Is uc a progressive disease?

It can be progressive and I would guess is more times than not.

Unquestionably it is more likely to be progressive if left untreated.

Ditto suebear. Also, I ran across this paper recently, which shows that even though you may not have symptoms, you can have active inflammation. The people who were in both symptomatic and endocsopic remission stayed in remission far longer than those only in symptomatic remission. Here's a copy and paste of what I posted back when I first found the article:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665176/

Above is a link to the whole article.

It's a pretty small study, but I think it's interesting. They only looked at people who were in clinical remission (i.e., no symptoms) and did a c-scope at the beginning of the study. They used a score of 0-3 to classify disease severity based on what was seen during the scope. There are pics and explanations in the article, but 0 is no disease evident, 1 is mild, 2 is moderate, and 3 is severe.

They found that only 24% of people in clinical remission had completely clear scopes (group A). 40% were in the "mild" category (group B), 26% in the moderate (group C), and 10% in the severe (group D). I was surprised that the majority of the patients had at least some disease activity.

They followed the patients to see if they stayed in remission or not. In 6 months, 100% of group A were, 93% of group B, 70% in group c, and 50% in group D.

In 5 years, 78% of group A were, 40% of group B, 10% of group C, and 0% of group D.

So, this basically shows that it IS important to achieve endoscopic remission in addition to clinical remission, if you want to stay in remission long-term.

They also note that patients in the study stayed on their meds. ;)

flares are hard to predict. for some likely triggers are apparent, for others not so much. some people respond quickly and get fairly high remission after each flare. some respond minimally and a flare may simmer for years.

It is not progressive like ALS or Alzheimer, but if not treated most people will progress to a very serious flare, and some will die. the gut microbes, leaky gut mucosa, and out of wack immune response make each other worse (no matter which one started it) and things can spiral out of control.

I'm not doubting that other inflammation and such can and do play a role in UC. However, I still think the article I posted is pretty striking, in that 78% of patients in both clinical and endoscopic remission were still in remission 5 years later, whereas only 40% of patients with mild disease activity (as defined by the c-scope, not symptoms) were.

So I still think that achieving endoscopic remission is important, and could perhaps be used in conjunction with the tests you're describing. I don't have any of the other symptoms of leaky gut, although I haven't had any testing done.

StealthGuardian said...
For starters, c-reactive protein, sed-rate, ammonia, hemoglobin a1c, blood glucose, LDL-B are far better predictors of current disease activity and future disease risk. This is why I've stopped getting the yearly colonoscopies, even when the past ones showed "remission".

This is not... good advice. Yearly colonoscopies might be a tad on the excessive side (once every 3 years should be good enough for most people, but it depends on the circumstances), but that caveat aside, colonoscopies with biopsies are easily the gold standard test for IBD. Inflammatory blood markers are notoriously unreliable for diagnosis, even the better ones like CRP and faecal calprotectin.

CRP is overall the most studied and most proven laboratory marker for IBD. It is also much better for detecting CD than UC.

www.ncbi.nlm.nih.gov/pmc/articles/PMC1856093/

But no doctor in their right mind would diagnose or track IBD through blood tests alone. If they did, it would be asking for trouble.

Post Edited (NiceCupOfTea) : 2/3/2014 11:35:02 AM (GMT-7)

Both are used: I've probably had more blood tests than you've had hot dinners. >_>

You can't ignore the disease and expect a roses. If you do it will make you pay attention to it one way or another.

"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665176/

So, this basically shows that it IS important to achieve endoscopic remission in addition to clinical remission, if you want to stay in remission long-term."

Interesting study but it is just speculating that more colonscopies and drugs will result in more patients in endoscopic remissions. Too bad the study wasn't larger and half the patients got more meds. They don't present any evidence that the treatment goal of a MES of 0 is even possible for those in clinical remission and persistent inflammation. They really have just shown that people in full endoscopic remission do better. Hard to believe that residual inflammation can't be detected without a colonscopy.

It really bothers me that large long term studies like this are not being done in North America. How about a 5 year study with low dose oral 5asa v. low dose oral/low dose rectal v. high dose both?

It should be noted that Japanese medicine use more testing and the government heavily promotes it. Some of the reason for this is because they manufacture the machines and devices. Tests are really cheap there though.

As far as not taking meds, 5asa drugs have very little downside for most people and there is definitely evidence they reduce cancer risk(which is significant after decades of disease) and increase time between flares. If you like missing work and sitting on the john, don't take them.