Talk:Ulcerative colitis

Given this is still largely a mystery,does anyone know where cutting edge research is being done on it?Andycjp14/05/04.

This is a question for Steve Holland, M.D., Wikipedia's own gastroenterologist. Try his talk page. AFAIK there is cutting edge research being done everywhere. Steve will be able to give you more. JFW | T@lk 12:27, 14 May 2004 (UTC)

Somebody should add something about the recently established connection to sulfate-reducing bacteria and hydrogen sulfide in the colon. AxelBoldt 07:18, 19 Jun 2005 (UTC)

I agree, but i don't think it should be included in the "Causes" section, it is yet to be confirmed that this is a significant factor in the development of the disease. I think a new section should be added, something like "Current research" which would list all or at least some of the most interesting theories currently proposed. I'll remove the hydrogen sulfide paragraph from the causes section for now, but it should definately be included in a future expanded version of the article. IMHO it's too misleading in its current form.

See "http://www.wjgnet.com/1007-9327/11/2371.asp" for a new theory on the cause of ulcerative colitis in the World Journal of Gastroenterology.

Current research and alt treatments

The claims on alternative treatment claim great success. Such is not the case. They need deflating. Kd4ttc 03:52, 20 February 2006 (UTC)

Which alternative treatments are you refering to? --Dr.Gonzo 21:28, 21 February 2006 (UTC)

There were claims on the page about probiotics and other treatments holding great promise. I editied them down in tone and my comment above was that I had. None of the treatements in the research section have shown anything stunning. Why do you ask? Kd4ttc 22:42, 21 February 2006 (UTC)

Bravo Samir

Samir धर्म rewrote the article based on his expertise and making extensive use of citations. Well done!

I have reorganised the article according to the outline on Wikipedia:WikiProject Clinical medicine/Template for medical conditions. I hope this does not disrupt the intended flow of the article. It can be changed back if necessary.

I have also improved the intro a bit, added links, and delinked words in titles as per the WP:MOS. With a bit of luck, we can push this article up to featured status at some point. JFW | T@lk 17:27, 7 March 2006 (UTC)

Yeah, I like it, too. I modified the bit on colonoscopy in severe UC to reduce the fright factor. Steve Kd4ttc 20:06, 7 March 2006 (UTC)

Reorganized like a pro JFW! It flows very well. Will see if I can find more pics to bolster it for WP:FA. -- Samir धर्म 22:30, 7 March 2006 (UTC)

Oh my. Hate to rain on your parade guys, but you basically butchered the article. It had a much more natural flow before. Granted, a lot of very usefull information has been added, and I applaud Samir for this, but it is written in a way you would expect from a medical encyclopedia. Which is bad. Wikipedia is a general encyclopedia and you basically made the article inacessible to laymen. Now, granted, there was a lot of space for improvement, but this is not the way. While I think the technical part is now better then before, I noticed you deleted quite a bit of usefull info. For example - no mention of pancolitis? Why?

Ok, so tell you what. Let's try and make this article even better, the theme deserves it. Let's get down to the technical, throw in as much relevant data as is needed, invoke the expertise of resident GIs like Samir and when we're done let's try and make brilliant prose out of it. After all, you have to consider this - many patients will be checking this article out, no sense in burying them in technicalities and scaring them out of their wits. It shoud be explained that while all those sideffect are possible they are not very probable. A great deal of UC patients NEVER experience any of them. I guess it's proffesional deformation, but GIs tend to see the worst, while a vast number of patients actually do ok most of the time. In any case, I'm prepared to invest a large portion of my time to improving this article, and if others feel like helping we could make it really shine. Who knows, maybe even a featured article? We'll see ;) Comment, please. --Dr.Gonzo 23:12, 7 March 2006 (UTC)

Well, if technically accurate is butchering then I applaud the butcher. I'd hope to keep out additions based on anecdotal cases unless very clearly marked as such. Kd4ttc 23:23, 7 March 2006 (UTC)

I agree with you 100%, the fact of the matter is the previous version wasn't going anywhere for a long time. So change is good. However, I believe we are now presented with a diamond in the rough. It needs to be polished. And we need more GI specialist input. I can provide prose if you can provide facts. But lets try and remain open-minded shall we, in my experience, way to many proffesionals are actually limited by their training and can't seem to be able to step back and look at the big picture. For example, why shove the alternative treatments to the very end of the article and treat them like a neccesary annoyance, when there are studies that suggest over 60% of IBD patients use or have used alternative remedies? Traditional medicine doesn't have all the answers (which is more true in the case of IBD then elsewhere) and treatments that were considered alternative yesterday become basis for new knowledge tommorow. I am also against anecdotal cases presented as fact, and that's precisely why I want to make this article something we can all agree on, since this theme (UC) is still very much open for debate. --Dr.Gonzo 23:40, 7 March 2006 (UTC)

Changes

Dr. Gonzo, I appreciate your comments, as usual. To tell you the truth, I wasn't a big fan of the previous article, and really wanted to add more on epidemiology and causes, add references, and cut out a lot of the redundancy in the article. There was a lot in the old article that was unsubstantiated (fistula formation, "fibrostenotic" UC, incorrect definition for pancolitis), a Medscape copyvio, and limited references. I do agree that physicians can sometimes get caught up in jargon when making general articles, but is it really that unaccessible to laymen? I had my UC patients in the clinic today look at the article in the waiting room computer, and feedback was pretty good as far as comprehension goes. They blue-linked the words they didn't follow and got descriptors. But that's WP:OR... -- Samir ∙ T C 09:55, 8 March 2006 (UTC)

I like the way you made the article more professional and accurate, and I think there is definately no going back now. You need to consider, however, that your UC patients may not be able to objectively grade the article for two reasons - 1.) you're their doctor after all so they have more confidence in your judgement 2.) more importantly, they are already quite familiar with terminology and subject. A Wikipedia article should ideally be oriented towards readers who encounter the subject for the very first time. So, from that perspective, this version can be quite confusing. IMO, we need a very consise brief at the top of the article and elaborate further in the segments below. A few more pictures would be great, and if you can provide them it would really help. They also need to be moved around a bit. In regard to fistula - I don't understand, are you saying they should not be included or that description was somewhat lacking in the previous article? Also, I don't think that clubbing picture should really be in this article, it's already included in the clubbing article, so it's somewhat redundant.

I'm basically proposing some touch ups to the flow of the article, some more prose (and not just dry terminology), and more imagery, one thing that was really lacking from the previous version of the article. For example, a nice big diagram of the intestine with different coloration for parts of the intestine that can be affected and the parts that are most often affected. We already have the endoscopy picture you provided, but it would be great if you could provide one with higher resolution. A picture of the healty colon endoscopy would also be most helpful. You could also add irigographic x-ray images showing characteristic colon de-haustration. Some sonography images showing toxic megacolon would also be great. There's a lot that can be improved, and I suggest, since you already did such a fine job, let's do it all the way, let's make this a featured article quality. --Dr.Gonzo 20:49, 8 March 2006 (UTC)

Sure, more pictures are a good idea. I can help in that regard. I agree that the clubbing picture probably can go. Wish I had a dehaustration picture; I'm sure Steve will agree that we really don't do many barium enemas in UC anymore. I can work on a diagram to show proctitis vs. L sided disease vs. extensive colitis vs. pancolitis.

I like the way that JFW made it fit with the WP:MOS. My worry is that the article will devolve into a lengthy narration of unsubstantiated information, like the previous one. I don't think that's in anyone's interest. -- Samir ∙ T C 22:02, 8 March 2006 (UTC)

Ok, so that's a good start. Let's get those pictures first and then we can start tweaking the article. I'll submit to your expertise on the traditional side, but I can contribute on the new and alternative treatments segment. I would like to add HBOT therapy info, some herbal remedies, some alternative diets (like SCD), and a few more "futuristic" ones like that dialysis-like treatment the Japanese have been experimenting for some time. I think it's important to include them because many patients who visit Wikipedia may come in contact with these ideas for the first time, and some of them may actually benefit from it. I actually don't agree with JFWs categorisation of alternatives as a sort of "necessary evil" because, unlike some other conditions, some of the alternative treatments for UC really do have verifiable effect on the course of the disease and length of remission. And including them in this article is a HUGE favour to patients and physicians alike because it gives them a neat overview and a lot more options to consider. As i said, traditional medicine, at least at this time, has its limitations. Of course, if included, everything needs to be backed by references from reputable sources. Concerning the images - I think the dehaustration x-ray would be one of the more informative ones, so let's try and make it a priority. It doesn't have to be original, an old encyclopedia image will do fine, just cite the source. I share your concern about the article devolving into a lengthy narration, but if you look at some of the featured articles they are quite long but not boring or uninformative. So I guess it's a matter of style and being to-the-point. Some things that are not explained elsewhere on Wikipedia need to be elaborated on, but many others do not. If a subject has it's own Wikipedia article just blue-link it and that's that. In any case, if someone is not satisfied with new aditions or elaborations we can always discuss and come to a compromise here. --Dr.Gonzo 22:54, 8 March 2006 (UTC)

Just a few points: unsubstantiated material can be safely removed if it is noncompliant with WP:NOR and WP:CITE. We all know this, and Wikipedia is influential enough to warrant reliable information.

The alternative treatments go at the end out of necessity: many patients use them, but the whole entity of UC is principally the domain of mainstream medicine. If a patient depended on alternative practicioners only, nobody would have a colonoscopy! I think the present arrangement is fine, and I don't think we need CAM apologetics.

I agree more images would be good, but healthy organs are our last concern (unless they are next to abnormal ones for comparison). A plain X-ray of toxic megacolon is just what the doctor ordered. JFW | T@lk 22:23, 8 March 2006 (UTC)

To use a rather corny line - "We agree to disagree" ;) It's good that we're talking about it at least, and the changes that I'm suggesting are little more than trivial at best so I think we can all come to a consensus very easily here. What I don't want is this article to become a dry, strictly "doctor lingo" assortment of blue-links that don't benefit anyone. Let's make it as informative and as approachable as possible, without the flaws the previous version had. Btw, I agree, alternatives should stay at the bottom, but should be expanded. And yes, i did mean that healthy endoscopy image should be next to the diseased one so that someone who is not a professional can also understand what changes take place. A dehaustration image right underneath that would illustrate the point magnificently. --Dr.Gonzo 23:12, 8 March 2006 (UTC)

I must say, I agree with Dr. Gonzo here when it comes to terminology. I'm a freelance writer specializing in medical, diet, and natural health articles and I wade through this language on a daily basis in scientific journals and research papers. Granted, this is much clearer than a research paper on "The insulinotropic, antihyperglycaemic and glucagonostatic effects of stevioside in vivo", but only marginally so. Bonus points if you understand all of that at first read.

It's understandable that Samir wrote this at his own level because inherently we write in our own voice, and his is obviously a well educated and technical one. However, if the purpose of this article is to inform the average layman of his or her options, it's invariably going to fail or at the very least cause them to do extensive research on just the terminology to understand the core information displayed in the article.

Over the years of freelance writing I've jumped from Technical, to Business, to Medical and many other fields along the way. One thing I've learned is it's absolutely essential that you learn to write in the voice of your average reader, or market. Failing to do so just ends up frustrating your market and giving them a negative impression of you and the information you portray.

I'm willing to rework parts of the article at request, but I don't want to step on anyone's toes since I'm new here. I've been looking over a lot of the work many of the editor's on this talk page have done and have to say I'm impressed with the overall quality. Keep up the good work! -- Oncehour 09:42, 2 April 2006 (UTC)

Changes to therapy

Great job by User:Andrewr47 to stratify therapy by disease extent! -- Samir (the scope) 04:01, 11 April 2006 (UTC)

Pictures

The endoscopy picture is fine, but I object to the mouth ulcer picture. -- THEBlunderbuss 15:38, 4 May 2006 (UTC)

Hi, was wondering what the reason was for your concern? I realize it's your picture, but you released it under GFDL and it's a reasonable representation of a finding that you can see in UC -- Samir (the scope) धर्म 18:41, 4 May 2006 (UTC)

I didn't have ulcerative colitus. -- THEBlunderbuss 13:46, 8 May 2006 (UTC)

It's a great picture! People who have UC can get aphthous ulcers very similar to the one photographed. It fits well with the article -- Samir (the scope) धर्म 15:18, 8 May 2006 (UTC)

I concede. It's not like it specifically says that I got the canker sore that way. I just didn't want that picture to mislead anyone. "hey, that doesn't look like MY ulcerative colitis mouth sore." -- THEBlunderbuss 02:27, 10 May 2006 (UTC)

But for the record, it was originally Creative Commons, until wikipedia stopped that nifty template for it. -- THEBlunderbuss 22:01, 10 May 2006 (UTC)

Folic Acid deficiency

Is there a source for the need for a folic acid supplement with sulfasalazine? M dorothy

HLA B-27

I'm not able to find any reference for the assertion that UC correlates with HLA B-27. I've moved it out of "causes" to "research".M dorothy 13:53, 10 June 2006 (UTC)

References

Still a lot uncited, will work on it -- Samir धर्म 02:46, 9 June 2006 (UTC)

GA failed

For these reasons :

• See WP:LEAD for a better lead section.
• and blood on rectal exam., abbreviations aren't favored.
• Sometimes the initial sign of the disease is unrelated to the bowel, such as painful knees. why?
• Needs brilliant prose more than lists.
• Needs more wikilinks. e.g. tenesmus, Proctosigmoiditis, rectosigmoid, cecum...
• and low grade fever., was there ever a grading system or is it to the doctor's own diagnosis?
• Missing inline citations. Lincher 05:35, 18 June 2006 (UTC)

Thanks for this input. As a technical writer, however, I disagree with the concept of "brilliant prose". The purpose here is to convey a lot of information in an organized way. If this were done with "brilliant prose", the article would be much too long. And, the important concepts would not be accessible to the person who wants to skim to what is important to him.M dorothy 14:59, 18 June 2006 (UTC)

I have to disagree with you there, this article should not be like an excerpt from a technical manual, it needs to be accesible to laymen. And in that sense, it does need more prose. It's very informative as is, but also very boring and overly technical. --Dr.Gonzo 15:51, 18 June 2006 (UTC)

• see WP:GI for my comments. I say we make this the next GI collaboration of the week -- Samir धर्म 04:05, 20 June 2006 (UTC)

I'm an experienced RN and a UC patient. I was surgically cured in 1997; my disease started late (age 29) and progressed rapidly (from the distal 7cm of colon to the hepatic flexure 11 months later, to pancolitis 15 months after that). Imuran (azathioprine) was the only medication that was able to give me a formed stool after I first showed symptoms, but it sent my LFTs through the roof. Fortunately, they returned to baseline once the Imuran was d/c'd. (I was mad, too, because Imuran allowed me to get off prednisone completely – but the cost was a liver biopsy and an ERCP. Liver biopsies hurt. A lot. I digress, though.)

I have to agree with Dr. Gonzo and Lincher about the style of this entry – it absolutely needs more prose. If I was a patient coming here for information, this entry would look to me like a long list (make that several long lists nested in more long lists) of doctorspeak (no offense, docs!). It's very difficult to read and digest (no pun intended), and if the point is to educate a layman or a patient about the condition – as I think it is – more paragraphs, more sentences, and fewer bullet points are necessary. The content is top-notch, but I don't think anything can be 'skimmed' here because the thing is just too long. It's very intimidating and someone in search of information – and reassurance, if s/he has UC or thinks s/he does – will and should look elsewhere until some changes are made. Collaboration of the week is a good idea.

I'll try to find one of my own endoscopy photos to scan in – the photo I have in mind clearly shows the demarcation between my ulcerated bowel and my normal bowel, and it would be helpful to show the striking difference between normal and ulcerated bowel. I hope I can find the photo. - BaseballBaby 04:35, 20 June 2006 (UTC)

Photo

It's been pointed out to me that the photo on the top of the article has ulcers that look serpiginous (which is more Crohn's like). The purulent stuff is definitely UC like, but this probably isn't the most representative UC photo. Better photo would be appreciated! -- Samir धर्म 06:09, 24 June 2006 (UTC)

Hydrogen peroxide and ulcerative colitis

I don't know if this should be included. It's not a mainstream view as far as a cause. I'll grant that there are case reports of hydrogen peroxide causing colitis, but I don't think there is consensus at all of it being a specific cause of UC now -- Samir धर्म 07:42, 18 July 2006 (UTC)

• Let me elaborate a bit: It is agreed that peroxide is a cause of chemical colitis. No question. It is also agreed that antioxidants have been hypothesized in pathogenesis of ulcerative colitis. However, with respect to peroxide being a specific cause of ulcerative colitis per se, there are only two references in the literature:
  • Sheehan JF, Brynjolfsson G. Ulcerative colitis following hydrogen peroxide enema: case report and experimental production with transient emphysema of colonic wall and gas embolism. Lab Invest. 1960 Jan-Feb;9:150-68. PMID 14445720
    • I think "ulcerative" colitis referred to in the title is literally colitis that ulcerates (i.e. chemical colitis with ulcers). I've asked for the abstract to be sent to my office and will clarify further when I can peruse it, but I don't think this paper cites peroxide as a cause of UC in any way.
  • Pravda J. Radical induction theory of ulcerative colitis. World J Gastroenterol. 2005 Apr 28;11(16):2371-84. PMID 15832404
    • This is really the only publication that espouses a putative causative relation between hydrogen peroxide and UC
• There are many chemicals that cause shallow confluent ulcers in the colon similar to ulcerative colitis that are unrelated to causality in UC. I don't think there's enough evidence that hydrogen peroxide is related enough to causality to merit a mention. -- Samir धर्म 08:11, 18 July 2006 (UTC)