What Is Ulcerative Colitis?
Ulcerative Colitis is a condition where the colon and rectum become inflamed and develop ulcers. It is a painful and sometimes debilitating condition, and while there is no known cure, symptoms like diarrhea, weight loss, and rectal bleeding can often be treated with medication.
Options if Medication Doesn’t Work
When medications are not enough to control symptoms of ulcerative colitis, the most common next step is the J-pouch surgery. In this surgery, the colon and rectum are removed. The end of the small intestine is folded up next to itself and the bottom of the newly created “J” is joined to the top of the anal canal. Once this pouch has healed, it functions in many ways like the intestines did before surgery. The person is able to control bowel movements and won’t need a permanent stoma bag.
While this surgery often improves quality of life, it can have side effects like diarrhea, and in extreme cases, sexual dysfunction in men and infertility in women. Sometimes, the pouch can become infected and inflamed, causing many of the same symptoms as ulcerative colitis in the new pouch. In most cases, the infection and associated inflammation can be treated with antibiotics, but if not, further surgery may be needed.
Studying the Cause of Intestinal Inflammation
Interestingly, people with another condition that often requires J-pouch surgery, called FAP (familial adenomatous polyposis), never experience the inflammatory symptoms after the surgery that can occur for sufferers of ulcerative colitis. This suggests that something that caused ulcerative colitis in the first place is still present even after surgery has been performed.
A group of researchers set about to figure out why this was the case by comparing people with FAP to those with ulcerative colitis. They discovered a few things, all of which are related to the presence of secondary bile acids in the intestines. Their discoveries not only offer promising insights into the cause of inflammation in ulcerative colitis, they also suggest some potential treatments.
Firstly, by studying stool samples, the researchers found that those with FAP had much higher levels of secondary bile acids in their intestines. Secondary bile acids are created from the primary bile acids that travel from the liver through the digestive tract, helping to break down fats. In the patients with ulcerative colitis, these secondary bile acids were essentially undetectable, leading the researchers to speculate that the secondary bile acids are directly linked to the intestinal inflammation in ulcerative colitis.
The researchers’ second observation was that ulcerative colitis patients had reduced levels of the gene that is needed for the conversion of primary bile acids into secondary bile acids.
Thirdly, the researchers also found that those with ulcerative colitis had far less of a family of bacteria called Ruminococcaceae in their gut. These bacteria help convert primary bile acids into secondary bile acids in the intestine.
Studies in Mice and Humans
With these clear links between a lack of secondary bile acids and ulcerative colitis, the researchers performed a study where they gave acid supplements to mice with the condition. In the mice models, the supplementation reduced intestinal inflammation. Excitingly, based on the way the study was performed, the results may be applicable to other inflammatory bowel diseases like Crohn’s disease, as well.
The researchers are now conducting trials to see if supplementing with secondary bile acids will have the same effect on people. Their data also suggest that finding a way to restore the missing Ruminococcaceae bacteria could be another treatment option to explore. These discoveries offer hope for a more effective and less invasive treatment than what is currently available for those who suffer from ulcerative colitis.