Ulcerative colitis

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:

• Diarrhea with blood or mucus (defecation or bowel movement 10 to 25 times a day)..
• Tenesmus (urgent desire to evacuate the bowel).
• Abdominal pain and cramping.
• Weight loss.

The main symptom is frequent episodes of bloody diarrhea triggered by infections or stress.

With increasing severity of disease, it may be followed by:

• Fever
• Anemia
• Tachycardia

Some patients may show some extra-intestinal manifestations such as:

• Swelling and tenderness of one or more joints (peripheral arthritis or sacroiliitis).
• Inflammation inside the eyes (uveitis).
• Skin conditions such as erythema nodosum (red bumps on the shins) or pyoderma gangrenosum (painful sores or ulcers on the legs).
• Inflammation of the bile ducts (sclerosing cholangitis).

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:

• Aminosalicylates (sulfasalazine)
• Corticosteroids (prednisolone)
• Azathioprine

In severe cases, that do not respond properly to the above treatments, the following drugs may be prescribed:

• Cyclosporine
• Biological agents (Infliximab, adalimumab or visilizumab)

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:

• Disease duration: The risk increases 8-10 years after onset of symptoms.
• Extent of the disease: The risk is higher in patients with pancolitis (a form of ulcerative colitis that affects the entire colon or large intestine), lower in those with only left-side colitis and not increased in those with ulcerative proctitis (where the inflammation is limited to the rectum).

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:

• Colon perforation
• Fulminant colitis
• Toxic megacolon
• Massive rectal bleeding
• Joint inflammation (arthritis)
• Ankylosing spondylitis
• Eye disorders (uveitis or epiescleritis)
• Pyoderma gangrenosum
• Erythema nodosum
• Primary sclerosing cholangitis