From the Guidelines
Ulcerative colitis is a chronic, relapsing-remitting inflammatory bowel disease characterized by diffuse mucosal inflammation of the colon. This condition is marked by recurring episodes of abdominal pain, diarrhea that may contain blood or mucus, rectal bleeding, urgency to defecate, weight loss, and fatigue 1. The disease typically begins in the rectum and lower colon but can spread continuously to involve the entire colon. Unlike Crohn's disease, which can affect any part of the digestive tract, ulcerative colitis is limited to the colon and rectum.
Key Characteristics
- Chronic inflammatory bowel disease
- Diffuse mucosal inflammation of the colon
- Relapsing-remitting course
- Symptoms include abdominal pain, diarrhea, rectal bleeding, and weight loss
The exact cause of ulcerative colitis remains unknown, but it's believed to involve an abnormal immune response where the immune system attacks the cells in the digestive tract, with genetic and environmental factors playing roles 1. Treatment typically includes anti-inflammatory medications like aminosalicylates, corticosteroids for flares, immunosuppressants, biologics, and in severe cases that don't respond to medication, surgical removal of the colon may be necessary 2.
Treatment Options
- Aminosalicylates (e.g., mesalamine)
- Corticosteroids for flares
- Immunomodulators (e.g., azathioprine, 6-mercaptopurine)
- Biologics (e.g., infliximab, adalimumab)
- Surgical removal of the colon in severe cases
It's worth noting that the incidence and prevalence of ulcerative colitis have increased over the past 50 years and continue to rise globally, with most patients having a mild-to-moderate course characterized by periods of activity or remission 1. The emergence of biologic agents and small molecule therapies has revolutionized the treatment of moderately to severely active ulcerative colitis, allowing for steroid-free remission, mucosal and histological healing, and reductions in hospitalizations and surgeries 1.
From the Research
Definition and Characteristics of Ulcerative Colitis
- Ulcerative colitis (UC) is a chronic disease featuring recurrent inflammation of the colonic mucosa 3
- It is a chronic idiopathic inflammatory bowel disorder of the colon that causes continuous mucosal inflammation extending from the rectum to the more proximal colon, with variable extents 4
- UC is characterized by a relapsing and remitting course, with symptoms including bloody diarrhea, abdominal pain, fecal urgency, and tenesmus 4, 5
Diagnosis of Ulcerative Colitis
- The diagnosis of UC is made by combining the clinical picture, tissue biopsy with the endoscopic appearance of mucosal ulceration, friable, edematous, erythematous granular appearing mucus 6
- Ileocolonoscopy with biopsy is the only way to make a definitive diagnosis of UC, with a pathognomonic finding of continuous colonic inflammation characterized by erythema, loss of normal vascular pattern, granularity, erosions, friability, bleeding, and ulcerations 4
- Histopathology is the definitive tool in diagnosing UC, assessing the disease severity and identifying intraepithelial neoplasia (dysplasia) or cancer 4
Treatment of Ulcerative Colitis
- The primary goal of treatment is to induce and maintain remission using therapy tailored to the individual patient 7
- For mild to moderate UC, oral and rectal 5-aminosalycilates are typically used, while in moderate to severe colitis, medication classes include thiopurines, biological agents targeting tumor necrosis factor and integrins, and the small-molecule Janus kinase inhibitors 5
- Anti-TNF therapy should be initiated in patients with acute severe refractory to corticosteroids ulcerative colitis and in patients with moderate-to-severe ulcerative colitis who are not responsive to conventional treatment with aminosalicylates, corticosteroids and immune modulators 7