Extraintestinal Conditions Of Ulcerative Colitis
Extraintestinal Manifestations Of Ulcerative Colitis
Note: See you eye doctor immediately if you develop any conditions of the eyes.
Extraintestinal Manifestations Associated with Ulcerative Colitis: The Symptoms of Ulcerative Colitis that we are already familiar are those affecting the colon like diarrhea, bloody stool, and rectal pain, among others. However, intestinal conditions and symptoms are not the only symptoms resulting from or related to the Ulcerative Colitis condition. There are other extraintestinal symptoms of Ulcerative Colitis and extraintestinal conditions of Ulcerative Colitis that correlate with Ulcerative Colitis that are hardly ever discussed or addressed in any great detail when discussing symptoms of the condition. The terms manifestations and conditions are interchangeable.
Extraintestinal Conditions of Ulcerative Colitis
The extraintestinal conditions of Ulcerative Colitis are conditions and symptoms associated with Ulcerative Colitis that occur outside of those symptoms and conditions within the colon. Contrary to popular belief, these conditions of Ulcerative Colitis are more common than we think. For example, studies show that up to 30% to 60% of persons with Ulcerative Colitis have lower than average bone density when compared with otherwise healthy individuals living without the condition . In essence, those with Inflammatory Bowel Diseases (IBDs), like Ulcerative Colitis, are more likely to struggle with conditions related to bone loss.
Due to a higher risk of bone loss, it is important that those who live with Ulcerative Colitis be screened or tested regularly for bone density decline so that preventative measures to halt bone loss can be implemented. Admittedly, there are several causes attributed to bone density loss in those living with IBD like Ulcerative Colitis.
Mouth Sores and Ulcerative Colitis
Ulcerative Colitis mouth ulcers or Ulcerative Colitis mouth sores are among the many different extraintestinal symptoms of Ulcerative Colitis that can occur in patients living with the condition. Mouth ulcers and Ulcerative Colitis can occur for a number of reasons. For starters, mouth sores and Ulcerative Colitis can be caused by some of the very medications that are used to treat the inflammatory bowel disease (IBD). The corticosteroid Budesonide commonly used as a part of treating Ulcerative Colitis can cause the tongue to swell. Similarly, inflammation of the mouth is a common side effect of the commonly used IBD treatment drugs methotrexate, mesalamine, and sulfasalazine .
How Common Are Ulcerative Colitis Mouth Sores
While it is true that mouth ulcers and Ulcerative Colitis do occur together, it is also true that it is difficult to put a figure on just how common these mouth ulcers actually occur in IBD patients. Currently, studies estimate anywhere from 20% to 50% of those suffering from IBDs like Ulcerative Colitis and Crohn’s Disease do experience mouth sores and ulcers. Additionally, mouth sores and mouth ulcers are shown to be more common in Crohn’s Disease sufferers than those living with Ulcerative Colitis. Children are also more likely to show up with mouth ulcers or sores than adults who are living with an IBD. Men and boys experience mouth sores more than women and girls, and there is a correlation between experiencing mouth sores and having inflammation around the esophagus or your anus .
Mouth Sores and UC
As intimated prior, mouth sores or ulcers can also be referred to as canker sores or Aphthous stomatitis. They are white spots in appearance with a red lining base around the bottom. For persons living with Ulcerative Colitis, these sores or ulcers tend to be larger than a centimeter and generally last around two weeks or more . The severity of the same can differ from one patient to the next and a wide range of treatment options can be used for the same.
Mouth sores often occur as a side effect in Ulcerative Colitis patients. In fact, it is estimated that in approximately 5% to 10% of IBD patients, that mouth sores are the first symptom they experience and have ‘checked out’ by a medical professional. Additionally, mouth sores can occur in various sections of the oral cavity. For example, they can occur on the cheeks, pharynx, lips, tongue, and gums. Importantly, these sores can take on appearances of swelling, redness, lesions, cracks, and white tags to name a few. In some extreme cases, mouth sores and Ulcerative Colitis can resemble the inflammation caused to the lining of the stomach .
It is important to note that when mouth ulcers and ulcerative colitis occur, there is not necessarily a lot of pain that is associated with the condition. This is due largely to the fact that the medication used to treat the IBD inflammation is also effective in treating the mouth sores. Still, there are treatment options that allow mouth ulcers and Ulcerative Colitis patients to treat their cold sores directly. These treatment options range from topical creams to various rinse or ‘swish and spit’ options . There are also home remedies for mouth sores that may help also.
Lidocaine, Tetracycline mouthwashes, and steroid medications that stick to the affected areas are among some of the oral treatments used when treating mouth sores and Ulcerative Colitis . Having an ice pop or something similar (i.e. cold) can help to soothe the discomfort of mouth ulcers and Ulcerative Colitis oral inflammation.
Musculoskeletal Manifestations of Ulcerative Colitis
Skeletal Extraintestinal Conditions of Ulcerative Colitis
Some of the Ulcerative Colitis extraintestinal conditions affect the bones in the body. Such skeletal extraintestinal conditions of Ulcerative Colitis include arthritis and osteoporosis.
Osteoporosis and Ulcerative Colitis
Osteoporosis and Ulcerative Colitis: Approximately 15% of Ulcerative Colitis patients have osteoporosis. Plus approximately 35% of Ulcerative Colitis patients have been found to have osteopenia. Ostopenia is when your bones are weaker than normal but not so far gone that they break easily which is characteristic of osteoporosis. Osteopenic/Osteoporotic bone fractures are fairly rare in persons living with Ulcerative Colitis. These figures are derived from DXA scans that are conducted.  Bone loss in Ulcerative Colitis patients has shown to be linked primarily to either inflammatory mechanisms or nutritional deficiencies. Your GI should order a bone density scan to check your bone density. You shouldn’t wait until bones start to deteriorate or break.
Arthritis and Ulcerative Colitis
Managing arthritis in patients with Ulcerative Colitis is not necessarily new, and is still evolving as new discoveries are made. Still, arthritis is the most common extraintestinal condition among patients with Ulcerative Colitis  and it may affect up to 25% of Ulcerative Colitis patients . The three types of arthritis in IBD patients include peripheral arthritis, ankylosing spondylitis, and axial arthritis .
Primary Sclerosing Cholangitis and Ulcerative Colitis
Primary Sclerosing Cholangitis is a long-term progressive disease of the liver and gallbladder associated with Rheumatoid Arthritis and characterized by inflammation and scarring/hardening of the bile ducts which normally allow bile to drain from the gallbladder. When it impedes the bile, cirrhosis of the liver develops. Primary sclerosing cholangitis is also associated with a higher risk of colorectal cancer. Primary Sclerosing Cholangitis (PSC) may result from an immune system reaction to toxins and infections. Additionally, both Primary Sclerosing Cholangitis and Ulcerative Colitis can occur in the same patient at different times. As such, a patient may be diagnosed with one condition before the other . As many as 5% of patients with IBD are co-diagnosed with PSC.  The disease is curable via a liver transplant .
Treatments for Bone Loss in Ulcerative Colitis
Thankfully, there are treatments that can be used to combat extraintestinal conditions of Ulcerative Colitis through reversing or preventing possible bone loss. Some treatment options include:
- Reducing your corticosteroid usage. Of course, this should be done under the guidance of a doctor.
- Use alternative drugs like infliximab or budesonide instead of heavy steroid options
- Take care of yourself by reducing alcohol intake, stop smoking, and exercising regularly
- Increase daily calcium intake (about 1,500mg) through dietary options like including liver and fish oils
Corticosteroids and Ulcerative Colitis
There is an increase in the inflammation response due to elevated levels of cytokine (specialized protein) in Patients with Ulcerative Colitis. “Proinflammatory cytokines … are involved in the up-regulation of inflammatory reactions. There is abundant evidence that certain pro-inflammatory cytokines … are involved in the process of pathological pain” 
Corticosteroids are powerful anti-inflammatory drugs that can help to counteract this inflammation. Unfortunately, prolonged use of corticosteroids have several side effects – including bone loss. Some studies indicate that as many as 50% of persons taking corticosteroids in the long-term are likely to develop osteoporosis .
Calcium and Vitamin D Deficiency
It is not a secret that calcium is great for healthy bone density. However, in order for calcium to be absorbed properly and utilized by the body, there needs to be Vitamin D. Those with Ulcerative Colitis are likely to struggle the most with Calcium and Vitamin D deficiency. Adequate sun exposure can also help to combat Vitamin D deficiency .
Dr Fuhrman’s Osteo Biotect is a good brand to combat bone loss.
Each capsule contains “250 IU vegan vitamin D3 and 200 mg food-derived calcium. The supplement also contains magnesium when combined in the body with calcium, is a structural component of bone, and vitamin K2,”which offers protection against bone loss and helps prevent calcification in the cardiovascular system”. For more information click here or on the image.
Complications Of The Eyes In Ulcerative Colitis Patients
Although rare, complications of the eyes do occur in patients living with Inflammatory Bowel Disease (IBD). Studies show that approximately 3% to 10% of people living with IBD, in particular, Ulcerative Colitis, suffer from Ulcerative Colitis extraintestinal conditions of the eye [9, 12]. Even more interesting is the correlation between race and eye complications in Ulcerative Colitis patients. Some studies indicate that blacks are more likely to have Ulcerative Colitis extraintestinal manifestations that affect the eyes. Hispanics, on the other hand, may have their manifestations primarily affecting the skin when compared with their white counterparts .
Major eye complications in Ulcerative Colitis shows up in a wide range of ways and as various conditions, including episcleritis, scleritis, and uveitis, among others. For holistic and effective patient care, it is important that these and other extraintestinal manifestations of IBD are considered in the management of Ulcerative Colitis patient care. Both patient and caregiver should know symptoms of ocular manifestations of IBD to look for include burning, pain, tearing, and itching of the eyes and vision changes . Below, we take a closer look at the aforementioned and other Ulcerative Colitis extraintestinal conditions of the eye, and carefully explore what they are and how they show up.
Ocular Inflammation and IBD
Ocular inflammation (inflammation of the eye) in patients with IBD like Ulcerative Colitis can develop with a diagnosis of the condition as well as can pre-date the condition . In most cases, these Ulcerative Colitis extraintestinal conditions of the eye are categorized as primary, secondary, coincidental. Keratopathy, episcleritis, and scleritis are among the primary eye conditions and these tend to be resolved through systemic treatment of the inflammation of the colon. . Secondary ocular complications, on the other hand, tend to arise from the primary complications and include conditions like the formation of cataracts (from corticosteroids usage to treat the inflammation), scleromalacia (thanks to the primary scleritis condition), and dry eye (resulting from hypovitaminosis A). As far as coincidental ocular conditions are concerned, these are eye conditions that can occur generally with not direct correlation to IBD specifically .
Ulcerative Colitis Extraintestinal Conditions of the Eye
Ulcerative Colitis Uveitis
Ulcerative Colitis Uveitis also known as Ulcerative Colitis Iritis due to the parts of the eyes that they affect, Ulcerative Colitis Uveitis is one of the less common Ulcerative Colitis Extraintestinal conditions of the eye. However, it is one of the more serious conditions. This condition carries with it, symptoms of pain, light sensitivity, redness, headaches, floating spots, a whitish patch towards the lower portion of the iris, and diminished vision .
Left untreated, glaucoma, cataracts, problems with the retina, and damage to the optic nerve can all occur. Due to its serious nature, all forms of this condition must be professionally treated . The condition is said to occur in women up to four times more than it does in the male counterparts .
Ulcerative Colitis Episcleritis
Ulcerative Colitis Episcleritis can sometimes resemble “pink eye (Conjunctivitis)”, but has effects that can be significantly more far-reaching. Thankfully, this condition does not affect one’s vision and can be treated using existing IBD therapies as the condition tends to mirror the ongoing intestinal activity of the disease itself .
Ulcerative Colitis Scleritis
Ulcerative Colitis Scleritis, however, is more serious than Ulcerative Colitis Episcleritis. For starters, the pain is more significant and symptoms such as significant tear production and light sensitivity are common. Scleritis, unlike Episcleritis, can affect one’s vision to the point of blindness. Due to its serious nature, professional attention is always recommended .
Ulcerative Colitis Steroid Related Cataracts
Ulcerative Colitis Steroid Related Glaucoma
As mentioned above, some Ulcerative Colitis extraintestinal conditions of the eye are secondary in nature, resulting either from a primary ocular condition, or the treatment of the disease. Ulcerative Colitis related Glaucoma and Ulcerative Colitis related Cataracts can occur as a result of using the corticosteroids that are used to treat the IBD. Admittedly, these conditions can also occur from untreated Ulcerative Colitis Uveitis. Either way, once these conditions show up in IBD, they must be treated so as to avoid blindness and permanent damage to the eyes. See your eye specialist immediately.
Ulcerative Colitis Keratomalacia Vitamin A Deficiency
Ulcerative Colitis Keratomalacia is an eye condition occurring from severe Vitamin A Deficiency, and can often occur in Ulcerative Colitis patients due to the impaired absorption, storage, and processing of Vitamin A that can occur with the condition. The condition is a secondary Ulcerative Colitis extraintestinal condition of the eye usually affects both eyes and left untreated can result in chronic infection, ruptured corneas, and eventually blindness. Early symptoms include night blindness, extreme dry eye, and progressive cloudiness, wrinkling and softening of the cornea.
8. https://www.ncbi.nlm.nih.gov/pubmed/20133759. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925026/