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Ulcerative colitis

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Ulcerative colitis

Ulcerative colitis (UC) is one of the two types of inflammatory bowel disease (IBD), with the other type being Crohn's disease. It is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptoms of active disease are abdominal pain and diarrhea mixed with blood (hematochezia). Weight loss, fever, and anemia may also occur. Often, symptoms come on slowly and can range from mild to severe. Symptoms typically occur intermittently with periods of no symptoms between flares. Complications may include abnormal dilation of the colon (megacolon), inflammation of the eye, joints, or liver, and colon cancer. The cause of UC is unknown. Theories involve immune system dysfunction, genetics, changes in the normal gut bacteria, and environmental factors. Rates tend to be higher in the developed world with some proposing this to be the result of less exposure to intestinal infections, or to a Western diet and lifestyle. The removal of the appendix at an early age may be protective. Diagnosis is typically by colonoscopy, a type of endoscopy, with tissue biopsies. Several medications are used to treat symptoms and bring about and maintain remission, including aminosalicylates such as mesalazine or sulfasalazine, steroids, immunosuppressants such as azathioprine, and biologic therapy. Removal of the colon by surgery may be necessary if the disease is severe, does not respond to treatment, or if complications such as colon cancer develop. Removal of the colon and rectum generally cures the condition.

Infobox

Specialty
Gastroenterology
Symptoms
Abdominal pain, diarrhea mixed with blood, weight loss, fever, anemia, dehydration, loss of appetite, fatigue, sores on the skin, urgency to defecate, inability to defecate despite urgency, rectal pain
Complications
Megacolon, inflammation of the eye, joints, or liver, colon cancer
Usual onset
15–30 years or 60 years
Duration
Long term
Causes
Unknown
Diagnostic method
Colonoscopy with tissue biopsies
Differential diagnosis
Dysentery, Crohn's disease, ischemic colitis
Treatment
Dietary changes, medication, surgery
Medication
Sulfasalazine, mesalazine, steroids, immunosuppressants such as azathioprine, biological therapy
Frequency
2–299 per 100,000
Deaths
47,400 together with Crohn's (2015)

Tables

Signs and symptoms · Signs and symptoms
Defecation
Defecation
Col 1
Defecation
Crohn's disease
Often porridge-like, sometimes steatorrhea
Ulcerative colitis
Often mucus-like and with blood
Tenesmus
Tenesmus
Col 1
Tenesmus
Crohn's disease
Less common
Ulcerative colitis
More common
Fever
Fever
Col 1
Fever
Crohn's disease
Common
Ulcerative colitis
Indicates severe disease
Fistulae
Fistulae
Col 1
Fistulae
Crohn's disease
Common
Ulcerative colitis
Seldom
Weight loss
Weight loss
Col 1
Weight loss
Crohn's disease
Often
Ulcerative colitis
More seldom
Crohn's disease
Ulcerative colitis
Defecation
Often porridge-like, sometimes steatorrhea
Often mucus-like and with blood
Tenesmus
Less common
More common
Fever
Common
Indicates severe disease
Fistulae
Common
Seldom
Weight loss
Often
More seldom
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Nutrient deficiency
Nutrient deficiency
Col 1
Nutrient deficiency
Col 2
Higher risk
Colon cancer risk
Colon cancer risk
Col 1
Colon cancer risk
Col 2
Slight
Crohn's disease
Considerable
Prevalence of extraintestinal complications
Prevalence of extraintestinal complications
Col 1
Prevalence of extraintestinal complications
Iritis/uveitis
Iritis/uveitis
Col 1
Iritis/uveitis
Col 2
Females
Crohn's disease
2.2%
Ulcerative colitis
3.2%
Males
Males
Col 1
Males
Col 2
1.3%
Crohn's disease
0.9%
Primary sclerosing cholangitis
Primary sclerosing cholangitis
Col 1
Primary sclerosing cholangitis
Col 2
Females
Crohn's disease
0.3%
Ulcerative colitis
1%
Males
Males
Col 1
Males
Col 2
0.4%
Crohn's disease
3%
Ankylosing spondylitis
Ankylosing spondylitis
Col 1
Ankylosing spondylitis
Col 2
Females
Crohn's disease
0.7%
Ulcerative colitis
0.8%
Males
Males
Col 1
Males
Col 2
2.7%
Crohn's disease
1.5%
Pyoderma gangrenosum
Pyoderma gangrenosum
Col 1
Pyoderma gangrenosum
Col 2
Females
Crohn's disease
1.2%
Ulcerative colitis
0.8%
Males
Males
Col 1
Males
Col 2
1.3%
Crohn's disease
0.7%
Erythema nodosum
Erythema nodosum
Col 1
Erythema nodosum
Col 2
Females
Crohn's disease
1.9%
Ulcerative colitis
2%
Males
Males
Col 1
Males
Col 2
0.6%
Crohn's disease
0.7%
Crohn's disease
Ulcerative colitis
Nutrient deficiency
Higher risk
Colon cancer risk
Slight
Considerable
Prevalence of extraintestinal complications
Iritis/uveitis
Females
2.2%
3.2%
Males
1.3%
0.9%
Primary sclerosing cholangitis
Females
0.3%
1%
Males
0.4%
3%
Ankylosing spondylitis
Females
0.7%
0.8%
Males
2.7%
1.5%
Pyoderma gangrenosum
Females
1.2%
0.8%
Males
1.3%
0.7%
Erythema nodosum
Females
1.9%
2%
Males
0.6%
0.7%
Risk factors · Causes
Smoking
Smoking
Col 1
Smoking
Crohn's disease
Higher risk for smokers
Ulcerative colitis
Lower risk for smokers
Age
Age
Col 1
Age
Crohn's disease
Usual onset between 15 and 30 years
Ulcerative colitis
Peak incidence between 15 and 25 years
Crohn's disease
Ulcerative colitis
Smoking
Higher risk for smokers
Lower risk for smokers
Age
Usual onset between 15 and 30 years
Peak incidence between 15 and 25 years
Pathophysiology · Pathophysiology
Cytokine response
Cytokine response
Col 1
Cytokine response
Crohn's disease
Associated with Th17
Ulcerative colitis
Vaguely associated with Th2
Crohn's disease
Ulcerative colitis
Cytokine response
Associated with Th17
Vaguely associated with Th2
Diagnostic findings · Diagnosis › Differential diagnosis
Terminal ileum involvement
Terminal ileum involvement
Col 1
Terminal ileum involvement
Crohn's disease
Commonly
Ulcerative colitis
Seldom
Colon involvement
Colon involvement
Col 1
Colon involvement
Crohn's disease
Usually
Ulcerative colitis
Always
Rectum involvement
Rectum involvement
Col 1
Rectum involvement
Crohn's disease
Seldom
Ulcerative colitis
Usually (95%)
Involvement around the anus
Involvement around the anus
Col 1
Involvement around the anus
Crohn's disease
Common
Ulcerative colitis
Seldom
Bile duct involvement
Bile duct involvement
Col 1
Bile duct involvement
Crohn's disease
No increase in rate of primary sclerosing cholangitis
Ulcerative colitis
Higher rate
Distribution of disease
Distribution of disease
Col 1
Distribution of disease
Crohn's disease
Patchy areas of inflammation (skip lesions)
Ulcerative colitis
Continuous area of inflammation
Endoscopy
Endoscopy
Col 1
Endoscopy
Crohn's disease
Deep geographic and serpiginous (snake-like) ulcers
Ulcerative colitis
Continuous ulcer
Depth of inflammation
Depth of inflammation
Col 1
Depth of inflammation
Crohn's disease
May be transmural, deep into tissues
Ulcerative colitis
Shallow, mucosal
Stenosis
Stenosis
Col 1
Stenosis
Crohn's disease
Common
Ulcerative colitis
Seldom
Granulomas on biopsy
Granulomas on biopsy
Col 1
Granulomas on biopsy
Crohn's disease
May have non-necrotizing non-peri-intestinal crypt granulomas
Ulcerative colitis
Non-peri-intestinal crypt granulomas not seen
Crohn's disease
Ulcerative colitis
Terminal ileum involvement
Commonly
Seldom
Colon involvement
Usually
Always
Rectum involvement
Seldom
Usually (95%)
Involvement around the anus
Common
Seldom
Bile duct involvement
No increase in rate of primary sclerosing cholangitis
Higher rate
Distribution of disease
Patchy areas of inflammation (skip lesions)
Continuous area of inflammation
Endoscopy
Deep geographic and serpiginous (snake-like) ulcers
Continuous ulcer
Depth of inflammation
May be transmural, deep into tissues
Shallow, mucosal
Stenosis
Common
Seldom
Granulomas on biopsy
May have non-necrotizing non-peri-intestinal crypt granulomas
Non-peri-intestinal crypt granulomas not seen
Management · Management › Surgery
Mesalazine
Mesalazine
Col 1
Mesalazine
Crohn's disease
Less useful
Ulcerative colitis
More useful
Antibiotics
Antibiotics
Col 1
Antibiotics
Crohn's disease
Effective in long-term
Ulcerative colitis
Generally not useful
Surgery
Surgery
Col 1
Surgery
Crohn's disease
Often returns following removal of affected part
Ulcerative colitis
Usually cured by removal of colon
Crohn's disease
Ulcerative colitis
Mesalazine
Less useful
More useful
Antibiotics
Effective in long-term
Generally not useful
Surgery
Often returns following removal of affected part
Usually cured by removal of colon

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