Ulcerative colitis is an inflammatory bowel disease characterized by bloody diarrhea where the colon and the rectum become inflamed.
Ulcerative colitis is an autoimmune condition that causes inflammation and ulcers on the inner lining of the large intestine.
Along with Crohn's disease, these two major forms of inflammatory bowel disease (IBD) represent distinct syndromes with overlapping features.
The exact cause of ulcerative colitis is unknown.
It may be related to infections, genetic predisposing factors and environmental influences.
The estimated incidence of ulcerative colitis is about 1-2 new cases per 10000 population per year.
It can occur at any age with the highest peak between 15 and 30 years and a second smaller peak between 50 and 70 years.
The disease is characterized by periods of remission (with no symptoms) and relapse.
Ulcerative colitis patients present with a variety of symptoms:
The main symptom is frequent episodes of bloody diarrhea triggered by infections or stress.
With increasing severity of disease, it may be followed by:
Some patients may show some extra-intestinal manifestations such as:
Ulcerative colitis may have similar symptoms compared to irritable bowel syndrome (IBS). The key to the differential diagnosis is the presence of blood in the stools that is not a feature of IBS. The biopsy will show a definitive conclusion.
The presence of bloody diarrhea along with extra-intestinal symptoms are decisive for the diagnosis of ulcerative colitis.
Colonoscopy is the critical diagnostic test. Tissue samples (biopsies) can be taken during a colonoscopy. Plain abdominal radiology of the abdomen may also provide useful information.
There is no curative treatment for ulcerative colitis.
The treatment of ulcerative colitis is based on the severity of the inflammatory process and its extent, the course of the disease during follow-up, complications, and extra-intestinal manifestations.
It may be adequate the use of anti-inflammatory and immunosuppressive drugs on an individualized basis. The most common drugs used are:
In severe cases, that do not respond properly to the above treatments, the following drugs may be prescribed:
If the medication has no effect, surgical therapy may be considered.
Ulcerative colitis is characterized by periods of remission and relapse.
Patients with long-standing ulcerative colitis are at an increased risk for developing colorectal cancer. The risk of developing colorectal cancer depends on:
It is recommended a follow-up with a sampling of multiple biopsies repeated every 1–3 years.
In addition to the possibility of suffering colorectal cancer, there are other possible complications: