You may know what it's like to have an urgent bowel movement. Imagine that happening on a regular basis or not being able to have a bowel movement when you need to. These symptoms are common in patients struggling with Ulcerative colitis (UC). This gastrointestinal (GI) condition is responsible for over a quarter million doctor visits yearly in the U.S., and the number is growing. Therefore, patients with these conditions must have various solutions to manage this condition effectively. An essential part of providing solutions is assessing underlying factors contributing to the associated symptoms and disease progression. This article will provide insights into the top labs commonly used to help patients address UC.

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What is Ulcerative Colitis?

UC typically affects adults before they turn the age of thirty. UC is the prevailing GI disorder under the inflammatory bowel disease (IBD) umbrella. IBD consists of two inflammatory GI disorders, UC and Crohn's disease. Crohn's can affect all parts of the digestive tract. In contrast, UC is mucosal inflammation and ulceration that is limited to the colon. However, UC is still classified by its location in the colon. These classifications include inflammation in the rectum (Ulcerative proctitis), the rectum and sigmoid colon (Proctosigmoiditis), the rectum to the descending colon (Left-sided colitis), and the entire colon (Pancolitis).

What Causes Ulcerative Colitis?

The exact cause of UC is still undetermined. However, it is suggested that it arises from a combination of genetic, environmental, and immune system factors. Genetics may play a significant role, as there is a higher prevalence of UC with a family history of the disease. Researchers have identified over 100 gene loci associated with inflammatory bowel disease, including 23 specific to UC. 

Immune dysfunction is another contributing factor, with exaggerated immune responses targeting the large intestine tissues, and antibodies against colonic epithelial cells have been found in many individuals with UC. 

Dysbiosis, an imbalance in the gut microbiota, also plays a role in the development of UC. UC patients will often have a decrease in the diversity of the microbiome. Additionally, lifestyle factors like a Westernized diet may contribute to the risk of developing UC. Overall, there are multiple contributing factors to this condition.

Ulcerative Colitis Symptoms

Symptoms of UC can be gradual, and some patients will have random remissions and relapses. NSAID (nonsteroidal anti-inflammatory drug) use can aggravate symptoms. Although the most typical symptom of UC is bloody diarrhea that may or may not contain mucus, other symptoms depend on the severity and include:

• A feeling of needing to pass a stool even after emptying
• Urgent bowel movements
• Abdominal pain
• Fatigue
• Decrease in weight
• Fever

Extraintestinal (outside the intestines) manifestations can occur in up to 30% of UC patients. It is important to note that symptoms in the hepatic (liver) system signify an increased risk of colorectal cancer. The extraintestinal symptoms include:

• Inflammation of the eye
• Arthropathies (joint pain)
• Cholangitis (Inflammation of the bile duct)

Top Labs To Run Bi-Annually On Your Ulcerative Colitis Patients

Before discussing the labs typically used regularly with UC patients, it's important to discuss how this condition is diagnosed. The antibody test for pANCA and ASCA (Anti-saccharomyces cerevisiae antibodies) can help differentiate Crohn's from UC as a preliminary option. The antibody for pANCA is present in up to 70% of UC patients, and ASCA is more prevalent in Crohn's. However, a definitive diagnosis and differentiation from other forms of IBD require a colonoscopy with biopsy. This procedure confirms and differentiates UC. With that stated, here are the top labs that should be considered to be completed on a bi-annual basis for UC:

Comprehensive Stool Test

This stool test is helpful in diagnosing UC and necessary in ruling out other pathogens that can cause similar symptoms. For example, Clostridium difficile infection is most common in patients with recent antibiotic exposure. Biomarkers such as fecal calprotectin and lactoferrin should also be added to the stool test bi-annually as they are elevated in active UC, reflecting inflammation and heightened white blood cell activity. Stool testing can be performed regularly to assess for microbiome imbalances contributing to symptoms associated with UC.

SIBO Breath Test

Research shows an increased prevalence of SIBO, small intestinal bacterial overgrowth, in patients with IBD and an occurrence of up to 19% in UC patients. The SIBO breath test can be completed at home to assess for SIBO. It involves fasting overnight, drinking a specialized mixture, and doing breath samples over 3-hours to assess for gases released from the bacteria associated with SIBO. Testing for SIBO can help patients with UC address and monitor underlying factors that may be contributing to their symptoms.

Food Sensitivities

Symptoms associated with food sensitivities can be tricky as they may occur hours or days after consuming certain foods. In the case of UC, approximately two-thirds of patients reported increased disease severity with food sensitivities. This food sensitivity panel measures antibodies in over 180 different foods and is completed by a finger prick or small blood sample. Regular testing for food sensitivities can be beneficial for UC to monitor any food reactions and associated symptoms and to personalize a dietary plan to eliminate foods that inhibit gut healing.

Inflammatory Markers

The markers of inflammation that should be tested regularly for Colitis patients are hs-CRP and ESR. These markers provide an understanding of the patient's disease profile and allow practitioners to track their inflammation. The hs-CRP is a high-sensitivity test and can assess for even minor inflammatory changes that can occur. ESR is another inflammatory marker that can be elevated in colitis patients. These tests can provide practitioners with information to target treatment approaches towards reducing inflammatory reactions in colitis patients, and regular monitoring can provide insights into treatment effectiveness.

Micronutrient Testing

Patients with IBD are prone to nutrient deficiencies due to absorption issues that can occur with this inflammatory digestive condition. Some of the nutrients these patients show frequent deficiencies in are Vitamins D, B12, and folate, which can impact how the body functions and various physiological processes. A micronutrient panel can provide regular screening on possible nutritional imbalances that may occur and provide patients with a specific dietary plan to address those imbalances.

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Summary

UC has multiple triggers; therefore, an integrative approach that can assess for those various triggers is an appropriate approach to help patients manage this condition. Relapses often occur, and patients can experience alleviation of their symptoms within days to weeks after adhering to a treatment protocol. Thus, regular monitoring and testing can help address these relapses and symptoms in UC patients so they can feel empowered and be proactive in their care.