Ulcerative colitis is one of the few diagnosed autoimmune inflammatory bowel diseases responsible for causing inflammation and ulceration of the intestines and rectum, affecting just under a million people annually.
Onset is a slow process and usually begins around 15-30 years of age, presenting symptoms of cramping and abdominal pain, diarrhea with or without blood and mucus, and bowel movement urgency. Over time, the patient will experience fatigue, anemia, and weight loss due to poorly managed disease. Diagnosis is typically made with a colonoscopy, tissue biopsy, and blood work.
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CC: Abdominal pain, Abdominal bloating, Frequent diarrhea with urgency, Generalized anxiety disorder
Shauna was a 19 years old female who presented with a recent onset of abdominal pain and bloated with frequent bloody diarrhea. She began having stomach problems at 15 years old but attributed most of it to her high-stress level as a varsity athlete year-round and honor student. Since beginning college, her symptoms have worsened. She had 6-10 bowel movements daily and could not eat food without abdominal pain and bloating, followed by bowel movement urgency. She avoided eating during the day and eating one large meal at night to avoid daily pain and urgency of bowel movement.
Additional History
When Shauna was 15, she had a bike accident that resulted in her needing two root canals on her teeth. She stated "since this happened, she had never felt the same but denied any oral pain." After the root canals, she began having more frequent infections, claiming she caught every cold or flu that came through school. When she was 18, she had another root canal on a neighboring tooth to the previous root canals due to a local infection that had developed, leading to extreme pain.
Her Diet consisted of 1 large dinner nightly ranging from burgers to salads; she was living in a college dorm at the time and limited to the cafeteria food. She was working out regularly and drinking plenty of water daily.
Initial Lab Work
Comprehensive Stool Test Results:
- Pancreatin: Low
- Fecal Fats: High
- Calprotectin: Mildly Elevated
- Fecal Secretory IgA: High
- Dysbiotic overgrowth of multiple commensal strains
Lab Analysis
- Shauna's labs indicate she is dealing with a high level of systemic inflammation, seen through elevated HsCRP and gastrointestinal inflammation based on her elevated calprotectin and fecal secretory IgA.
- She has multiple food intolerances that are commonly in her daily diet, directly fueling inflammation and ongoing symptoms. Her nutrient levels indicate borderline low nutrient stores, which could be related to the high level of inflammation and poor digestive enzyme production, seen through the low pancreatin and elevated fecal fats.
- Shauna was not dealing with any pathogenic bacterial overgrowth but had a vast overgrowth of commensal bacteria, which could likely contribute to her symptoms. Her iron level was within normal limits, but her ferritin level was borderline low, likely due to frequent blood loss in bowel movements.
Interventions
- Begin avoiding identified food intolerances, with the priority being wheat/gluten, dairy, and corn.
- She was also instructed to avoid processed foods and sugar, sticking to a paleo diet with pre-cooked vegetables and easily digested fruits.
- Diet recommendations were made of smoothies/shakes/cold pressed or fresh juice in the morning and bone broth-based soup at lunch to get the essential nutrients needed for tissue healing and repair.
- Ortho Digest digestive enzymes were recommended with each meal to support food breakdown and nutrient absorption, restore pancreatic acid production, and support fat absorption.
- Begin weekly behavioral, and cognitive therapy for ongoing anxiety and coping mechanisms with patients' ongoing gastrointestinal symptoms
- Follow up with a biological dentist for oral DNA microbiome analysis and evaluation of 3 root canals.
- Follow up with a Gastroenterologist for colonoscopy.
- Liquid multivitamins to provide baseline nutrients and avoid capsules/pills due to decreased digestive function.
- Start a liquid fish oil supplement with food at 3 grams of combined DHA/EPA a day.
- SBI Protect by Ortho Molecular/ Serum Derived Bovine Colostrum powder recommended one scoop morning and night with liquid.
- After three weeks on the above supplement, bring in RF Plus capsules with food. RF Plus is a supplemental herbal formula that supports digestion while reducing inflammation and promoting healing in the digestive tract.
1.5 Month Follow Up
The patient followed up after seeing the biological dentist, who said she had advanced infections in the root pulp and initial stages of bone loss in her jaw surrounding the two teeth she had the initial root canals on when she was 16 years old. She was able to begin the process of having the two infected root canal teeth extracted and the local area cleaned and oral microbiome re-established through the use of an ozonated mouthwash and oral chewable probiotic capsules.Due to the complexity of the infection, it would be three months before she was able to have the infected teeth and replaced with zirconia implants.
She was able to get in quickly with a gastroenterologist due to the severity of her symptoms. Her colonoscopy showed multiple areas with ulcerations and inflammation stemming from the rectum and beginning to affect her distal colon. They recommended beginning a short round of corticosteroids, but the patient refused as she had already seen improvement in her symptoms with the diet and supplement changes.
Shauna initially had difficulty committing to the diet, but after three weeks, she found a balance and quickly began noticing less frequent stool that was more formed and far less abdominal pain, bloating, and blood seen with bowel movements. She was also noticing an increase in energy and was sleeping much better. She had not yet followed up with mental health support at this visit.
3 Month Follow Up
Three months into treatment labs were repeated and showed good improvement.
Shauna had been fully paleo for 2.5 months and was able to bring some raw vegetables back into her diet with the support of ongoing digestive enzymes. She was not experiencing any abdominal pain and only infrequent bloating after dinner when overeating. Her bowel movements had reduced to 2x daily and were still on the looser end but more formed, Bristol stool chart #5, and no blood, mucus, or undigested foods were seen.
Shauna went through a few therapists to find one she clicked with but was very happy with the results she saw with her anxiety and overall mental health daily. She was told to stick with the current treatment plan but reduce her fish oil to 2 grams daily and the SBI protection to 1 scoop nightly.
6 Months Follow Up
A stool and food intolerance panel was recommended; the patient denied repeating it as she felt so good on the paleo diet that she was not interested in going off it.
Comprehensive Stool Test Results:
- Pancreatin Low Normal
- Fecal Fats Normal
- Calprotectin Normal
- Fecal Secretory IgA High end of normal
- Dysbiotic overgrowth of only Bacteroides spp.
6 Month Interventions
Begin a 6-month trial of a spore-based probiotic containing quercetin, marshmallow, and aloe vera: ½ capsule every three nights and every 1-week increase dosage until she reaches one capsule nightly.
Shauna was also recommended to bring nut butters and gluten-free grains back into her diet on a rotational basis for short-chain fatty acid and fiber support, as well as challenging new foods to see how her system reacted; she was advised to continue a gluten-free, dairy free, sugar limited, and processed food free diet ongoing.
She was also told to continue the RF Plus formula until she followed up with her gastroenterologist for a repeat colonoscopy at one year. If everything looked good, she would begin weaning off the supplement.
Results
At the six months follow-up, the patient was doing exceptionally well. She was having regular bowel movements and no episodes of abdominal pain or bloating. She was able to bring the recommended foods back into her diet and have the occasional "treat" meal, diverging from her anti-inflammatory diet, without any gastrointestinal symptoms. Overall she had noticed her energy level continued to improve and was sleeping a solid 8 hours nightly. She could also reduce her therapy sessions to 1x monthly instead of weekly, as her anxiety level had improved overall.
Throughout her six months of treatment, Shauna continued working diligently with a biological dentist to have her two infected root canals successfully extracted and replaced with dental implants. She had repeated oral 3D x-rays six months into her treatment, and the surrounding bone was remineralizing well, and the implants were healthy. The patient was extremely pleased with the results and did not follow up again in the office for gastrointestinal issues as her symptoms remained gone.
Summary
This case is a wonderful example of the deep connection and possible bacterial translocation between the oral and gastrointestinal microbiome. The impact an underlying hidden infection also has on stimulating the immune system to the point of eliciting an autoimmune disease also should be considered when investigating a recent onset autoimmune disease with no genetic predispositions.
Not all ulcerative colitis is as effectively treated as in this case. Still, the patient's dedication to seeing results and sticking to the diet and supplement recommendations, as well as lifestyle changes, helped immensely with her prognosis.
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