Ulcerative colitis

Abstract

Ulcerative colitis is an idiopathic, chronic inflammatory disorder of the colonic mucosa, which starts in the rectum and generally extends proximally in a continuous manner through part of, or the entire, colon; however, some patients with proctitis or left-sided colitis might have a caecal patch of inflammation. Bloody diarrhoea is the characteristic symptom of the disease. The clinical course is unpredictable, marked by alternating periods of exacerbation and remission. In this Seminar we discuss the epidemiology, pathophysiology, diagnostic approach, natural history, medical and surgical management, and main disease-related complications of ulcerative colitis, and briefly outline novel treatment options. Enhanced understanding of how the interaction between environmental factors, genetics, and the immune system results in mucosal inflammation has increased knowledge of disease pathophysiology. We provide practical therapeutic algorithms that are easily applicable in daily clinical practice, emphasising present controversies in treatment management and novel therapies.

Temporal Comorbidity of Mental Disorder and Ulcerative Colitis

“…Although the exact etiology of ulcerative colitis remains unknown, a combination of genetic predisposition and environmental risk factors underlie its pathogenesis. 7 Unlike the findings from our study, Molodecky et al 2 found that ulcerative colitis appears to be on the rise around the globe. Ulcerative colitis is more prevalent in developed nations, with the highest prevalence in Europe (51 per 10,000 persons) and North America (25 per 10,000 persons).…”

Systematic analysis of factors associated with progression and regression of ulcerative colitis in 918 patients

“…At diagnosis, UC patients presented with the following disease extent: proctitis [199 patients (21.7%)], left-sided colitis [338 patients (36.8%)] and extensive colitis/pancolitis [381 (41.5%)]. During a median disease duration of 9 [4][5][6][7][8][9][10][11][12][13][14][15][16] years, progression and regression was documented in 145 patients (15.8%) and 149 patients (16.2%) respectively. In addition, 624 patients (68.0%) had a stable disease extent.…”

“…1,2 Ulcerative colitis is thought to develop as a consequence of a dysregulated mucosal immune response to commensal gut flora in genetically susceptible individuals. 3,4 Roughly, one-third of newly diagnosed UC patients initially presents with ulcerative proctitis/proctosigmoiditis. 5,6 Another third of newly diagnosed patients presents with left-sided colitis at the time of diagnosis.…”

“…The remaining one-third of all patients presents with extensive colitis or pancolitis at the time of diagnosis. 4,7 The disease may progress proximally over time. Ayres et al have reported that 16% and 31% of patients presenting with ulcerative proctitis/proctosigmoiditis at the time of diagnosis have more extensive disease at 5 and 10 years after diagnosis respectively.…”

Patchy colitis, and young age at diagnosis and at the time of surgery predict subsequent development of Crohn's disease after ileal pouch‐anal anastomosis surgery for ulcerative colitis

“…Approximately 20–30% of patients with ulcerative colitis (UC) require surgery at some stage of their disease 1. Indications for surgical treatment of UC include chronic refractory disease despite optimal medical therapy, corticosteroid dependence, complications of medical therapy, acute severe UC, and development of colorectal dysplasia or malignancy.…”