Diagnosis

Ulcerative colitis

Etiology

Cause [kbr]

• The exact etiology of ulcerative colitis is unknown

• Genetic component: first-degree relatives has a four times higher risk, higher incidence in Jewish populations, Northern Europe and North America

• Immune system reactions

• Environmental factors: more common in the Western world

Pathophysiology

1. Defective epithelial barrier in the colon mucosa --> increased uptake of luminal antigens

2. Imbalance between enteric microflora and the host's mucosal immunity

3. A pathological immune response to non-pathogenic colon bacteria --> cytotoxic response against epithelial cells

4. T cells, B cells and plasma cells (production of IgG and IgE) accumulate in the lamina propria of the diseased colonic segment

5. Acute and chronic inflammatory infiltrate of the lamina propria, crypt branching, and villous atrophy

6. Clinical manifestation:

   • Bloody diarrhea with or without mucus

   • Tenesmus, abdominal pain, malaise, weight loss, and fever

Complications [kbr]

• Incontinence

• Pelvic abscess

• Perforation

• Stricture

• Toxic megacolon

• Colon/rectal cancer

• GI bleeding

• Growth retardation in children

• Treatment complications: Leak from anastomosis, enterocutaneous fistulas, pouch prolapse, pouchitis, sexual dysfunction

Epidemiology

Incidence per 100.000 [kbr][o7z][eua][dy1][1fs][u7p]

Prevalence per 100.000 [kbr][o7z][eua][dy1][1fs][u7p]

Approach

• Blood test: Calprotectin

• Colonoscopy

• Biopsy

Treatment

Treatment based on the extent and severity of the disease [kbr]

1. First-line treatment: Sulfasalazine and 5-aminosalicylates, given orally or rectally, which have a remission rate of about 50%

2. Glucocorticoids, orally or rectally, can be added for those who fail to achieve remission within two weeks.

3. Other treatment with some evidence: probiotics and fecal microbiota transplantation

4. Refractory disease: Stronger immunsuppression

   • Azathioprine or 6-mercaptopurine

   • Biological anti-TNF-alpha drugs: infliximab, adalimumab, golimumab, vedolizumab

5. Colectomy - Curative surgical treatment:

   • Indications: failure of medical therapy, intractable fulminant colitis, toxic megacolon, perforation, uncontrollable bleeding, intolerable side effects of medications, strictures, high-grade or multifocal dysplasia, cancer, or growth retardation in children

Differential diagnoses

Abdominal abscess, Acute mesenteric ischemia, Adhesion, Amebiasis, Appendicitis, Benign neoplasm of the small intestine, Celiac disease, Cholelithiasis, Colorectal cancer, Colorectal polyp, Crohn disease, Diverticulitis, Erythema nodosum, Femoral hernia, Gastroenteritis, Incisional hernia, Infectious colitis, Inguinal hernia, Intussusception, Irritable bowel syndrome, Ischemic colitis, Meckels diverticulum, Ovarian torsion, Peritonitis, Peutz-Jeghers syndrome, Pseudomembranous colitis, Radiation colitis, Ruptured ectopic pregnancy, Schistosomiasis, Small bowel cancer, Toxic megacolon, Trauma, Tuberculosis, Umbillical hernia