Ulcerative colitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Ulcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD). Ulcerative colitis is a form of colitis, a disease of the intestine, specifically the large intestine or colon, that includes characteristic ulcers, or open sores, in the colon. The main symptom of active disease is usually diarrhea mixed with blood, of gradual onset. Ulcerative colitis is, however, a systemic disease that affects many parts of the body outside the intestine. Because of the name, IBD is often confused with irritable bowel syndrome ("IBS"), a troublesome, but much less serious condition. Ulcerative colitis has similarities to Crohn's disease, another form of IBD. Ulcerative colitis is an intermittent disease, with periods of exacerbated symptoms, and periods that are relatively symptom-free. Although the symptoms of ulcerative colitis can sometimes diminish on their own, the disease usually requires treatment to go into remission.
Historical Perspective
Classification
The inflammatory bowel disease (IBD) is divided primarily into ulcerative colitis and Crohn's disease. Some cases which depict overlapping features of both ulcerative colitis and Crohn's disease can be classified as intermediate colitis. Depending on the location of involved are with respect the descending colon, ulcerative colitis can be classified as proximal or distal. Based on the severity, ulcerative colitis can be classified into mild, moderate, severe or fulminant.[1]
Pathophysiology
Causes
The exact cause of ulcerative colitis s still unknown. Several possible causes have been suggested including genetic, environmental and autoimmune factors.[2][3]
Differentiating Ulcerative colitis from other Diseases
Ulcerative colitis should be differentiated from other causes of diarrhea. It is very important to differentiate it from Crohn's disease as the management of both conditions is different though the initial presentation may be confused for any of these disorders.[4][5]
Epidemiology and Demographics
United States, Canada, the United Kingdom, and Scandinavia have the highest incidence of inflammatory bowel disease i.e ulcerative colitis and Crohn's disease.The incidence of ulcerative colitis in North America is 10-12 cases per 100,000.[6] with highest incidences in the United States, Canada, the United Kingdom, and Scandinavia. Higher incidences are seen in northern locations compared to southern locations in Europe and the United States.[7]
Risk Factors
Risk factors include a family history of ulcerative colitis, or Jewish ancestry. It may affect any age group, although there are peaks at ages 15 - 30 and then again at ages 50 - 70. It affects men and women equally and appears to run in families, with reports of up to 20 percent of people with ulcerative colitis having a family member or relative with ulcerative colitis or Crohn's disease. A higher incidence of ulcerative colitis is seen in Whites and people of Jewish descent.
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Patients with ulcerative colitis present with a history of bloody diarrhea mixed with mucus, of gradual onset. Some patients may present with a sudden attack of diarrhea, fever and abdominal pain. The extra intestinal symptoms may include joint swelling and pain, inflammation of the eye and skin involvement.[8]
Physical Examination
Laboratory Findings
Abdominal X Ray
CT
Other Imaging Findings
Other Diagnostic Findings
Treatment
Medical Therapy
Surgery
Alternative Treatments
Primary Prevention
Secondary Prevention
Future or Investigational Therapies
References
- ↑ Kornbluth A, Sachar DB, Practice Parameters Committee of the American College of Gastroenterology (2010). "Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee". Am J Gastroenterol. 105 (3): 501–23, quiz 524. doi:10.1038/ajg.2009.727. PMID 20068560.
- ↑ Orholm M, Binder V, Sorensen TI, Rasmussen LP, Kyvik KO. Concordance of inflammatory bowel disease among Danish twins. Results of a nationwide study. Scand J Gastroenterol 2000;35:1075-81. PMID 11099061.
- ↑ Tysk C, Lindberg E, Jarnerot G, Floderus-Myrhed B (1988). ""Ulcerative colitis and Crohn's disease in an unselected population of monozygotic and dizygotic twins. A study of heritability and the influence of smoking". Gut. 29: 990–996.
- ↑ Fattahi MR, Malek-Hosseini SA, Sivandzadeh GR, Safarpour AR, Bagheri Lankarani K, Taghavi AR; et al. (2017). "Clinical Course of Ulcerative Colitis After Liver Transplantation in Patients with Concomitant Primary Sclerosing Cholangitis and Ulcerative Colitis". Inflamm Bowel Dis. doi:10.1097/MIB.0000000000001105. PMID 28520586.
- ↑ Burisch J, Ungaro R, Vind I, Prosberg MV, Bendtsen F, Colombel JF; et al. (2017). "Proximal disease extension in patients with limited ulcerative colitis: a Danish population-based inception cohort". J Crohns Colitis. doi:10.1093/ecco-jcc/jjx066. PMID 28486626.
- ↑ Podolsky DK. Inflammatory bowel disease. N Engl J Med 2002;347:417-424. PMID 12167685.
- ↑ Shivananda S, Lennard-Jones J, Logan R, Fear N, Price A, Carpenter L, van Blankenstein M. Incidence of inflammatory bowel disease across Europe: is there a difference between north and south? Results of the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD). Gut 1996;39:690-7. PMID 9014768.
- ↑ Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.