant or refractory disease. Increased risk of colorectal cancer and use of immunosuppressive therapies affect the preventive care needs for these patients.

Ulcerative colitis is a relapsing and remitting inflammatory bowel disease frequently encountered in primary care. This article provides a summary of ulcerative colitis and a review of the available evidence for management.

Epidemiology and Risk Factors

Ulcerative colitis most commonly presents between 15 and 30 years of age and is more common in industrialized nations, with a prevalence of 286 per 100,000 adults in the United States. 1 , 2

Incidence is similar in men and women. 3

Risk factors include urban living; family history of ulcerative colitis; recent Salmonella , Clostridioides difficile , or Campylobacter infection; tobacco cessation; and soda consumption. 4 , 5

Protective factors include history of appendectomy, active tobacco use, tea consumption, and having been breastfed as an infant. 4 , 5

DIFFERENTIAL DIAGNOSIS

Active Salmonella , Shigella , Escherichia coli , Yersinia , Campylobacter , or C. difficile infection should be ruled out using stool studies. 1

Amebic dysentery should be considered if an appropriate travel or exposure history exists. Cytomegalovirus infection should be excluded in immunocompromised patients. 1

Other causes of bloody diarrhea include ischemic colitis, Crohn disease, and colitis caused by medications or radiation. Non-bloody diarrhea can be caused by microscopic colitis, irritable bowel syndrome, celiac disease, or food intolerances. 6

SIGNS AND SYMPTOMS

The most common presenting symptom is bloody diarrhea. Other common symptoms include abdominal pain, tenesmus, and fecal urgency. 1 , 2

Extraintestinal manifestations include arthropathies, erythema nodosum, pyoderma gangrenosum, uveitis, iritis, and primary sclerosing cholangitis. These may be present before the onset of gastrointestinal symptoms. 7 , 8

Overall, extraintestinal manifestations are only 6% more common in patients with inflammatory bowel disease than in the general population and are more common with Crohn disease compared with ulcerative colitis. 8

DIAGNOSTIC TESTING

Lower endoscopy should be performed on all adult patients with suspected ulcerative colitis. 1 , 9

Fecal calprotectin testing has a high negative predictive value and helps to differentiate inflammatory bowel disease from irritable bowel syndrome, but no serum biomarkers alone are sufficient for the diagnosis of ulcerative colitis. 10 A normal fecal calprotectin level (100 mcg per g or less) in children virtually excludes the diagnosis of ulcerative colitis (100% negative predictive value; 95% CI, 98% to 100%). Therefore, in children with a negative fecal calprotectin test, endoscopy can be limited to those whose symptoms persist without another diagnosis. 9 , 11

Bacterial stool culture, including C. difficile toxin assay and stool examination for ova and parasites, should be performed. Other tests, such as complete blood count, erythrocyte sedimentation rate, and measurement of C-reactive protein, may be useful but are nonspecific. 1

Endoscopic evidence of continuous colonic inflammation starting at the rectum with confirmatory biopsies establishes the diagnosis of ulcerative colitis. 1

Elevation in serial measurements of fecal calprotectin predicts relapse, whereas serial values in the normal range predict continued remission over time. 12

INDUCTION AND MAINTENANCE OF REMISSION

The goal of managing patients with ulcerative colitis is to attain mucosal healing with symptom control so that sustained steroid-free remission can be achieved and prevent hospitalizations and surgeries.

Initiation of treatment begins with stratifying disease activity into mild vs. moderate to severe. The American College of Gastroenterology Ulcerative Colitis Activity Index provides a set of criteria to help determine if the disease is in remission, mild, moderate to severe, or fulminant. 1

Therapy and medication delivery modes ( Table 1 ) are based on the location and extent of mucosal inflammation. This is broadly divided into proctitis (i.e., 18 cm from the true anal verge), left-sided colitis (i.e., extending to the splenic flexure), and pancolitis (i.e., extending proximal to the splenic flexure). 1

TREATMENT OF MILD DISEASE

The 2019 guidelines from the American College of Gastroenterology recommend treatment of mild ulcerative proctitis with rectal 5-amino-salicylic acid (5-ASA) therapies. 1

Mild to moderate colitis should be treated with a combination of rectal 5-ASA enemas and oral 5-ASA therapies. Rectal 5-ASA enemas are preferred to rectal steroid formulations. Mesalamine is more potent than sulfasalazine for inducing remission. 1 , 13

Patients who are unresponsive to or intolerant of 5-ASA should use oral budesonide, extended release (Uceris; multimatrix formulation designed to deliver medication to the colonic mucosa). 1

TREATMENT OF MODERATE TO SEVERE DISEASE

First-line therapy for moderate to severe ulcerative colitis is biologics. 14

Biologic agents with or without glucocorticoids and immune modulators should be used to induce and maintain remission. Thiopurines or methotrexate should not be used as monotherapy. 1

Systemic corticosteroids are effective in inducing remission, but dosages and treatment duration should be limited. Other options for inducing remission include tumor necrosis factor–alpha antibodies, anti-integrin antibodies, anti-interleukin antibodies, and Janus kinase inhibitors 1 ( Table 1 ) .

Fecal microbiota transplantation induces remission in some patients with ulcerative colitis, but current use is limited to clinical trials. 15 – 17

SURGICAL TREATMENT

Among patients with ulcerative colitis, 15% will ultimately need colectomy. Indications include failure of medical therapy, toxic megacolon, perforation, uncontrolled hemorrhage, or dysplasia/malignancy. 7

About 50% of patients who undergo colectomy will experience postoperative inflammation of the residual rectal tissue. 18

Predictors for aggressive disease include age younger than 40 years, pancolitis, severe disease activity seen on endoscopy, presence of extraintestinal manifestations, early need for steroids, and elevated inflammatory markers. 1

COMPLEMENTARY MEDICINE

One probiotic (VSL#3) modestly improves symptoms. It also helps to prevent pouchitis, an abnormal immune response in patients susceptible to autoimmune disease that leads to inflammation of the rectal pouch fashioned after a colectomy. 19 – 21

A systematic review of six small studies found that curcumin (2 to 3 g daily) promotes clinical and endoscopic improvement when added to conventional therapy in patients with mild ulcerative colitis. 22

Fish oil does not improve remission rates. 23 , 24

Acupuncture is considered safe in addition to conventional treatment, but high-quality evidence of effectiveness is lacking. 25

LIFESTYLE AND BEHAVIORAL INTERVENTIONS

Exercise and diet interventions help improve symptom burden and quality of life.

A low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet reduces symptoms but does not change clinical severity. 26 , 27

Physical activity improves quality of life and the anxiety that commonly affects patients with inflammatory bowel disease. 28

HOSPITAL CARE

Up to 25% of patients with ulcerative colitis will require hospitalization for severe disease.

Early endoscopy should be performed to exclude cytomegalovirus colitis, and C. difficile testing should be ordered.

Avoidance of nonsteroidal anti-inflammatory drugs, opiates, and anticholinergic medications is recommended. Antibiotics should not be used routinely.

Surgical consultation should be obtained for patients not responding to intravenous corticosteroids after three days, or earlier if other surgical indications (e.g., toxic megacolon) arise.

If there is failure of intravenous corticosteroids after three days of treatment, cyclosporine (Sandimmune) or infliximab (Remicade) may be used as rescue therapy. 29

Preventive Care Considerations

Vaccinations should be given according to routine recommendations from the Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention, paying special attention to additional vaccinations necessary for patients on immunosuppressive therapies. 30

Dual energy x-ray absorptiometry is recommended to check for low bone mineral density in patients with ulcerative colitis, especially those with a history of chronic oral corticosteroid use for three months or more. 31

Skin cancer occurs at higher rates in patients with inflammatory bowel disease. In addition, common therapies for ulcerative colitis increase the risk of melanoma and nonmelanoma skin cancer. 32

The American College of Obstetricians and Gynecologists recommends annual cytology screening for cervical cancer in women on immunosuppressive therapy. 33

Colonoscopy is recommended starting eight years after diagnosis of ulcerative colitis or immediately if primary sclerosing cholangitis is also present because of an increased risk of colorectal cancer. Interval surveillance in those with disease proximal to the sigmoid colon should occur every one to three years based on risk factors and prior endoscopy findings, with annual colonoscopies in patients with concomitant primary sclerosing cholangitis, due to very high risk of developing colorectal cancer. 1 , 34

Most patients with ulcerative colitis experience a mild to moderate course with periods of remission and flare-ups.

Ulcerative colitis does not increase mortality but is associated with high morbidity. 7

ULCERATIVE COLITIS AND COVID-19

Based on a panel of international experts, in the absence of definitive data, the American Gastroenterological Association has concluded that the risk of a patient with ulcerative colitis becoming infected with SARS-CoV-2 is no higher than that of the general population, independent of treatment.

It is unknown whether active inflammation from ulcerative colitis can increase the risk of infection with SARS-CoV-2.

The American Gastroenterological Association recommends ongoing biologic therapy, deeming it safe for patients who are on such medications to continue working in environments with those who have known or suspected SARS-CoV-2 infection.

Patients who test positive for SARS-CoV-2 and whose ulcerative colitis medications are held because of this can restart their medications after 14 days if they do not develop symptoms or if symptoms resolve. 35

A retrospective review of patients vaccinated against SARS-CoV-2 suggests the vaccine effectiveness and adverse event rate in patients with inflammatory bowel disease is similar to the general population. 36

This article updates a previous article on this topic by Adams and Bornemann . 37

Data Sources: This article was based on ACG and AGA Guidelines, the Cochrane database, Essential Evidence Plus, and a PubMed search including meta-analyses, randomized controlled trials, and systematic reviews. Search dates: December 2020 through October 2021.

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Paramsothy S, Kamm MA, Kaakoush NO, et al. Multidonor intensive faecal microbiota transplantation for active ulcerative colitis: a randomised placebo-controlled trial. Lancet. 2017;389(10075):1218-1228.
Costello SP, Hughes PA, Waters O, et al. Effect of fecal microbiota transplantation on 8-week remission in patients with ulcerative colitis: a randomized clinical trial. JAMA. 2019;321(2):156-164.
Imdad A, Nicholson MR, Tanner-Smith EE, et al. Fecal transplantation for treatment of inflammatory bowel disease. Cochrane Database Syst Rev. 2018;(11):CD012774.
Nguyen N, Zhang B, Holubar SD, et al. Treatment and prevention of pouchitis after ileal pouch-anal anastomosis for chronic ulcerative colitis. Cochrane Database Syst Rev. 2019;(11):CD001176.
Tursi A, Brandimarte G, Papa A, et al. Treatment of relapsing mild-to-moderate ulcerative colitis with the probiotic VSL#3 as adjunctive to a standard pharmaceutical treatment: a double-blind, randomized, placebo-controlled study. Am J Gastroenterol. 2010;105(10):2218-2227.

Limketkai BN, Wolf A, Parian AM. Nutritional interventions in the patient with inflammatory bowel disease. Gastroenterol Clin North Am. 2018;47(1):155-177.

Lin SC, Cheifetz AS. The use of complementary and alternative medicine in patients with inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2018;14(7):415-425.

Coelho MR, Romi MD, Ferreira DMTP, et al. The use of curcumin as a complementary therapy in ulcerative colitis: a systematic review of randomized controlled clinical trials. Nutrients. 2020;12(8):2296.
Scaioli E, Sartini A, Bellanova M, et al. Eicosapentaenoic acid reduces fecal levels of calprotectin and prevents relapse in patients with ulcerative colitis. Clin Gastroenterol Hepatol. 2018;16(8):1268-1275.e2.

Turner D, Steinhart AH, Griffiths AM. Omega 3 fatty acids (fish oil) for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2007;(3):CD006443.

Wang X, Zhao NQ, Sun YX, et al. Acupuncture for ulcerative colitis: a systematic review and meta-analysis of randomized clinical trials. BMC Complement Med Ther. 2020;20(1):309.
Cox SR, Lindsay JO, Fromentin S, et al. Effects of low FOD-MAP diet on symptoms, fecal microbiome, and markers of inflammation in patients with quiescent inflammatory bowel disease in a randomized trial. Gastroenterology. 2020;158(1):176-188.e7.
Prince AC, Myers CE, Joyce T, et al. Fermentable carbohydrate restriction (low FODMAP diet) in clinical practice improves functional gastrointestinal symptoms in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2016;22(5):1129-1136.
Eckert KG, Abbasi-Neureither I, Köppel M, et al. Structured physical activity interventions as a complementary therapy for patients with inflammatory bowel disease - a scoping review and practical implications. BMC Gastroenterol. 2019;19(1):115.

Fudman DI, Sattler L, Feuerstein JD. Inpatient management of acute severe ulcerative colitis. J Hosp Med. 2019;14(12):766-773.

Centers for Disease Control and Prevention. Recommended adult immunization schedule by medical condition and other indications, United States, 2021. U.S. Department of Health and Human Services. Last reviewed February 12, 2021. Accessed September 8, 2021. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult-conditions.html#table-conditions

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Adams SM, Bornemann PH. Ulcerative colitis. Am Fam Physician. 2013;87(10):699-705. Accessed September 8, 2021. https://www.aafp.org/afp/2013/0515/p699.html

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Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting the rectum and the colon. This PrimeView describes the epidemiology, pathophysiology and diagnosis of UC, and highlights the current and emerging therapeutic strategies.

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Review article, research trends of omics in ulcerative colitis: a bibliometric analysis.

1 Department of Gastroenterology, Guang' anmen Hospital, China Academy of Traditional Chinese Medical Sciences, Beijing, China
2 Office of Good Clinical Practice, Guang' anmen Hospital, China Academy of Traditional Chinese Medical Sciences, Beijing, China

Background: Omics has emerged as a promising biological science to shed light on the etiology, pathogenesis, and treatment of ulcerative colitis (UC). At present, although research on the omics of UC has drawn global attention, there is still a lack of bibliometric analysis in this field. This study aimed to access the trends and hotspots of omics in UC research.

Method: Publications related to omics in UC from 1 January 2000 to 15 October 2022 were retrieved from the Web of Science Core Collection database. VOSviewer, CiteSpace, and the online bibliometric analysis platform “Bibliometrix” were adopted to extract and visualize information.

Results: A total of 385 publications were finally included and the annual number of publications fluctuated. The trend in publications increased rapidly after 2019. The United States showed its dominant position in several publications, total citations, and international collaborations. The top five research organizations for publications on the research of omics in UC were Harvard Medical School, the Icahn School of Medicine at Mount Sinai, Karolinska Institutet, the Brigham and Women's Hospital, and the Massachusetts General Hospital. Ashwin Ananthakrishnan from the Massachusetts General Hospital was the most productive author, and Séverine Vermeire from the Catholic University of Leuven was co-cited most often. Inflammatory bowel disease was the most popular and co-cited journal in this field. The reference with citation bursts and trend topics showed that “ulcerative colitis,” “inflammatory bowel disease,” “microbiome,” “transcriptomics,” “genomics,” “metabolomics,” “proteomics,” “dysbiosis,” “biomarkers,” “loci,” and “therapy” are currently research hotspots.

Conclusion: Our study presents several important insights into the research trends and developments in the field of omics in UC, which will provide key information for further research.

Introduction

Omics is a rapidly evolving, comprehensive, and emerging field of study in biological science that encompasses genomics, transcriptomics, proteomics, metabolomics, and microbiomics ( 1 ). More specifically, genomics is the study of the structure, function, and inheritance of an organism's entire genome ( 2 ). Transcriptomics examines all messenger RNA molecules qualitatively or quantitatively in one cell, tissue, or organism ( 3 ). In contrast, proteomics evolved from genomics and focuses on quantifying proteins/peptides, modification, and interaction in multiple sample types by MS-based methods or high-throughput analyses ( 4 , 5 ). Metabolomics is the large-scale study of multiple small molecules, such as amino acids, fatty acids, organic acids, and ketones, which are the end products of complex biochemical processes ( 6 ). More than 1,000 species of microbial cells constitute human gut microbiota, and the amount of genes present in the microbial community is 100 times greater than the human genome ( 7 ). Microbiomics, driven by the development of genomic sequencing technology, is the science of characterizing the microbial community ( 8 ). Overall, each type of omics science is typically used to identify, characterize, and quantify all biological molecules, which are associated with diseases. Omics can explore markers of disease and advance our understanding of biological pathways or processes.

Ulcerative colitis (UC) is a chronic disease where the colon and rectum become inflamed and develop ulcers or sores ( 9 ). UC occurs worldwide, with increasing incidence and prevalence ( 10 ). The prevalence rates of UC in the United States range from 214 to 286 cases per 100,000 from 2000 to 2011 ( 11 , 12 ). The characteristics of UC in remission are without symptoms. However, in the period of relapsing, typical gastrointestinal presentation of UC includes bloody diarrhea, rectal urgency, mucus in the stool, and variable degrees of abdominal pain. Until now, the pathogenesis of UC is still poorly understood, which may be related to abnormal reactions of the immune system, environmental factors, and genetics ( 13 – 15 ).

The omics is a good way to gain insights into the etiology, pathogenesis, and treatment of UC, especially with a large number of research articles published per year. The bibliometric analysis first appeared in the late 19th and early 20th centuries ( 16 ). Nowadays, bibliometric methods are frequently adopted to decipher and map the cumulative scientific knowledge, the impact of a set of researchers, and obtain hot topics of certain research ( 17 ). The benefit of bibliometric analysis is to enable and empower scholars to gain an overview of the hotspot, co-authorship, co-citation, and the development of the specific field, which would build firm foundations for advancing a field. However, the research of omics in UC has not been assessed through bibliometric analysis. Therefore, in this study, a bibliometric analysis of publications on omics in UC was carried out. The aim of this study was to assess global trends and hotspots of omics in UC research.

Data source and search strategy

A search was conducted on the Web of Science Core Collection (WoSCC) database ( https://www.webofscience.com/wos/woscc/basic-search ) from 1 January 2000 to 15 October 2022 ( 18 ). The search formula was ((((((TS = (Genomics)) OR TS = (Metabolomic)) OR TS = (Transcriptomics)) OR TS = (Proteomics)) OR TS = (Microbiomics)) AND TS = (ulcerative colitis)) AND LA = (English). Only articles and review articles were included in this study. To avoid bias due to daily database updates, all searches were performed on the same day. The literature screening procedure is depicted in Figure 1 .

Figure 1 . The flowchart of publications screening.

Data analysis

In the present study, VOSviewer (version 1.6.18), CiteSpace (version 6.1.R3), and Bibliometrix (version 3.2.1) ( https://www.bibliometrix.org ) were applied to analyze the data from the literature ( 19 ). The literature's authors, organizations, titles, abstracts, keywords, journals, and cited references were downloaded in plain text. VOSviewer, developed at Leiden University Centre for Science and Technology Studies, is an open-source software tool for mapping and visualizing bibliometric networks ( 20 , 21 ). In our study, VOSviewer was used to analyze the co-authorship (authors, organizations, and countries), co-occurrence (author keywords), bibliographic coupling (sources), and co-citation (cited references, cited sources, and cited authors). In the networks constructed by VOSviewer, items such as author, country, organization, and keywords were represented by nodes, and the links were called edges reflecting the degree of collaboration or co-citation of each item. In order to optimize the figures display clearly, a minimum threshold was set and no more than 200 nodes were displayed in each network map. For example, 37 countries, 99 organizations, 49 most productive authors, 52 author keywords, 62 most frequently used journals, 40 co-cited references, 193 co-cited journals, and 127 co-authors were shown in the visualization maps. CiteSpace, developed by Professor Chaomei Chen of Drexel University, is a freely available application for visualizing and analyzing the literature of a scientific domain ( 22 , 23 ). In this study, the dual-map overlay of journals and citation bursts was built based on CiteSpace, which helped to identify emerging trends and the distribution of academic journals in real time. The CiteSpace settings were as follows: time span (2000–2022), years per slice ( 1 ); link strength (Cosine), link scope (within slices); and selection criteria (a modified g-index in each slice). R package “Bibliometrix” was adopted to perform a global distribution of publications and the thematic evolution analysis ( 24 ). Let us install the R package and start biblioshiny digiting: library (Bibliometrix) biblioshiny. Information on scientific studies extracted from the WoSCC database. The figures were created using “biblioshiny,” a shiny application that performed a web interface for the Bibliometrix. In addition, Microsoft Office Excel 2019 was used to analyze the annual publications. The 2022 impact factor (IF) and JCR division of journals were obtained from the Web of Science group (InCites, Journal Citation Reports).

Quantitative analysis of publication

Finally, there were a total of 385 studies included, comprising 311 articles and 74 reviews on the research of omics in UC. The annual number of publications from 2000 to 2022 is shown in Figure 2 . From 2000 to 2007, it was the initial stage where the annual publication number was relatively small. The number of publications from 2008 to 2018 showed continued instability, with an average annual publication number of 16.5. An outbreak of omics in UC research was witnessed from 2019 to 2022. The statistic showed the number of publications in the field of omics in UC peaked in 2021.

Figure 2 . Annual number of publications in omics in UC research.

Countries and institutions analysis

In total, 49 countries and 809 institutions are involved in the research of omics in UC. The top 10 leading countries were distributed in North America, Asia, and Europe, as shown in Table 1 . The United States (USA) (132, 22.8%) had the largest number of publications. China was in second place with 66 publications, followed by the United Kingdom (41, 7.1%) and Germany (40, 6.9%). Figure 3A presents the network of countries on the research of omics in UC, with the minimum threshold of two documents of a country. Among the 49 countries, 37 met the threshold. The network offered a clear image of seven clusters in the countries, with the highest link strength. The figure suggested the frequent coupling among the United States, United Kingdom, Germany, Italy, and Canada.

Table 1 . The top 10 countries and institutions on the research of omics in UC.

Figure 3 . (A) Map of visualization of countries on research of omics in UC. (B) Country collaboration map. (C) Map of visualization of institutions on research of omics in UC.

Subsequently, a collaborative network was constructed according to the number and relationship of publications in each country ( Figure 3B ). The world collaboration map also highlighted collaboration and networking among countries. The blue color on the map referred to the collaboration between different countries. In addition, the pink lines between the countries reflected the degree of collaboration between the authors. The United States had the highest number of collaborations with the United Kingdom researchers ( 16 ), followed by Germany ( 13 ), Canada ( 8 ), and Brazil ( 7 ).

The 10 institutions with the largest number of publications are also presented in Table 1 . Among the institutions, the top five research organizations for publications on the research of omics in UC were Harvard Medical School (13, 1.6%), the Icahn School of Medicine at Mount Sinai (12, 1.5%), Karolinska Institutet (10, 1.2%), the Brigham and Women's Hospital (9, 1.1%), and the Massachusetts General Hospital (9, 1.1%).

In Figure 3C , the institutions that met the thresholds of more than or equal to three minimum number of documents of the organization were included. The network displayed the organizations that had collaborated on the scientific documents. The size of the node referred to the total number of publications and the size of the link reflected the number of collaborations. Harvard Medical School had the highest number of scientific collaborations with international organizations, followed by the Icahn School of Medicine at Mount Sinai, the Massachusetts General Hospital, and Harvard University.

Authors and co-cited authors

A total of 2,607 authors have participated in the research of omics in UC. Detailed information of the top 10 writers based on publications is presented in Table 2 . Three of them, including Ashwin Ananthakrishnan (Massachusetts General Hospital), Vibeke Andersen (University of Southern Denmark), and Ramnik Xavier (Massachusetts General Hospital) had published five articles. The author's collaborative network is presented in Figure 4A . Ashwin Ananthakrishnan, Katherine Li, Carrie Brodmerkel, Shannon E Telesco, and Carmen Argmann had the largest nodes due to the most related publications. A close collaboration existed among multiple authors. Ashwin Ananthakrishnan and Ramnik Xavier were working together. Katherine Li had close cooperation with Carrie Brodmerkel.

Table 2 . The top 10 authors and co-cited authors on the research of omics in UC.

Figure 4 . (A) Network of authors on research of omics in UC. (B) Network of co-cited authors on research of omics in UC.

The top 10 co-authors are presented in Table 2 . The most co-cited author was Séverine Vermeire ( n = 66), followed by Jacob Tveiten Bjerrum ( n = 62), Marie-Alice Meuwis ( n = 56), and Luke Jostins ( n = 52). Authors with minimum co-citations of equal to 15 were filtered to map co-author network graphs ( Figure 4B ). As shown in Figure 4B , the authors were presented as the nodes in the network. The size of the author node represented citation counts. There were also close collaborations among different co-cited authors, such as Séverine Vermeire, William Jeffery Sandborn, Marie-Alice Meuwis, and Jacob Tveiten Bjerrum.

Journals and co-cited journals

In total, publications related to omics in UC were published in 205 journals. The top 10 journals are presented in Table 3 . Inflammatory bowel disease had published the most articles ( n = 31, 15.1%), followed by Journals of Crohn's and Colitis ( n = 12, 5.9%), Gastroenterology ( n = 12, 5.9%), and World Journal of Gastroenterology ( n = 10, 4.9%). The top 10 productive journals had an impact factor (IF) ranging from 3.752 to 33.883. Furthermore, the active journals appeared in the Journal Citation Reports (JCR) Q1 or Q2. The journal network is shown in Figure 5A .

Table 3 . The top 10 journals and co-cited journals on the research of omics in UC.

Figure 5 . (A) Network of journals on research of omics in UC. (B) Network of co-cited journals on research of omics in UC. (C) The dual-map overlay of journals on research of omics in UC.

Co-citation was called as the frequency with which two documents were cited together. The co-citation analysis of journals was considered the assessment of the influence within a particular field. As shown in Table 3 , among the 2,913 co-cited journals, inflammatory bowel disease had the most co-citations (1,223), followed by Gastroenterology (1,204) and gut (1,005). Moreover, Nature (IF = 69.504) has the highest impact factor, followed by Nature Genetics (41.376). Figure 5B presents the co-citation network, which is filtered by journals' minimum co-citation equal to 20.

The dual-map overlay map is the discipline co-occurrence network, which simultaneously displays both the journals and co-cited journals. As shown in Figure 5C , the dual-map overlay of journals showed two main citation paths. The orange path, articles published in Molecular Biology/ Immunology area, and the cited publications were mostly published in journals in the fields of Molecular Biology/Genetics. The green path represented the research published in Medicine/Medical/Clinical and was mainly cited by the literature in Molecular Biology/Genetics/Health/Nurse/ Medicine.

Co-cited references

Co-cited references are considered as two documents cited together. From 2000 to 2022, there were 19,478 co-cited references on the topic of omics and ulcerative colitis. Of those, 26 studies had more than 20 citations. Table 4 presents the top 10 co-cited references with the most citations. Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease ( 15 ) published in Nature, was the most frequently co-cited ( n = 51), followed by association analyses identify 38 susceptibility loci for inflammatory bowel disease and highlight shared genetic risk across populations ( 25 ), published in Nature Genetics, and biomarker discovery for inflammatory bowel disease, using proteomic serum profiling ( 26 ) published in Biochemical Pharmacology. The co-cited reference network map of references with a co-citation of more than or equal to 15 was constructed ( Figure 6 ).

Table 4 . The top 10 co-cited references on the research of omics in UC.

Figure 6 . Network of co-cited references on research of omics in UC.

Reference with citation bursts

Citation bursts refer to a frequency surge of publications over a period of time, which can reflect the dynamics of a certain field in part. In our study, Figure 7 shows the top 20 references with the strongest citation bursts, which are identified by CiteSpace. As shown in Figure 7 , the blue line represented the time interval, and the red line depicted the year of the beginning and end of each citation burst. Citation bursts appeared as early as 2007, the strength of these 20 references ranged from 4.24 to 9.07. The reference with the strongest citation burst of 9.07 entitled “ Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies ” published in The Lancet, with citation burst from 2019 to 2022, was written by Ng et al. ( 27 ). The second strongest citation burst (strength = 8.5) was entitled “ Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease ” with citation burst from 2016 to 2020, which was published in Nature ( 15 ).

Figure 7 . Top 20 references with the strongest citation bursts for publications on omics in UC.

Analysis of keywords and frontiers

A co-occurrence keywords map has been created based on VOSviewer to quickly capture research hotspots, as shown in Figures 8A , B . In total, 924 author keywords were found, and 53 keywords met the threshold of a minimum number of occurrences more than or equal to four. As shown in Figure 8A , six clusters were obtained in total, which was indicating six research directions. The five closest keywords in those five main clusters (red, green, blue, purple, and yellow) were as follows: (1) colorectal cancer, innate immunity, gene expression, rheumatoid arthritis, and microarray; (2) transcriptomics, inflammatory bowel disease, microbiome, bioinformatics, and systems biology; (3) ulcerative colitis, Crohn's disease, proteomics, biomarkers, and mass spectrometry; (4) inflammatory bowel disease, metabolomics, gut microbiota, microbiota, and metabolome; (5) inflammation, genomics, genetics, colitis, and extracellular matrix. Table 5 highlights the 20 most occurring keywords. In addition, the trend topic analysis of the keywords was conducted in order to gain further insights into the trends in the field of omics in UC ( Figure 8C ). From 2008 to 2011, the main keywords were systemic lupus erythematosus, necrosis factor alpha, and antineutrophil cytoplasmic antibodies. High-throughput sequencing has greatly assisted in research on proteomics, metabolomics, transcriptomics, genomics, and gut microbiota since 2012. Notably, these keywords of dysbiosis, gut microbiota, loci, expression, and inflammation have remarkably represented the current research hotspots of omics in UC in the past 3 years (2020–2022).

Figure 8 . (A) Network of keyword on research of omics in UC. (B) Density map of keyword on research of omics in UC. (C) Trend topics.

Table 5 . The top 20 keywords on the research of omics in UC.

This study adopted VOSviewer, CiteSpace, and Bibliometrix to conduct a bibliometric analysis of 385 articles from the Web of Science core database in order to identify the research hotspots and new research trends in the field of omics in UC. The results showed that the annual publications from 2000 to 2007 were extremely rare, indicating that the research foundation of omics in UC was lacking. From 2008 to 2018, the trend in publications in this field fluctuated, with an average annual publication of 16.5 articles. According to the analysis of the citation number of articles and H-index, we found the publications with high citations were located in 2012 and 2017. Therefore, during the period of 2008 to 2018, research of omics in UC was in explosive period. The number of related publications increased rapidly after 2019, indicating that research of omics in UC had entered the maturity stage of development and drew more and more researchers' attention.

The publications show a dynamic trend and change varying with years as well as the difference among the different countries. The United States, Europe, and Asia were the main regions and countries conducting research on omics in UC, especially the United States. The United States was globally dominant in publication outputs, cited authors, international collaborations, and total citations. When it came to publication numbers, the United States, China, United Kingdom, and Germany ranked favorably. Furthermore, we noticed that the United States had active cooperation with the United Kingdom, Germany, Canada, and Brazil. Although China ranked second with a large number of publications, and international collaborations and citation publications were relatively low, which may indicate that Chinese researchers should carry out extensive cooperation with foreign research institutions and promote the development of omics in UC with high-quality publications. Among the top 10 leading institutions, six institutions were located in the USA, explaining the reasons for and rapid development of omics in UC in the USA. Harvard Medical School, the Icahn School of Medicine at Mount Sinai, the Massachusetts General Hospital, and the Brigham and Women's Hospital have extensive experience in this research field. The top 10 leading institutions are quite well research platforms for collaboration and further learning.

To deeply understand the research of omics in UC, the top 10 prolific authors are summarized. Ashwin Ananthakrishnan and Ramnik Xavier are both working at the Massachusetts General Hospital. They focus on research of epidemiology and outcomes of inflammatory bowel diseases and therapy personalized medicine. Their publications of “ Multi-omics of the gut microbial ecosystem in inflammatory bowel diseases ”( 28 ), “ Multi-omics reveal microbial determinants impacting responses to biologic therapies in inflammatory bowel disease ”( 29 ), and “ Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease ”( 15 ) are associated with multi-omics profiles to facilitate therapeutics for patients and serve as targets for new therapies. Vibeke Andersen, from the University of Southern Denmark, has paid much attention to differential genetic architecture and new therapeutic targets in inflammatory bowel disease ( 15 , 30 , 31 ). The three authors have a close collaboration. The publication with the most citations “ Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease ” was co-authored by them.

From the perspective of the co-author, Séverine Vermeireis was the most frequently cited author, followed by Jacob Tveiten Bjerrum and Jacob Tveiten Bjerrum. Séverine Vermeire coming from the Catholic University of Leuven led a research team that focused on the genetics and pharmacogenetics of inflammatory bowel disease ( 32 ). Jacob Tveiten Bjerrum is interested in the research of characterizing ulcerative colitis by metabonomics. For example, one of his publications is “ Metabonomics of human fecal extracts characterize ulcerative colitis, Crohn's disease and healthy individuals ” ( 33 ). Marie-Alice Meuwis has paid attention to proteomics studies of inflammatory bowel diseases ( 34 , 35 ). Thus, the achievements of the top 10 leading co-authors laid the foundation for the research of omics in UC.

Meanwhile, most of the research on omics in UC was published in inflammatory bowel diseases (IF = 7.29, Q1), followed by Journals of Crohn's and Colitis (IF = 10.02, Q1) and Gastroenterology (IF = 33.883, Q1). The journals and co-cited journals can be divided into four groups: gastrointestinal-related journals, omics professional journals, biology and molecular journals, and comprehensive journals. Compared with journals, the citation of the journals is more high-quality international journals. From the category of journals, it demonstrates that gut, genome, and proteome are new important research areas.

Hotspots and frontiers

References with citation bursts and keywords represent frontiers and hotspots within a particular field ( 36 ). The reference with strong citation bursts “ Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies ” pointed out that IBD was a global disease with increasing incidence and prevalence in different regions ( 27 ). The publication “ Host–microbe interactions have shaped the genetic architecture of inflammatory bowel disease ” was undertaken a meta-analysis of Crohn's disease and ulcerative colitis genome-wide association scans to emphasize the relationship and pathways shared between host mucosal immune system and microbes ( 15 ). In addition, keywords can also quickly shed light on the distribution and evolution of hotspots in the research field of omics in UC. Table 5 mainly illustrated the following keywords: ulcerative colitis, inflammatory bowel disease, proteomics, metabolomics, inflammation, transcriptomics, biomarkers, genomics, and gut microbiota. Based on keyword clusters and trend topic analysis, we summarized that the research of omics in UC mainly focused on the following aspects ( Figure 9 ):

1. To monitor the changes in UC microbial community composition and function,

Figure 9 . Research trend of omics in UC.

Evidence has suggested that dysbiosis of intestinal microbiota resulting in excessive intestinal inflammation contributes to the complex pathogenesis of UC ( 37 ). In patients with UC, the microbial community composition, functional diversity, and stability are compromised ( 38 ). For example, some specific bacteria associated with Firmicutes are decreased greatly while Bacteroidetes bacteria and facultative anaerobes display certain increments ( 39 ). In addition, an increase in Desulfovibrio and pathogenic bacteria such as Fusobacterium varium were also found in patients with UC ( 40 ). Omics is a good way to explore and map the intestinal microbiota change in patients with UC. Genomics, such as metagenomic analysis and microbiome genome-wide association study (mGWAS), has provided new insights into host–microbiota interactions. Several recent efforts have been made to construct genomes collection of gut microbes associated with healthy humans using metagenome sequencing, as a reference database for gut microbiota studies ( 41 ). Microbiome genome-wide association study (mGWAS) could not only identify some heritable bacterial taxa but also characterize the composition and gene contents of the intestinal microbiome associated with human health or disease ( 42 ). The interactions of intestinal microbiota and host cells occur through metabolite production, such as short-chain fatty acids (SCFAs) which have a close relationship with inflammation in the host digestive tract. SCFAs exert beneficial effects on the intestinal immune system, including regulating the recognition of intestinal epithelial cells and secretion of repair cytokine ( 43 ). Previous studies revealed that dysbiotic microbiota in patients with IBD was mainly linked to decreased abundance of SCFA species, which may affect other important metabolic pathways ( 44 ). Metabolomics focuses on the functional status of host–microbial relationships in order to identify key drivers of metabolites and metabolic pathways. The co-cited reference “ Metabonomics in Ulcerative Colitis: Diagnostics, Biomtherapyntification, And Insight into the Pathophysiology ” pointed out that patients with active UC showed antioxidants and a range of amino acids increased, while lipid, glycerophosphocholine (GPC), myo-inositol, and betaine decreased ( 45 ). In addition, the gut microbiota appears to be a promising target in the treatment of UC. Evidence was shown that stemming from a multi-omics approach, the overabundance of proteases originating from the bacterium Bacteroides vulgatus contributed to UC disease activity, which gain an understanding of functional microbiota alterations that drive UC and provided a strategy to treat UC ( 46 ).

2. To explore the genetic etiology of UC

Genetic susceptibility increased the chance of developing a certain disease through genetic variation. The genetic epidemiological data clearly show that genetic susceptibility to the etiology of UC is inherited. Owing to the development of genome-wide association studies (GWAS), many potential culprit genes in UC have been successfully identified, as shown in Table 6 .

Table 6 . Susceptibility to loci/gene for UC.

3. To diagnose and distinguish UC and Crohn's disease

Until now, the diagnosis of UC is based on clinical implications, laboratory analysis, histopathological investigation, and imaging examination. Currently, studies have demonstrated that omics can be a diagnostic tool in active and quiescent UC and also provide a differential diagnosis of Crohn's disease (CD) and UC. The most common approach to explore UC biomarkers, especially proteomics, metabonomics, and metagenomics, is to assess relative differences in proteins, metabolites, and genes between patients with UC and controls (healthy or patients with CD). Han et al. ( 60 ) compared the protein profiles of colonic mucosa in three individuals (UC, CD, and healthy controls). Twenty-seven potential biomarkers for UC, 37 biomarkers for CD and bone marrow proteoglycan (PRG2), L-plastin (LCP1), and proteasome activator subunit 1 (PSME1) for active CD were identified. In addition, UC has been associated with dramatic changes in the gut microbiota changes in the gut metabolome and gene. Thus, it is a good way to explore biomarkers associated with diagnosis and distinguishing UC through a combination of 16S rRNA gene sequencing, shotgun metagenomics, and metabolomics ( 61 , 62 ). Research on candidate biomarkers for UC could not only provide insights into UC pathogenesis but also future therapeutic targets.

Furthermore, with the progress in different omics fields, it is being recognized that multi-omics variously combined with two or more omics data during analysis could provide more valuable assistance in the diagnosis, biological processes, and treatment of UC. Multi-omics profiles could demonstrate dynamic changes in gut microbiota, as well as molecular disruptions in microbial transcription, metabolite pools, and levels of antibodies in host serum during UC activity ( 28 ). Moreover, a biomarker could develop to predict disease evolution and guide stratified therapeutic approaches. Multi-omics profiles such as fecal metagenomics, serum metabolomics, and proteomics markers serve as targets for newer therapies of UC ( 29 , 63 ).

Currently, there are multiple challenges in UC management due to the course of the disease and its outcome. Therefore, there is a growing need for personalized approaches to enable timely therapy and avoid a one-size-fits-all standard of treatment and care. Omics, a systems biology approach, will help to identify and validate potential biomarkers that promote personalized treatment for UC ( 64 ). With the increase of research in UC through omics technology, network biology could become a useful tool for analyzing patient data generated from various omics platforms to improve risk assessment, disease monitoring, and personalized treatment for patients with UC.

Limitations

This study also has several limitations inherent in bibliometrics. First, a few relevant studies not included in the WoSCC database are ignored. However, WoSCC is a multidisciplinary, core journal citation index database covering approximately 34,000 journals worldwide ( 65 ). The search results can be exported from the WoSCC database and then imported into other software tools for further analysis. The WoSCC database is thought to be the most commonly used and appropriate database for bibliometric analyses. Second, only studies published in English were included, which may mean non-English publications were underestimated. Moreover, bibliometric analysis has its own weaknesses and bias. The publications with high frequency and citations may be cited for both negative as well as positive reasons. The recent publications are underrepresented due to time constraints. Nevertheless, our study still provides researchers with great objective information and insights.

For this study, we used bibliometrics to analyze and evaluate the related publications on omics and UC. Generally, the number of publications in this field fluctuated. The publications increased rapidly after 2019, indicating that the research of omics in UC had attracted global attention. In total, 49 countries, 809 institutions, 2,607 authors, and 205 journals were represented in all 385 articles. The United States and China ranked favorably. The USA had active cooperation with the United Kingdom, Germany, Canada, and Brazil. Harvard Medical School topped the list of institutions with the most publications. Ashwin Ananthakrishnan from the Massachusetts General Hospital was the most productive author and Séverine Vermeire from the Catholic University of Leuven was the co-cited author most often. Moreover, inflammatory bowel disease is the most popular and co-cited journal in this field. Through the analysis of references with citation bursts and trend topics, we find “ulcerative colitis,” “inflammatory bowel disease,” “microbiome,” “transcriptomics,” “genomics,” “metabolomics,” “proteomics,” “dysbiosis,” “biomarkers,” “loci,” and “therapy” are currently research hotspots. Further studies on gut microbiota and the pathological mechanism of omics will promote understanding and targeted therapies for UC.

Author contributions

HZ and SL design this study. HZ and YN collected and analyzed the data. HZ, HJ, and HL participated in writing the original draft. SL reviewed and revised the manuscript. All authors contributed to the article and approved the submitted version.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: bibliometrics, omics, ulcerative colitis, inflammatory bowel disease, CiteSpace, VOSviewer, Bibliometrix

Citation: Zhang H, Ni Y, Ji H, Liu H and Liu S (2023) Research trends of omics in ulcerative colitis: A bibliometric analysis. Front. Med. 10:1115240. doi: 10.3389/fmed.2023.1115240

Received: 03 December 2022; Accepted: 20 February 2023; Published: 27 March 2023.

Reviewed by:

Copyright © 2023 Zhang, Ni, Ji, Liu and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Shaoneng Liu, liushaoneng@126.com

This article is part of the Research Topic

Challenges in Inflammatory Bowel Disease: Current, Future and Unmet Needs - Volume II

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Ulcerative colitis.

Whitney D. Lynch ; Ronald Hsu .

Affiliations

Last Update: June 5, 2023 .

Continuing Education Activity

Ulcerative colitis is an idiopathic inflammatory condition of the colon that results in diffuse friability and superficial erosions on the colonic wall and associated bleeding. It is the most common form of inflammatory bowel disease worldwide. Characteristically, it involves inflammation restricted to the mucosa and submucosa of the colon. Typically, the disease starts in the rectum and extends proximally in a continuous manner. In the United States, the disease accounts for a quarter-million provider visits annually. This activity reviews the evaluation and management of ulcerative colitis and highlights the role of the interprofessional team in evaluating and improving care for patients with this condition.

Explain the history and physical examination of patients with ulcerative colitis.
Outline evaluation of patients with ulcerative colitis.
Describe treatment considerations for patients with ulcerative colitis.
Identify interprofessional team strategies for improving care coordination and outcomes in patients with ulcerative colitis.
Introduction

Ulcerative colitis is an idiopathic inflammatory condition of the colon that results in diffuse friability and superficial erosions on the colonic wall associated with bleeding. It is the most common form of inflammatory bowel disease worldwide. It characteristically involves inflammation restricted to the mucosa and submucosa of the colon. Typically, the disease starts in the rectum and extends proximally in a continuous manner. In the United States, the disease accounts for a quarter-million provider visits annually, and medical costs directly related to the disease are estimated to exceed four billion dollars annually. [1] [2] [3] Ulcerative has no cure and is a lifelong disorder with a significant impact on both physical and mental health.

The specific cause of inflammatory bowel disease is not known. There seems to be a primary genetic component since the most important independent risk factor is a family history of the disease (8% to 14% of patients). A first-degree relative of a patient with ulcerative colitis has a four times higher risk of developing the disease. Additionally, ulcerative colitis has a higher incidence in Jewish populations than other ethnicities.

Although there is little evidence to support this, it has been postulated that alterations in the composition of the gut microbiota and defects in mucosal immunity could lead to ulcerative colitis. Autoimmunity may also play an important role in the etiology of ulcerative colitis. [4] [5]

Some evidence suggests that smoking may be protective, but so far, no one has been able to confirm a direct relationship between the two.

Epidemiology

Worldwide, the highest incidence and prevalence of inflammatory bowel diseases are seen in Northern Europe and North America. Inflammatory bowel disease is closely linked to a Westernized environment and lifestyle. Ulcerative colitis has an incidence of 9 to 20 cases per 100,000 persons per year. Its prevalence is 156 to 291 cases per 100,000 persons per year. Compared to Crohn disease, ulcerative colitis has a greater prevalence in adults. When considering the pediatric population, however, ulcerative colitis is less prevalent than Crohn disease.

Ulcerative colitis has a bimodal pattern of incidence. The main onset peaks between the age of 15 and 30 years. A second, and the smaller peak of incidence occurs between the age of 50 and 70 years. Though some studies show a slight predilection for men, most studies note no preference regarding sex. There is an increased prevalence of ulcerative colitis in nonsmokers or those who recently quit smoking. Additionally, smokers diagnosed with ulcerative colitis tend to have milder disease, fewer hospitalizations and need for less medication. There is evidence, though weak, that non-steroidal anti-inflammatory drug use is associated with the onset or relapse of ulcerative colitis.

There is also an association of inflammatory bowel disease with the removal of an inflamed appendix. Appendectomy before the age of twenty is associated with a decreased incidence of ulcerative colitis, whereas the opposite is true for Crohn disease. In fact, appendectomy has been shown to reduce the risk of developing ulcerative colitis by 69%. [6] [7]

Pathophysiology

The pathophysiology of ulcerative colitis involves defects in the epithelial barrier, immune response, leukocyte recruitment, and microflora of the colon. [8] [9]

The epithelial barrier has a defect in colonic mucin and possibly tight junctions, leading to increased uptake of luminal antigens. The lamina propria of the mucosa also has an increased number of activated and mature dendritic cells, which include a large number of toll-like receptors (TLR), specifically TLR2 and TLR4. There also seems to be an atypical T-helper (Th) cell response in patients with ulcerative colitis, specifically Th2, which exerts a cytotoxic response against epithelial cells. Other immune-related factors that play a role in the pathophysiology of ulcerative colitis include tumor necrosis factor-alpha (TNF-alpha), interleukin 13, and natural killer T-cells. Levels of IgM, IgA, and IgG are elevated in inflammatory bowel disease; however, a disproportionate increase in IgG1 antibodies is found in patients diagnosed with ulcerative colitis.

Leukocyte recruitment is affected on two fronts. There is an upregulated release of the chemoattractant CXCL8 in ulcerative colitis so that leukocytes are recruited to the mucosa from systemic circulation. Additionally, there is an upregulation of mucosal cellular adhesion molecule-1 (Mad-CAM1) on the endothelium of mucosal blood vessels, which promotes leukocyte adhesion and extravasation into mucosal tissue.

Studies have shown that enteric microflora is important in the pathogenesis and severity of inflammation and disease phenotype. Ulcerative colitis seems also to result, in part, from a homeostatic imbalance between enteric microflora and the host's mucosal immunity. This results in an aberrant response to non-pathogenic bacteria.

Histopathology

Histologically, the mucosal layer of the colon in a patient with ulcerative colitis includes infiltrates of varying density and composition, depending on the stage of the disease. These infiltrates primarily consist of lymphocytes, plasma cells, and granulocytes, with the latter being more prominent during acute flares of the disease. Additionally, goblet cell depletion, ulcerations, and alterations in mucosal crypts are sometimes apparent. These findings might also be present on histological evaluation of the distal ileum, even though ulcerative colitis is a disease confined to the colon. This is backwash ileitis.

History and Physical

The main symptom of ulcerative colitis is bloody diarrhea, with or without mucus. Associated symptoms also include urgency or tenesmus, abdominal pain, malaise, weight loss, and fever, depending on the extent and severity of the disease. The onset of the disease is typically gradual, and patients will likely experience periods of spontaneous remission and subsequent relapses. Factors that typically exacerbate ulcerative colitis include smoking cessation and nonsteroidal anti-inflammatory drug use.

There are some extraintestinal manifestations (EIMs) that are also present in 10% to 30% of patients with ulcerative colitis. Extraintestinal manifestations associated with disease activity include episcleritis, scleritis, uveitis, peripheral arthropathies, erythema nodosum, and pyoderma gangrenosum. Extraintestinal manifestations independent of colitis activity include axial arthropathies, sacroiliitis, and ankylosing spondylitis. A significant hepatic extraintestinal manifestation of ulcerative colitis includes primary sclerosing cholangitis and is associated with a greater risk of colorectal cancer.

Diagnosis of ulcerative colitis is made clinically with supportive findings on endoscopy, biopsy, and by negative stool examination for infectious causes. Because colonic infection can produce clinical findings indistinguishable from idiopathic ulcerative colitis, microbiologic studies for bacterial infection and parasitic infestation should be included in the initial evaluation. [10] [11]

Radiologic examinations are not critical for the diagnosis but may be useful. Patients with longstanding ulcerative colitis may show a "stove-pipe" sign on double-contrast barium enema (DCBE).

Colonoscopy or proctosigmoidoscopy might reveal loss of typical vascular pattern, granularity, friability, and ulceration, which involve the distal rectum and proceed proximally in a symmetric, continuous, and circumferential pattern. The disease can range from isolated to the rectum and sigmoid colon (proctitis) to disease of the entire colon (pancolitis). Population-based studies show that, upon presentation, proctitis is found in 30% to 60% of patients, left-sided colitis is found in 16% to 45%, and pancolitis is found in 14% to 35%.

Laboratory evaluation will usually reveal an increase in inflammatory factors (ESR, CRP, leukocytosis), especially during an acute flare. Regardless of disease stage, 60% to 70% of ulcerative colitis patients are positive for perinuclear antineutrophil cytoplasmic antibodies (P-ANCA). P-ANCA is also found in a small number of patients with Crohn disease. In addition to P-ANCA, anti-saccharomyces cerevisiae antibodies (ASCA) are found in both Crohn disease and ulcerative colitis but are more prevalent in Crohn disease; therefore, testing for both P-ANCA and ASCA has some utility in distinguishing types. Testing for carcinoembryonic antigen (CEA) can also be helpful in ulcerative colitis, as higher levels can indicate a flare.

Testing for fecal calprotectin also has some utility in the diagnosis of ulcerative colitis, though it is nonspecific. Fecal calprotectin correlates with increased neutrophils in the intestine and, therefore, can be helpful in ruling out inflammatory bowel disease. Studies show that less than 1% of patients with low fecal calprotectin are likely to suffer from inflammatory bowel disease.

An endoscopy (colonoscopy) must be done at some point which will reveal:

Fragile mucosa
Granular mucosa
Loss of vascular pattern
Presence of erosions and pseudopolyposis

Multiple biopsies should be obtained to confirm the diagnosis.

When a diagnosis of ulcerative colitis is made, the most common classification system used to determine the extent and severity of the disease is the Montreal classification system. Extent (E) is determined by endoscopic evaluation and includes E1 (Proctitis), E2 (left-sided or distal colitis), and E3 (pancolitis). Symptoms and systemic findings determine severity (S). It ranges from S0 (remission) to S3 (severe).

Treatment / Management

Treatment choice for patients with ulcerative colitis is based on both the extent of the disease and the severity. The prognosis during the first decade after diagnosis is often generally good, and most patients go into remission. Rectal application of medical therapy, via suppository or enema, is usually appropriate for isolated distal disease (proctitis); however, a rectal application is usually used in combination with systemic therapy to help target the distal colon and, therefore, decrease tenesmus. [6] [12] [13]

First-line treatment is sulfasalazine and 5-aminosalicylates, given orally or rectally, which have a remission rate of about 50%. Glucocorticoids, orally or rectally, can be added for those who fail to achieve remission within two weeks. Except for glucocorticoids, all of these medications can be used in the maintenance of remission. Additionally, there is some evidence that probiotics are helpful in attaining remission. Fecal microbiota transplantation also shows promise in the treatment of ulcerative colitis to help establish healthy gut microbiota.

If patients are refractory to glucocorticoids, thiopurines or biological drugs can be added to therapy. Thiopurines are immunosuppressants such as azathioprine or 6-mercaptopurine. Biological drugs include anti-TNF-alpha drugs, such as infliximab, adalimumab, and golimumab. Infliximab is the most widely used for ulcerative colitis and can be used in severe cases during hospital admissions. The newest class of biological drugs are anti-adhesion molecule inhibitors, such as vedolizumab, which blocks alpha-4-beta-7 integrin.

Since patients with ulcerative colitis have reduced expression of peroxisome proliferator-activated receptor-gamma (PPAR-gamma) in their colonocytes, future treatment may include (PPAR-gamma) agonistic activity. PPAR-gamma is a negative regulator of NF-KB-dependent inflammation. Novel 5-aminosalicylic acid (5-ASA) analogs are being developed that have greater PPAR-gamma activity. Cardiotoxicity and metabolic toxicity restrict the use of existing PPAR-gamma agonists.

Colectomy is curative in patients with ulcerative colitis since the disease is restricted to the colon. Indications for surgery are a failure of medical therapy, intractable fulminant colitis, toxic megacolon, perforation, uncontrollable bleeding, intolerable side effects of medications, strictures, unresectable high-grade or multifocal dysplasia, cancer, or growth retardation in children. The procedure of choice is proctocolectomy with ileal pouch-anal anastomosis (IPAA); however, in patients who are ineligible for IPAA, proctocolectomy with ileostomy is a viable alternative.

Because of the risk of colon cancer, colonoscopy is recommended at regular intervals.

All patients need maintenance therapy to prevent relapse. Oral aminosalicylates are the drugs of choice, but others may respond to azathioprine and 6-mercaptopurine.

There is no specific diet for patients with ulcerative colitis, but many develop lactose intolerance. Unlike Crohn disease, there is no role for elemental or parenteral nutrition.

Differential Diagnosis

In patients presenting with lower abdominal pain and bloody diarrhea, the following differentials should be considered:

Crohn disease
Parasitic colitis
Tuberculosis
Radiation colitis
Colon cancer
Toxic megacolon
Bacterial/viral gastroenteritis

The severity of ulcerative colitis is graded from mild to severe depending upon rectal bleeding:

Mild: Fewer than four rectal bleeding episodes per day
Moderate: More than four rectal bleeding episodes per day
Severe: More than four rectal bleeding episodes per day, and the patient has systemic features of an illness combined with hypoalbuminemia

Ulcerative colitis is a lifelong illness, but the overall mortality is not greater than in the general population. However, mortality is increased in patients who develop shock and surgical complications. When the muscularis propria is involved, it may damage the nerves resulting in dilatation, aperistalsis, and ischemia (toxic megacolon). Today, toxic megacolon is the most common cause of death in ulcerative colitis. At least 5% of patients develop colon cancer, and this risk increases with the duration of the disease. Unlike Crohn disease, stricture formation is rare.

Complications

Ulcerative colitis is a lifelong disease with periods of remission and relapse. Following complications can occur in patients suffering from ulcerative colitis:

Leak from anastomosis
Pelvic abscess
Enterocutaneous fistulas
Pouch prolapse,
Pouchitis, acute is less than 4 weeks, chronic is more than 4 weeks
Incontinence
Sexual dysfunction
Toxic megacolon
Colon/rectal cancer
Deterrence and Patient Education

American College of Gastroenterology has made guidelines on preventive care in patients with ulcerative colitis. These recommendations include:

Screening for skin malignancies, irrespective of the use of biological agents
Assessing bone mineral density
Be vaccinated against Herpes zoster
Vaccinated against Pneumococcus, H. influenzae , and the flu virus
Should not travel to areas of yellow fever without first consulting with an infectious disease expert
Be screened for depression and anxiety
Women with ulcerative colitis should get annual cervical cancer screening
Pearls and Other Issues

There is an increased risk of colorectal cancer in patients with ulcerative colitis. The risk is cumulative, with a 2% chance of colorectal cancer after ten years of diagnosis, 8% after 20 years, and 20% to 30% after 30 years. Two factors associated with increased risk of colorectal cancer are the duration and extent of the disease.

Enhancing Healthcare Team Outcomes

Ulcerative colitis is a systemic disorder with no cure. The disorder has numerous extraintestinal involvement in addition to the colon. Thus, it is best managed by an interprofessional team. All patients with the disorder need lifelong monitoring. Because of the risk of colorectal cancer, surveillance colonoscopy should occur every 1-2 years. Further, since patients are often treated with biological agents, they need to undergo screening for melanoma and nonmelanoma skin cancer.

The pharmacists should assist the team by educating the patient on the importance of medication compliance to avoid relapse. The nurse should encourage regular vaccinations, hand washing, and cancer screening. A dietary consult should be obtained to educate the patient on foods to eat and what not to eat, especially if they have a stoma. In addition, a stoma nurse should be involved in the teaching of stoma care.

An infectious disease nurse should monitor the patient in the outpatient setting to ensure that they are not immunocompromised. Social workers should be involved to ensure that the patient has ample support and finances so that the treatments are not missed. Patients with risk factors for osteoporosis need screening for bone mineral density periodically. Patients should be encouraged to undergo annual vaccination against influenza and pneumococcus. Finally, many patients with ulcerative colitis develop depression and anxiety and should be referred to a mental health counselor. [14] [15]

Ulcerative colitis has no cure, and despite treatment, many continue to have increased bouts of stool frequency. An increase in mortality is usually seen in older patients, those with complications like infection, shock, and anemia, and those who require repeated surgical interventions. Data show that when the disease involves the muscularis propria, it can lead to bowel dysmotility, necrosis, and gangrene. A certain number of patients also develop toxic megacolon with poor outcomes. It is estimated that about 5% of patients will develop colorectal cancer over time. The risk of colon cancer is higher in patients with pancolitis and in patients whose disease started before the age of 15. Overall, the quality of life in patients with ulcerative colitis is poor. [16] [17] [Level 5]

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Disclosure: Whitney Lynch declares no relevant financial relationships with ineligible companies.

Disclosure: Ronald Hsu declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Cite this Page Lynch WD, Hsu R. Ulcerative Colitis. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Denelle Cosier stands with her arms crossed, in a black dress, in front of a garden background. Photo: Michael Gray

Do blackcurrants hold the key to understanding ulcerative colitis?

March 5, 2024

New study will examine whether anti-inflammatory compounds can alleviate symptoms of debilitating disease

A new study from the University of Wollongong (UOW) is examining, for the first time, whether blackcurrants can help alleviate the symptoms of Inflammatory Bowel Disease in adults.

A chronic autoimmune condition, Inflammatory Bowel Disease affects more than 100,000 Australians and can have a crippling financial, physical, and social impact on one’s quality of life. Inflammatory Bowel Disease, which occurs when the digestive tract becomes damaged by prolonged inflammation, encompasses two serious illnesses – ulcerative colitis and Crohn’s disease. There are no known causes and no known cures, and rates of inflammatory bowel diseases are on the rise around the world.

Denelle Cosier, an Accredited Practising Dietitian and PhD researcher in UOW’s School of Medicine, Indigenous and Health Sciences , is leading the study alongside Professor Karen Charlton , Associate Professor Kelly Lambert , and Professor Marijka Batterham . The researchers are aiming to untangle whether blackcurrants hold the key to improving the symptoms of sufferers.

“This is the first research study to look at the effect of the anti-inflammatory compounds from blackcurrants in Inflammatory Bowel Disease. Additionally, we are looking at whether combining the blackcurrants with a probiotic can enhance the anti-inflammatory effect that people experience,” said Ms Cosier.

“We expect that this novel intervention will reduce inflammation, improve gut health, and increase the disease-related quality-of-life of our study participants.”

Karen Charlton and Denelle Cosier stand at a table, each with a glass of blackcurrant juice. Photo: Michael Gray

The study will also examine the link between the gut and the brain, known as the gut-brain axis. Stress, depression, and anxiety, have been shown to trigger inflammation and gastrointestinal issues in the gut, which, in turn, perpetuate the negative emotions, thus creating a destructive cycle. Rates of anxiety and depression are higher in people living with Inflammatory Bowel Disease than the general population. Interventions that have a positive effect on both the gut and the brain will be beneficial.

The researchers are calling for more participants to be involved in the clinical study. The outline of the experiment, called The INHABIT Inflammatory Bowel Disease Study, was recently published in the Journal of Nutritional Science.

They are searching for adults with Ulcerative colitis to participate. More than five million people around the world suffer from ulcerative colitis, a chronic and progressive form of Inflammatory Bowel Disease that causes inflammatory ulcers in the colon.

An image of a cluster of blackcurrants on a leafy tree. Photo: Shutterstock

“People living with ulcerative colitis experience chronic inflammation and many different disease symptoms, which can affect their daily living and quality of life,” Ms Cosier said. “There is not a lot of knowledge about how nutrition and diet affect this disease and the inflammation levels.

“This study will provide valuable data on how inflammation and the gut microbiome are related. The findings from this study may contribute to the development of personalised gut microbiome and dietary therapies for people living with Inflammatory Bowel Disease.”

For more information or to be involved in the study, contact Denelle Cosier on [email protected] .

About the research

‘The INHABIT (synergistic effect of aNtHocyAnin and proBIoTics in Inflammatory Bowel Disease trial: a study protocol for a double-blind, randomised, controlled, multi-arm trial’ is published in the Journal of Nutritional Science .

Co-authors are Denelle Cosier, School of Medicine, Indigenous and Health Sciences, UOW; Karen Charlton, School of Medicine, Indigenous and Health Sciences, UOW; Kelly Lambert, School of Medicine, Indigenous and Health Sciences, UOW; Marijka Batterham, Statistical Consulting Centre, National Institute for Applied Statistical Research, UOW, Martina Sanderson-Smith, School of Chemistry and Molecular Bioscience and Molecular Horizons, UOW; Kylie J Mansfield, Graduate School of Medicine, UOW.

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Abstract LB360: Establishment of predictive biomarkers for carcinogenesis in ulcerative colitis using RNA editing analyses

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Version of Record April 5 2024

Toshiaki Takahashi , Kunitoshi Shigeyasu , Yoshitaka Kondo , Hibiki Umeda , Kazuya Moriwake , Masashi Kayano , Kaori Nitta , Fuminori Teraishi , Yuzo Umeda , Hiroshi Tazawa , Toshiyoshi Fujiwara; Abstract LB360: Establishment of predictive biomarkers for carcinogenesis in ulcerative colitis using RNA editing analyses. Cancer Res 1 April 2024; 84 (7_Supplement): LB360. https://doi.org/10.1158/1538-7445.AM2024-LB360

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Background: Ulcerative colitis (UC) is a chronic inflammatory disease continuous from the rectum. We previously reported that chronic inflammation may induce the RNA-editing enzyme ADAR1 and promote carcinogenesis (Journal of Crohn's and Colitis, 2023). However, the relationship between RNA editing and carcinogenesis in UC remains unresolved because we could not identify specific RNA editing sites. Therefore, in this study, we performed a new comprehensive RNA analysis using RNA sequencing to clarify the role of RNA editing in the carcinogenesis process in UC and to construct a prediction model of carcinogenic risk.

Methods: We performed immunostaining of ADAR1, an RNA-editing enzyme, in 139 cases of ulcerative colitis. In addition, normal colorectal tissue, UC inflammatory phase, normal rectal mucosa of UC carcinoma cases, and UC carcinoma sites were submitted to RNA-Seq testing in 6 cases each (24 cases total). Bioinformatics analysis was performed to compare RNA editing sites in each group.

Results: RNA-seq analysis showed a significant increase in global RNA editing sites in the inflammatory phase compared to normal colon tissue (p = 0.02). This phenomenon was due to increased ADAR1 expression associated with type 1 interferon. We hypothesized that global RNA editing was decreased in normal colonic mucosa during the remission phase but that some sites of prolonged RNA editing might promote carcinogenesis. We attempted to identify carcinogenesis-specific RNA editing sites. We identified 72 cancer-specific RNA editing sites, mainly in long noncoding RNAs such as NEAT1 and in the 3'UTR region of mRNAs such as CTSS. Assuming that the accumulation of these RNA editing leads to carcinogenesis, pathway analysis revealed that pathways promoting cancer invasion and stemness are activated. When ROC curves were generated using these editing sites as markers, the AUC was 0.935, suggesting that analysis of RNA editing in the colonic mucosa of UC patients may be able to predict the risk of carcinogenesis.

Conclusions: We identified potential editing sites for carcinogenesis in UC, allowing the identification of carcinogenic mechanisms in UC and the establishment of predictive markers for carcinogenic risk.

Citation Format: Toshiaki Takahashi, Kunitoshi Shigeyasu, Yoshitaka Kondo, Hibiki Umeda, Kazuya Moriwake, Masashi Kayano, Kaori Nitta, Fuminori Teraishi, Yuzo Umeda, Hiroshi Tazawa, Toshiyoshi Fujiwara. Establishment of predictive biomarkers for carcinogenesis in ulcerative colitis using RNA editing analyses [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB360.

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Apr 2, 2024

Ulcerative Colitis Remission With a Plant-Based Diet

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A whole food, plant-based diet successfully led to remission for ulcerative colitis in three individuals in a new case series published in the American Journal of Lifestyle Medicine . 1 Two people eliminated their need for medication and the third reduced the dose. Returning to a meat-based diet resulted in a recurrence of symptoms. A case study from the Physicians Committee showed that a whole food, plant-based diet was also effective at Crohn’s disease, another form of inflammatory bowel disease. 2

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Bausch Health, Canada Inc. announces first public drug plan listings for Pr UCERIS ® (budesonide) aerosol foam to help address the unmet need for the treatment of mild to moderate distal ulcerative colitis in adults

April 03, 2024

LAVAL, QC, April 3, 2024 - Bausch Health, Canada Inc., part of Bausch Health Companies Inc. (NYSE: BHC) (TSX: BHC ), ("Bausch Health" or the "Company") today announced the first public drug plan listings for Pr UCERIS ® (budesonide) aerosol foam to treat mild to moderate distal ulcerative colitis in adults. 1

UCERIS is now available for patients through the public drug plans of five Canadian provinces: Ontario, Quebec, Saskatchewan, New Brunswick and Nova Scotia.

These first public drug plan listings for UCERIS come following the signing of a letter of intent with the pan-Canadian Pharmaceutical Alliance (pCPA) early this year, setting out the parameters for listing of the treatment by the public drug plans of the provinces, territories and federal government.

“Bausch Health is very pleased that patients with distal ulcerative colitis in five provinces, including the two largest, will now have access to UCERIS and we look forward to the rapid completion of listing agreements with other public drug plans so more Canadians will have insured access to this new therapy,” said Cees Heiman, Senior Vice-President, Europe and Canada, Bausch Health. “We want to provide additional effective treatment options to Canadians.” UCERIS, part of the Company’s growing gastrointestinal franchise, has been available in Canada by prescription since September 2023 and is covered by the majority of private insurance drug plans in Canada.

“Living with ulcerative colitis means experiencing painful, frequent bowel movements, which can also be bloody. Effective treatments for this chronic inflammatory bowel disease are vital to have any quality of life,” said Gail Attara, President and Chief Executive Officer of the Gastrointestinal Society, a patient group known by its badgut.org website. “We are pleased that public drug plans in Canada are starting to make the new ulcerative colitis treatment UCERIS available as a covered benefit and look forward to their example being followed by all drug insurance plans across Canada.”

UCERIS is the only glucocorticosteroid rectal foam available in Canada indicated for the induction of remission in adult patients with active mild to moderate distal ulcerative colitis extending up to 40 cm from the anal verge.1 In a study comparing budesonide foam and budesonide enema in patients with active distal ulcerative colitis, most patients (84%) preferred the foam formulation because of its better tolerability and easier application. 2

Ulcerative colitis is a chronic disease affecting the large intestine, or colon. The condition causes inflammation and ulceration (sores) along the lining of the colon, which can lead to abdominal pain, cramps, bleeding and diarrhea.3 In ulcerative colitis, the inflammation starts at the rectum and continues through the colon. Symptoms include diarrhea with blood and mucus, pain on the left-hand side of the abdomen, urgency and tenesmus (the feeling of needing to pass stools even if the bowel is empty). 3

In the two clinical studies on which the approval of UCERIS rectal aerosol foam was based, a significantly higher proportion of patients in the UCERIS group than in the placebo group were in remission at Week 6 (38.3% and 44.0% vs. 25.8% and 22.4% respectively, pooled p 1

About Bausch Health

Bausch Health Companies Inc. (NYSE/TSX: BHC) is a global diversified pharmaceutical company enriching lives through our relentless drive to deliver better health outcomes. We develop, manufacture and market a range of products, primarily in gastroenterology, hepatology, neurology, dermatology, medical aesthetic devices, international pharmaceuticals, and eye health, through our controlling interest in Bausch + Lomb. Our ambition is to be a globally integrated healthcare company, trusted and valued by patients, healthcare professionals, employees and investors. For more information, visit www.bauschhealth.com and connect with us on Twitter and LinkedIn .

The Bausch Health Canadian prescription treatment portfolio is focused on dermatology, gastrointestinal and cardio-metabolic conditions. Bausch Health also has two manufacturing facilities for prescription pharmaceuticals in Canada: in Laval, Quebec, and Steinbach, Manitoba. More information can be found at the Company's website at www.bauschhealth.ca .

1 Bausch Health, Canada Inc., UCERIS rectal foam Product Monograph, https://bauschhealth.ca/wp- content/uploads/2022/06/Uceris-PM-E-2020-04-15.pdf. 2 Gross V, et al, Budesonide foam versus budesonide enema in active ulcerative proctitis and proctosigmoiditis, Aliment Pharmacol Ther . 2006;23(2):303-312. 3 IBD Clinic, University of Alberta: http://www.ibdclinic.ca/what-is-ibd/ulcerative-colitis/.

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"Mirikizumab is the first antibody targeting p19/interleukin-23 to be approved for the treatment of ulcerative colitis. Its performance in both induction and maintenance phases of the clinical trials is truly impressive," said Bruce Sands, MD, MS, senior author of the clinical trial study published in The New England Journal of Medicine (NEJM). Dr.
Ulcerative colitis
Ulcerative colitis is a lifelong inflammatory disease affecting the rectum and colon to a variable extent. In 2023, the prevalence of ulcerative colitis was estimated to be 5 million cases around the world, and the incidence is increasing worldwide. Ulcerative colitis is thought to occur in people with a genetic predisposition following environmental exposures; gut epithelial barrier defects ...
Mirikizumab as Induction and Maintenance Therapy for Ulcerative Colitis
A new aspect of the LUCENT trial program was the inclusion of end points relating to bowel urgency. 21,22 Many patients with ulcerative colitis consider control of bowel movements to be more ...
Acute severe ulcerative colitis management: unanswered questions and
Acute severe ulcerative colitis (ASUC) is a distinctive ulcerative colitis flare presentation characterised by the presence of systemic inflammation as well as bloody diarrhoea, and occurs at least once in 25% of patients with ulcerative colitis during their disease course. Each episode carries a risk of complications, need for colectomy, and mortality. Little is known about ASUC pathogenesis ...
Ulcerative colitis
A new study shows that a sustainable faecal microbiota transplantation (FMT) treatment protocol, including anaerobic sample preparation, induces remission of active ulcerative colitis.
Ulcerative colitis
Ulcerative colitis (UC) is a chronic inflammatory bowel disease of unknown aetiology affecting the colon and rectum. Multiple factors, such as genetic background, environmental and luminal factors ...
Ustekinumab as Induction and Maintenance Therapy for Ulcerative Colitis
The therapeutic goal in patients with ulcerative colitis is to induce and maintain long-term remission, because the disease often has a relapsing and remitting course. 16,17 Endoscopic improvement ...
Stanford scientists link ulcerative colitis to missing gut microbes
Prior research has suggested, without much elaboration or follow-up, that secondary bile acids are depleted in ulcerative colitis patients and in those with a related condition, Crohn's disease, in which tissue-destroying inflammation can occur in both the colon and the small intestine.
New developments in ulcerative colitis: latest evidence on management
Introduction. Ulcerative colitis (UC) was first described in mid-1800s.1 It is an idiopathic, chronic inflammatory disorder of the colonic mucosa that commonly involves the rectum and may extend in a proximal and continuous fashion to involve other parts of the colon.2 The disease typically affects individuals in the second or third decade of life with hallmark clinical symptoms of bloody ...
Ulcerative colitis: an update
Ulcerative colitis (UC) is a relapsing and remitting inflammatory bowel disease (IBD) characterised by mucosal inflammation which starts distally and can extend proximally to involve the whole colon. It has a reported incidence in the UK of 12.6/100,000 person years (95% confidence interval (CI) 11.4-13.9). 1 Importantly, prevalence appears ...
A comprehensive review and update on ulcerative colitis
Abstract. Ulcerative colitis (UC) is a chronic idiopathic inflammatory bowel disorder of the colon that causes continuous mucosal inflammation extending from the rectum to the more proximal colon, with variable extents. UC is characterized by a relapsing and remitting course. UC was first described by Samuel Wilks in 1859 and it is more common ...
Ulcerative colitis: Recent advances in the understanding of disease
Introduction. The Inflammatory Bowel Diseases (IBDs), namely Ulcerative Colitis (UC) and Crohn's disease (CD) ( Table 1), are chronic immune-mediated conditions with a high prevalence in developed countries (>0.3%) and rapidly increasing incidence in newly industrialised countries (annual percentage change +14.9%) 1, 2.Global prevalence is projected to affect up to 30 million individuals by ...
Ulcerative Colitis Treatment: What's New and Next?
New and Next in UC Treatment. While many treatments for ulcerative colitis (UC) are available, they work better in some people than others. That's why research is always ongoing to learn new ...
New Therapeutics for Ulcerative Colitis
Ulcerative colitis (UC) is a relapsing and remitting inflammatory disease of the colon with a variable course. Despite advances in treatment, only approximately 40% of patients achieve clinical remission at the end of a year, prompting the exploration of new treatment modalities. ... New Therapeutics for Ulcerative Colitis Annu Rev Med. 2021 ...
Ulcerative colitis: Recent advances in the understanding of disease
Inflammatory bowel diseases are common, complex, immune-mediated conditions with a sharply rising global prevalence. While major advances since 2000 have provided strong mechanistic clues implicating a de-regulation in the normal interaction among host genetics, immunity, microbiome, and the environment, more recent progress has generated entirely new hypotheses and also further refined older ...
Ulcerative Colitis: Rapid Evidence Review
Ulcerative colitis most commonly presents between 15 and 30 years of age and is more common in industrialized nations, with a prevalence of 286 per 100,000 adults in the United States. 1, 2 ...
Ulcerative Colitis
When inflammatory bowel disease is identified in a new population, ulcerative colitis invariably precedes Crohn's disease and has a higher incidence. ... Lerner Research Institute, Department of ...
Colon Targeting pH‐Responsive Coacervate ...
Ulcerative colitis (UC), an immune-mediated chronic inflammatory disease, drastically impacts patients' quality of life and increases their risk of colorectal cancer worldwide. However, effective oral targeted delivery and retention of drugs in colonic lesions are still great challenges in the treatment of UC.
Ulcerative colitis
Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting the rectum and the colon. This PrimeView describes the epidemiology, pathophysiology and diagnosis of UC, and highlights ...
Frontiers
BackgroundOmics has emerged as a promising biological science to shed light on the etiology, pathogenesis, and treatment of ulcerative colitis (UC). At present, although research on the omics of UC has drawn global attention, there is still a lack of bibliometric analysis in this field. This study aimed to access the trends and hotspots of omics in UC research.MethodPublications related to ...
Ultraprocessed Food Increases Disease Burden in UC
AI Shows Potential for Detecting Mucosal Healing in Ulcerative Colitis Ultraprocessed Food Consumption Increases Disease Burden in Ulcerative Colitis 3090D553-9492-4563-8681-AD288FA52ACE
Examining the Predictors of Symptom Progression in Patients with Newly
The following is a summary of "Predictors of symptom trajectory in newly diagnosed ulcerative colitis: a 3-year follow-up cohort study," published in the March 2024 issue of Gastroenterology by Houte et al.. Prior studies have found a link between psychological symptoms and worse outcomes in ulcerative colitis (UC), but most of this research was limited to a single point in time.
Ulcerative Colitis
Ulcerative colitis is an idiopathic inflammatory condition of the colon that results in diffuse friability and superficial erosions on the colonic wall associated with bleeding. It is the most common form of inflammatory bowel disease worldwide. It characteristically involves inflammation restricted to the mucosa and submucosa of the colon. Typically, the disease starts in the rectum and ...
Do blackcurrants hold the key to understanding ulcerative colitis?
Do blackcurrants hold the key to understanding ulcerative colitis? New study will examine whether anti-inflammatory compounds can alleviate symptoms of debilitating disease ... "This is the first research study to look at the effect of the anti-inflammatory compounds from blackcurrants in Inflammatory Bowel Disease. Additionally, we are ...
Abstract LB360: Establishment of predictive biomarkers for
Abstract. Background: Ulcerative colitis (UC) is a chronic inflammatory disease continuous from the rectum. We previously reported that chronic inflammation may induce the RNA-editing enzyme ADAR1 and promote carcinogenesis (Journal of Crohn's and Colitis, 2023). However, the relationship between RNA editing and carcinogenesis in UC remains unresolved because we could not identify specific RNA ...
Ulcerative Colitis Remission With a Plant-Based Diet
A whole food, plant-based diet successfully led to remission for ulcerative colitis in three individuals in a new case series published in the American Journal of Lifestyle Medicine. 1 Two people eliminated their need for medication and the third reduced the dose. Returning to a meat-based diet resulted in a recurrence of symptoms.
Bausch Health, Canada Inc. announces first public drug plan listings
Ulcerative colitis is a chronic disease affecting the large intestine, or colon. The condition causes inflammation and ulceration (sores) along the lining of the colon, which can lead to abdominal pain, cramps, bleeding and diarrhea.3 In ulcerative colitis, the inflammation starts at the rectum and continues through the colon.

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Edward Roberts, PhD, (left) and fellow Scripps Research professor Hugh Rosen, MD, PhD, invented ozanimod (marketed as Zeposia), which addresses overactive immune responses. The novel drug was approved for multiple sclerosis in 2020 and now is approved for ulcerative colitis.

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Abstract LB360: Establishment of predictive biomarkers for carcinogenesis in ulcerative colitis using RNA editing analyses

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Bausch Health, Canada Inc. announces first public drug plan listings for Pr UCERIS ® (budesonide) aerosol foam to help address the unmet need for the treatment of mild to moderate distal ulcerative colitis in adults

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