UC Usually starts in the rectum-What may have caused my UC

This is part of what I wrote in the what causes UC thread.  Got me thinking.

Anyhow my questions to everyone is did you have any of the following prior to UC?

What I am trying to figure out here is, was there some injury/mucosal breach in the rectal/anal area which exposed the immune system directly to bacteria.  Once immune system exposed directly to colon bacteria

the cascade might begin.  Have not researched this aspect yet of physical mucosal breach.

It would seem to me that this can happen to anyone,but not all,might answer the questions as

to why everyone does not get UC, or why the mice heal after DSS.

Old Mike

Question List: Add your own question if I missed something that might cause a breach/tear.

Hemmies.

Some form of rectal/anal tear.

Anal abscess.

Fistula.

And if you wish to answer, anal sex,or anything else up your butt.

The reason I ask about anal sex is that it might cause some kind of tear.

Even a finger,with a sharp finger nail.

Eat a lot of nuts, came out in sharp pieces.

Constipated,with hard stools that were difficult to get out, excessive straining.

Any traces of blood way prior to UC.

Eat any other type of abrasive foods,or substance in large quantities, such as pumpkin seed shells,whole

seed bread.

Used any type of enema.

Any type of burning pain inside anal area, after a case of D,which lasted say longer than one day.

Did you have a bad case of D,during,before or after antibiotic use,might cause unsuspected tear.

What I wrote.

Korea 1971 had a bad case of the Korean craps for about 2 weeks.
Lot of burning and strain on the anus,well one day felt something actually tear, it burned
for 3 days then healed.
Come home 1972,feel something strange in my butt, low and behold a big anal abscess, emergency
surgery,seton and the whole bit,healed up.  Large size of egg puss ball.
Then I got another and another but they would drain,also turned into fistula tracks leading out.
Quit smoking 1977,still had the fistula tracks which would ooze once in a while or get infected.
Anyhow proctitis 1980.
The old fart proctologist who used to give me all the rigid scopes said probably due to all the bacteria
associated with the fistulas. So probably had mucosa breach,and some kind of infection on and off in there for years,finally immune system being fed up with the bacteria it was exposed to and could not clear, went nuts
father up in the rectum,and stil trying to destroy it.

 

PS: Since most everyones UC starts in the rectum,I have to wonder if there is not some sort of mucosal breach, from say pressure or abrasion even a small one that you don't notice,along with some infection. 

The immune system is now primed,with memory cells for these bacteria,when it sees them farther up it attacks

and destroys,or the bacteria migrate up and are attacked,or the immune system just tries to destroy the whole mess,after it figures out it cant clear the bacteria any other way,or your rectum get overran with this bacteria at the expense of the others,and immune system really goes nuts

 

Post Edited (Old Mike) : 6/21/2014 7:12:41 AM (GMT-6)

I personally had none of the issues you asked about; at least none that were obvious to me.

Mechanical destruction of the mucosal/epithelial layer could definitely be involved in the priming events of the immune system against the commensal microbes, but that wouldnt explain the location of origin (i.e. the rectum). There has to be some sort of molecular basis for it.

Actually Maraudar it does, bc it is at the anal canal that things get pushed out and hence most likely to be in touch with the mucosa.

For me it would defo have to be constipation. But then constipation can be a sigh of early inflammation so.....

I had a hemmie just before UC but never suspected it as having anything to do with causing it. Right now it's waaaaaaaaaaaaaaaaaay down my list. I do wonder from time to time though how much the hemmie interacts with the UC since having UC but my hemmie seems to get worse when my UC is better and vice versa. I suspect that has something to do with stool coming out. If it's soft and mushy it doesn't bother my hemmie but when it is harder it bothers my hemmie more and I have to strain more to get things out.

I've had constipation my whole life and hemmies since I gave birth to my first Child almost 22 years ago. I started having symptoms after my last child was born almost 7 years ago.

I don't remember any of the above, although I really didn't pay that much attention to my properly-functioning bowel. I know for sure I never had any fissures, tears, or injuries to the rectal area. No one in my family has UC or any other IBD. My theory is that I'm just lucky. Not.

Previous to my first symptoms, I bought a bag of this farmers market breakfast cereal, I remember the stuff was like trail mix but worse, like gravel and glass actually, I threw it in the garbage cause my left side hurt and rectum felt like it got cheese grated, and I knew it was the cereal.

After that I had constipation for a long time, then full blown diagnosed UC.

Often I wondered if my episode with the cereal and UC were linked or coincidence.


Also, pregnancy puts a lot of pressure of the distal colon, makes it very likely for constipated stools to cause small surface tears and abrasions.

Anybody who gets these small injuries (from whatever cause) might not even realize it, simply for the lack of nerve endings higher up.

Also proposing injury from anal sex is a valid scenario, read once that a confidential poll showed that 40% of women and 11% of (otherwise)straight men have been on the receiving end of anal sex at some point in their lives, I suspect the actual percentages for men may be higher, as I doubt it is something they would readily admit.

Injury could be one of the potential triggers that sets off the inflammatory cascade in genetically susceptible individuals. Or perhaps, or probably, it's more complex, that you have to have more ducks in a row, like be genetically susceptible, have eaten a diet high in vegetable oil for years, have taken antibiotics at some point previously, ect, ect, ect, THAN, finally, a small trivial injury(that you may or may not notice) is the nail in the coffin, that sets it all off.

Old Mike - your theory/thoughts sound very interesting to me - I had hemmaroids, rectal bleeding and constipation for years before my UC came in and my UC def. started in the rectum.  In fact, I had symptoms early and had a colonoscopy and they found redness of the rectum and sigmoid colon but biopsies showed nothing.  Then I had another colonoscopy a few years later when my symptoms got worse and bam I had pancolitis.

The only thing that I wonder is - hemmaroiids are very very common - but UC is not nearly as common.  So, there might be more to it as to why we got UC and all the others with hemaroids and constipation did not.

Also, lets say this theory of yours is accurate - how would we go about to fix the problem? I am hoping to enter the Canada SSI vaccine trial where they inject u with dead ecoli bacteria in hopes to stimulate the innate immune system and recruit macrophages to the colon.  I wonder if this would help a disease condition that is caused by your thoughts/theory?

Pmitra: Why does not everyone with hemmies get UC.

As the doc's say genetically susceptible individual.

Whats that mean.

Perhaps a bunch of stuff.

Weak mucus,thin mucus,weak immune system unable to clear bacteria.

Over active immune system,that goes nuts.

Gut bacteria mix,antibiotic alterations.

Epigenetics,some genes shut down,others turned on.

Everyone with hemmies may not expose immune system to bacteria,impossible for me to know.

Could be 100 other reasons that define genetically susceptible individual.

Anyhow might narrow down why everyone does not get UC,they all don't have hemmies,or a mechanical mucosal breach.

Don't know how to fix UC of course,theory or no theory.

Best guess is to repair the mucus barrier, but in ulcers, the mucus is denuded.

Need meds to stop the inflammation,unless something else works like protease inhibitors.

This of course is a big circle.

FT works in some but not others, don't know why,but believe when it does work it replaces whole sets

of bacteria which are missing due to collateral damage from the immune system.  The mucus modulates

gut bacteria and the bacteria in turn modulate mucus.

Whole thing boils down to a breach in the barrier.  After the immune cascade starts,all bets are off.

Old Mike

 

Post Edited (Old Mike) : 6/21/2014 12:15:09 PM (GMT-6)

Marauder93 said...
OM, I know you're very interested in the mucus barrier and microbiota with regards to the etiology of UC, so have you every looked into altered antimicrobial expression in UC patients? Thats the specific area that I research in the lab and I think it may be of interest to you if you havent already. Let me know, I can provide you with some really good resources if you need/would like them!

Why don't you just post them?

Marauder: Thanks have posted lots on dysbiosis, as many others have,more links are always good.

A thread dedicated to dysbiosis sounds great.
I believe that the dysbiosis is mostly caused by the immune system, and perhaps meds in UC,crohn's another story.
They have found no bacteria dysbiosis in early onset UC without meds.
The more time with UC the worse the dysbiosis,gets real bad after 5 years.

Then we may also have fungal and viral dysbiosis,not too much written on that,but

we have a few scattered papers on the site.
Old Mike

Post Edited (Old Mike) : 6/21/2014 12:56:07 PM (GMT-6)

AMP's (Antimicrobial Peptides) or really what are known as defensin, cathelicidin, and histamine (in Humans) but the list of antimicrobial peptides is very long, and also very difficult to study. They are both very, very, small and well slightly larger protein molecules.

There's some back and forth argument going on in regards to disfunction in these in IBD... but as we all know, there's always a back and forth argument, haha. Pick anything immune system wise - literally, and you can generally find an increase of it demonstrated in patients with IBD.

What's most important about AMP's really is the charge (cationic charge) of the peptide. This is what is really allows them to do what they need to do. So with a positive charge they are really attracted to some bacterial/viral membranes.

You can kind of think about them (or some of them) as front line soldiers - or better yet, bullets and missiles from front line soldiers shooting at the bad guys. The tip of the bullet or missile being positively charged - moving through the mucus and penetrating the bacterial/viral membranes.

Epithelial cells secrete them, neutrophils secrete them BUT so do Paneth cells and Globlet Cells (and other cells).

So here's the thing - with a breach/defect in the mucus barrier along with say the development of a biofilm directly on our epithelial cells, the biofilm coating itself can physically block our bullets and missiles...

Since intestinal paneth cells which are located at the very bottom of the crypts secrete these, if the bottom of our crypts are filled with bacteria, then the bullets are not able to get out... OM (You'll notice this in relation to the 10,000 biopsy paper).

Some bacteria (such as Fragilis) can even paralyze neutrophils by secreting enzymes and their own peptides and march right by them (our neutrophils). Which again in the 10,000 biopsy paper shows very clearly.

Now what's also interesting to note is that not only do Antimicrobial Peptides function as bullets and missiles, but they also modulate the immune system - This interests me specifically because defensins and cathelicidins act on Mast cells and cause them to degranulate or (open and release) which in turn releases serotonin, histamine, Tnf-a etc. All of which play a big role in IBD.

My thoughts: A problem in the mucus - where it has for some reason been breached by say stress or physical damage or even perhaps a mucosal viral infection, could allow for a few specific bacterial species (if we are unlucky and harbour them) to start to mess with all of this. Once this happens we are kinda screwed and it's hard to get back on top. To borrow the words from SCD: a viscous cycle perhaps develops.

As well, on the charge side of things, if the mucus is messed up and not expanding properly this can in turn effect a lot of things from increased bacterial adhesion to faulty bullets (AMP's).

Experiment you could try:

Water is really what's responsible for the expansion of mucus. It's a polar molecule and the polar charge is what's important. I was messing around a few weeks ago and thought hmm.... just how important is water to our mucus??? We know it's made up of 95% water. But what effect does external water have on it. What if it thins out like in UC and is not expanding properly?? So I came up with this.

If you're a smoker, when you wake up in the morning - yak up a solid chunk of mucus (hopefully it will be clear) haha, and spit this out onto a flat plate or piece of glass. Now let it sit there for say a full day. Heck, be brave and let that mucus sit there for a whole week. Look at it every now and then. It will slowly dehydrate and will eventually become so very thin you can barely see it.... this is important because this is what appears to be the case in UC.

Now, do the things. First touch the dried up mucus. If you left it for a week it will just be like a thin film and your finger won't stick to it. In fact you'd have a heck of a time trying to even scrape it off. Remember this cause in many mucus studies there is a layer right against the cells that cannot be physically scrapped off without causing damage to the actually cells you're trying to view under the microscope.

Now take a dropper and drop one or two drops onto the mucus. Then touch it - feel how slippery it gets. In an instant the surface becomes like super lube... the s-e-x industry would pay billions for this stuff! but none the less it still adheres to the surface below.

Now cover the mucus in a thin layer of water and leave it sit like that under the water for about 10 minutes, or heck even a few hours. Now when you go to touch it watch what happens. See how it's expanded up and can actually be removed after soaking for some time without leaving any trace of what was perviously firmly adhered to the plate.

This is what happens in our intestine and how the mucus expands, and flushes out. Water works it's way through based on the polar charge all the way to the plate. This is how nutrients also move through for absorption into our bodies. And finally this is how AMP's (our bullets) move their way through the mucus to kill bacteria/viruses.

If something messes with this process everything goes wonky - just like IBD.

EDIT: Excuse the spelling etc but I typed it semi-quick and now have to run out. I'll check it later!

Post Edited (Canada Mark) : 6/21/2014 6:19:55 PM (GMT-6)

Several have mentioned hemmies, including me. Is there any bacterial connection to hemmies or are they purely physical in nature?