I have belly discomfort and pain due to ulcerative colitis. How to get rid of the symptoms?

Question

Hi doctor,

I have had ulcerative colitis since I was 19 years old, and now I am 26 years old. I have not had urgency or blood in stool since I started taking Remicade at age 19. I have been off from Remicade since I was 24-year-old. The only symptoms I have now are belly discomfort and pain. I do not have a strict diet; I eat pretty much anything. Sometimes I am very gassy as well. The belly pain comes and goes, feeling like there is inflammation, but it is not painful. I feel there is a kind of pressure or tenderness when I touch. There is no diarrhea, and I regularly go about once in a day. Do you know what I could do to get rid of these symptoms?

Answer 1

Hi,

Welcome to icliniq.com.

Well, since you have an established condition, thinking of other possibilities causing increased gas is a foolish thing to do. You may have these symptoms because of underlying subacute active colitis. Well, the narrowing of the lumen is not a feature of ulcerative colitis. Still, sometimes it is narrowing that causes obstruction and slowing of the bowel, pain, and increased bacterial transmission upward into the small bowel, causing excessive gas production.

The condition is called small intestinal bacterial overgrowth (SIBO), and it can be confirmed with a hydrogen breath test (HBT) after an oral lactulose challenge test. Again, the tenderness has to be carefully looked at, and this suggests there is ongoing inflammation. You can check stool for fecal calprotectin, a surrogate marker for the endoscopic examination telling about the disease's activity. You can discuss with me the reports once they are available and follow up as advised.

Best regards.