Ulcerative colitis – Knowledge @ AMBOSS

Last updated: August 30, 2021

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) characterized by chronic mucosal inflammation of the rectum, colon, and cecum. Common symptoms include bloody diarrhea, abdominal pain, and fever. Laboratory findings typically show elevated inflammatory markers and the presence of autoantibodies (pANCA). Definitive diagnosis requires biopsies showing abnormal colonic mucosa and characteristic histopathology. Aminosalicylic acid derivatives are the mainstay of treatment, although severe episodes typically require corticosteroids and immunosuppressants to achieve remission. In the case of distal colitis, some drugs may be administered topically (e.g., via enema), whereas more proximal inflammation requires systemic treatment. Proctocolectomy is curative and indicated for complicated UC or dysplasia. Individuals with UC are predisposed to colorectal cancer and should thus undergo regular surveillance colonoscopy.

References: [2][4][5]

Epidemiological data refers to the US, unless otherwise specified.

The exact mechanism is unknown but studies suggest that ulcerative colitis is the result of abnormal interactions between host immune cells and commensal bacteria. [2][6]

The rectum is always involved in UC.

Primary sclerosing cholangitis (PSC) is often associated with inflammatory bowel disease, especially UC. However, only around 4% of people with inflammatory bowel disease develop PSC!

For the characteristics of ulcerative colitis, think ULCCCERS: Ulcers, Large intestine, Continuous/Colon cancer/Crypt abscesses, Extends proximally, Red diarrhea, Sclerosing cholangitis.

References:[11]

Endoscopy (e.g., colonoscopy) with histological examination is considered the best test to definitively diagnose UC.

Observe caution in taking biopsies from patients with severe disease, as the risk of perforation is high.

Imaging studies may serve as useful adjunct diagnostic procedures for UC, particularly when it comes to detecting complications.

References:[12][13][15]

In ulcerative colitis, the extent of intestinal inflammation is limited to the mucosa and submucosa. In contrast, Crohn disease shows a transmural pattern of intestinal involvement.

Noncaseating granulomas are seen in Crohn disease but are not a feature of ulcerative colitis!

The differential diagnoses listed here are not exhaustive.

Initially, UC is treated conservatively with drugs to induce and maintain disease remission. Curative proctocolectomy is generally indicated if medical therapy fails or complications arise.

Systemic corticosteroids should only be used for the treatment of an active flare and are not recommended as a maintenance medication for ulcerative colitis.

In contrast to Crohn disease, ulcerative colitis can be cured surgically (proctocolectomy).

References:[14][19]

We list the most important complications. The selection is not exhaustive.

On average, the life expectancy of patients with UC is normal.

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Ulcerative colitis - Knowledge @ AMBOSS