Ulcerative colitis

Ulcerative colitis (UC) is a type of inflammatory bowel disease characterised by diffuse inflammation of the colonic mucosa and a relapsing, remitting course.

Patients commonly experience bloody diarrhoea, chronic diarrhoea (or both), lower abdominal pain, faecal urgency, and extraintestinal manifestations, particularly those related to activity of the colitis.

Diagnosis requires endoscopy with biopsy and negative stool culture.

Relapses are often associated with pathogens; therefore, stool should be obtained for culture in all cases of disease flare-up.

Treatment aims to induce and maintain remission. Drug choice and formulation depends on the severity and extent of disease.

Toxic megacolon can occur with associated risk of perforation. Bowel adenocarcinoma is a complication in 3% to 5% of patients.

UC is a type of inflammatory bowel disease that characteristically involves the rectum and extends proximally to affect a variable length of the colon. It is recognised as a multifactorial polygenic disease, as the exact aetiology is still unknown. Included in the aetiological theories are environmental factors, immune dysfunction, and a likely genetic predisposition.[1]Podolsky DK. Inflammatory bowel disease. N Engl J Med. 2002 Aug 8;347(6):417-29. http://www.ncbi.nlm.nih.gov/pubmed/12167685?tool=bestpractice.com [2]Hanauer SB. Inflammatory bowel disease: epidemiology, pathogenesis, and therapeutic opportunities. Inflamm Bowel Dis. 2006 Jan;12 Suppl 1:S3-9. http://www.ncbi.nlm.nih.gov/pubmed/16378007?tool=bestpractice.com ​​[3]Collins P, Rhodes J. Ulcerative colitis: diagnosis and management. BMJ. 2006 Aug 12;333(7563):340-3. http://www.ncbi.nlm.nih.gov/pubmed/16902215?tool=bestpractice.com

This topic covers the diagnosis and treatment of ulcerative colitis in adults.