Ulcerative colitis is classified by the extent of colonic involvement using the Montreal Classification system, with disease extent significantly influencing symptoms, treatment approach, and cancer risk.
| Type | Extent of Inflammation | Common Symptoms | Considerations |
|---|---|---|---|
| Ulcerative Proctitis (E1) | Rectum only | Urgency, tenesmus (feeling of incomplete evacuation), rectal bleeding | Mildest form; affects 30-60% at presentation; no increased cancer risk; may progress proximally |
| Left-Sided Colitis/Distal Colitis (E2) | Rectum to splenic flexure | Bloody diarrhea, abdominal cramping, urgency, weight loss | Affects 16-45% at presentation; moderate cancer risk; responds well to topical therapy |
| Extensive Colitis/Pancolitis (E3) | Beyond splenic flexure to entire colon | Severe bloody diarrhea, significant abdominal pain, fatigue, weight loss, fever | Affects 14-35% at presentation; highest cancer risk; requires systemic therapy; 10-19% progress from limited disease within 5 years |
| Fulminant/Toxic Colitis | Severe pancolitis with systemic toxicity | High fever, severe bloody diarrhea, abdominal distension, tachycardia | Medical emergency; may require hospitalization or surgery; risk of toxic megacolon |
Gastrointestinal Symptoms:
Systemic Symptoms:
Complications and Severe Disease:
Extraintestinal Manifestations:
Comprehensive ulcerative colitis evaluation requires thorough assessment to determine disease extent, severity, and underlying factors contributing to inflammation. At Whole Gut Health, we use advanced diagnostics to create personalized treatment protocols that address root causes alongside disease management.
Testing options may include:
Colonoscopy with Biopsy to visualize the entire colon, assess disease extent and severity, obtain tissue samples for definitive diagnosis, and differentiate from Crohn's disease. Dr. Shustina is no longer performing colonoscopies. We will review any prior records of colonoscopies. If a colonoscopy is needed during your care. We will refer you to one of the carefully screened Gastroenterologists within our network who will perform the procedure on our behalf.
Applied Kinesiology or muscle testing to help delineate root causes and confirm precise customized treatment protocols
Comprehensive Stool Analysis with Microbiome Profiling to assess gut microbiome composition, identify dysbiotic patterns characteristic of ulcerative colitis, and measure inflammation markers including calprotectin and lactoferrin.
Inflammatory Markers and Serologic Testing including CRP, ESR, pANCA antibodies, and ASCA to help confirm diagnosis, monitor disease activity, and differentiate from Crohn's disease.
Complete Blood Count and Nutritional Assessment to evaluate anemia severity, nutritional deficiencies (iron, folate, vitamin D, vitamin B12), and overall disease impact.
Short-Chain Fatty Acid Analysis to evaluate butyrate and other metabolite production critical for colonic health and mucosal integrity.
SIBO Breath Testing since small intestinal bacterial overgrowth is more prevalent in ulcerative colitis patients and may contribute to symptoms.
We customize testing protocols based on symptom patterns, disease history, and suspected contributing factors to ensure comprehensive evaluation and optimal treatment planning.
Our Three-Phase Crohn's Resolution Protocol Includes:
1. Assessment and Root-Cause Identification
2. Targeted Intervention
3. Long-Term Remission and Prevention
Dr. Alexandra Shustina, NYC’s and Miami’s premier gut health specialist doctor is a board-certified gastroenterologist and internist. She is a gut health specialist with training in conventional gastroenterology and functional gut health. She is an expert in the gut microbiome and its role in health and wellness.
At Whole Gut Health, our care is led by experienced functional medicine clinicians with a deep understanding of the gut microbiome and advanced diagnostics. We combine evidence-based strategies from conventional gastroenterology with a functional and integrative lens to give you the clarity and support needed for long-term healing.
Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that causes continuous inflammation and ulceration of the colon's innermost lining, always beginning in the rectum and extending proximally in a continuous pattern. Unlike Crohn's disease, ulcerative colitis is confined to the colon and doesn't involve deeper bowel wall layers. The disease results from complex interactions between genetics, immune dysfunction, environmental triggers, and gut microbiome imbalances that reduce beneficial bacteria and compromise mucosal protection.
Ulcerative Proctitis (E1) - 30-60% at presentation
Left-Sided Colitis (E2) - 16-45% at presentation
Extensive Colitis/Pancolitis (E3) - 14-35% at presentation
Fulminant/Toxic Colitis
Gastrointestinal: Bloody diarrhea (90% of patients), increased stool frequency and urgency, rectal bleeding, tenesmus, abdominal cramping, nocturnal bowel movements, paradoxical constipation in proctitis
Systemic: Fatigue, weight loss, fever during flares, loss of appetite, night sweats
Complications: Dehydration, severe anemia, toxic megacolon, bowel perforation, increased colorectal cancer risk
Extraintestinal: Joint pain, skin conditions, eye inflammation, liver complications, blood clotting abnormalities
Comprehensive evaluation includes multiple assessment approaches:
Colonoscopy with Biopsy
Applied Kinesiology
Comprehensive Stool Analysis
Blood Testing
Short-Chain Fatty Acid Analysis
SIBO Breath Testing
Our comprehensive three-phase ulcerative colitis resolution protocol includes:
Ulcerative colitis patients consistently show reduced bacterial diversity, decreased butyrate-producing bacteria, and abnormal microbial composition compared to healthy individuals. This dysbiosis reduces short-chain fatty acid production (especially butyrate) essential for colonic epithelial cell energy and mucosal integrity. The resulting barrier dysfunction allows bacterial products to contact immune cells, triggering the chronic inflammatory response characteristic of ulcerative colitis.
Yes, with comprehensive treatment, most patients achieve periods of remission. The goal of modern ulcerative colitis management is mucosal healing, not just symptom control, which significantly reduces complication risk and colorectal cancer development. Our approach combines root cause healing with gut microbiome restoration, anti-inflammatory nutrition, and lifestyle modification to maximize remission duration and quality of life. Conventional medical treatment is used only when necessary.
At Whole Gut Health, we take a comprehensive approach to ulcerative colitis that addresses underlying factors alongside disease management:
Dr. Alexandra Shustina is a board-certified gastroenterologist and internist who serves as NYC's and Miami's premier gut health specialist. She has training in both conventional gastroenterology and functional gut health, with particular expertise in inflammatory bowel diseases and comprehensive gut microbiome restoration protocols.
The first step is scheduling a comprehensive consultation where we'll:
Contact our office to schedule your initial consultation and begin your journey toward sustained remission and optimal gut health.
Let us help. CALL NOW
