Ulcerative Colitis
Ulcerative Colitis
Ulcerative Colitis
Abstract
Introduction
Epidemiology
Etiology
Pathophysiology
Symptoms, signs, and laboratory findings
Diagnostic methods
Differential diagnosis
Therapy
Prognosis
Surgery
References
Abstract
Ulcerative colitis (UC) is an inflammatory chronic disease primarily affecting the colonic mucosa; the
extent and severity of colon involvement are variable. In its most limited form it may be restricted to the
distal rectum, while in its most extended form the entire colon is involved. UC belongs to the inflammatory
bowel diseases (IBD), which is a general term for a group of chronic inflammatory disorders of unknown
etiology involving the gastrointestinal tract. UC is usually associated with recurrent attacks with complete
remission of symptoms in the interim. In Western Europe and in the USA, UC has an incidence of
approximately 6 to 8 cases per 100.000 populations and an estimated prevalence of approximately 70 to
150 per 100.000 populations. The leading initial symptom of UC is diarrhea with blood and mucus,
sometimes with pain. Fever and weight loss are less frequent. Extra intestinal symptoms can be an initial
manifestation or can occur later in the course of the disease. Eighty percent of the patients have only
proctitis or proctosigmoiditis, and only 20% have extensive colitis. However, in about 50% of patients with
initial proctosigmoiditis, proximal extension occurs later, and in some patients the opposite takes place.
Depending of the stage of the disease, endoscopy reveals reddening of the mucosa, increased
vulnerability, mucosal bleeding, irregular ulcers, pseudopolyps, granularity, and loss of vascular
architecture. Several drugs interacting with various points along the immune and inflammatory cascades
are currently available for the treatment of UC. Corticosteroids, aminosalicylates, immunomodulators are
the mainstay of medical treatment.
Keywords
Ulcerative colitis, inflammatory bowel diseases, colonic mucosa, gastrointestinal tract, proctitis,
proctosigmoiditis, corticosteroids, aminosalicylates, immunomodulators
Diarrhea 96.4%
Pathophysiology Blood in stool 89.3%
While the cause of UC remains unknown, a Pain 81;3%
number of findings in recent years point to an Generally unwell 40.2%
over stimulation or inadequate regulation of the Weight loss 38.4%
mucosal immune system as a major Arthralgia 27.7%
pathophysiologic pathway, and particular Fever 20.5%
emphasis has been given to either the study of Skin changes 20.5%
mucosal inflammation or immunologic reactions. Loss of appetite 15.2%
When the disease is active, the lamina propria of Ophtalmopathies 7.1%
the mucosa becomes heavily infiltrated with a Nausea 6.3%
mixture of acute and chronic inflammatory cells. Vomiting 4.5%
There is a predominant increase in mucosal IgG Abscesses 3.6%
production, evidence of complement activation, Fistulae 3.6%
and activation of macrophages and T cells. This Lymphe node swelli 1.8%
immunological activity is associated with the
release of a vast array of cytokines, kinins,
leukotriens, platelet activating factor (PAF) and The relapse rate is higher in the younger
reactive oxygen metabolites. These mediators patients and seems to decrease with increasing
not only serve to amplify the immune and age. In a large cohort analysed over 25 years,
inflammatory response, but they also have direct 50% of the patients were able to work after 10
effects on epithelial function, on endothelial years.
function (which may increase permeability and
lead to ischaemia), and on repair mechanisms, Table 2: Frequency of extraintestinal
thus increasing collagen synthesis. In addition, manifestations of the course of UC
many of the cytokines (interleukins 1 and 6,
tumor necrosis factor) will activate an acute All 64-66%
phase response, resulting in fever and a rise in
serum acute phase proteins. Some of the clinical Skin 15.9%
features of acute ulcerative colitis may explain Erythema nodosum 8.0%
by these mechanisms. It follows, therefore, that Pyoderma gangrenosum 7.1%
any treatment which is able to inhibit the Aphtae 6.2%
activation of these immunological and
inflammatory effector mechanisms is likely to Eyes 9.7%
lead to an improvement in the patient’s Conjunctivitis 5.3%
symptoms and to a decrease in the inflammatory Iritis 4.4%
activity. Uveitis 0.9%