Ulcerative colitis is a type of inflammatory bowel disease that solely affects the rectum, sigmoid colon and descending colon. UC usually causes symptoms clearly related to the affected areas of the bowel, such as: rectal bleeding, diarrhoea (and the sensation of needing to empty one's bowels when there is nothing there to void), mucous discharge from the rectum, lower abdominal pain, and potentially, if severe enough, dehydration resulting from excessive mucous discharge and/or diarrhoea. Extraintestinal manifestations of UC include arthropathies (e.g., ankylosing spondylitis, sacroiliitis, migratory polyarthritis, etc.), uveitis, erythema nodosum, aphthous ulcers of the mouth, pleuritis, multiple sclerosis, episcleritis, thrombosis, pyoderma gangrenosum and primary sclerosing cholangitis (which occurs in between 2.5 and 7.5% of patients).
Classification and distinction from Crohn diseaseEdit
Unlike the other major form of IBD, Crohn disease (CD), where the sites of disease in the colon can be patchy for UC it is always continuous and does not skip any areas. Additionally it can be distinguished from CD in that it extends into the mucosa and submucosa, as opposed to CD that is usually transmural.
UC is usually treated with medication, although surgery to remove the affected parts of the bowel can be used in cases of desperation. Medications used to induce remission in mild-moderate UC are usually oral/rectal aminosalicylates or if this fails oral corticosteroids may be used. Moderate-severe UC is usually induced into remission with corticosteroids, calcineurin inhibitors (e.g., ciclosporin, tacrolimus) or monoclonal antibodies (usually directed at TNF-α; e.g., adalimumab, golimumab, infliximab). Maintenance therapy usually consists of an aminosalicylate or if this fails, or is intolerable, an antimetabolite immunosuppressant such as azathioprine or mercaptopurine.
Over half of patients with UC have clinically mild disease, although 30% of patients require a colectomy within 3 years of diagnosis, due to uncontrollable symptoms. Being a subtype of IBD it follows a relapsing-remitting course in most individuals with almost all patients experiencing at least one relapse within ten years of their diagnosis. A colectomy cures intestinal disease, but extraintestinal manifestations often persist.
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- ↑ 1.0 1.1 1.2 1.3 Basson, MD (14 November 2014). Anand, BS; Grosso, MA; Jacocks, J; Le, TH; Lovato, LM; Minocha, A; Talavera, F; Williams, N, ed. "Ulcerative Colitis". Medscape Reference. New York, USA: WebMD. Retrieved 9 January 2015.
- ↑ Ordás, I; Eckmann, L; Talamini, M; Baumgart, DC; Sandborn, WJ (3 November 2012). "Ulcerative colitis.". Lancet 380 (9853): 1606–19. PMID 22914296. doi:10.1016/S0140-6736(12)60150-0.
- ↑ 3.0 3.1 3.2 Kumar, V; Abbas, AK; Aster, AC (July 2014). "Chapter 17. The Gastrointestinal Tract". Robbins & Cotran Pathologic Basis of Disease 9e. Philadelphia, USA: Saunders. p. 800. ISBN 978-0-8089-2450-0.
- ↑ Kumar, V; Abbas, AK; Aster, AC (July 2014). "Chapter 17. The Gastrointestinal Tract". Robbins & Cotran Pathologic Basis of Disease 9e. Philadelphia, USA: Saunders. p. 797. ISBN 978-0-8089-2450-0.
- ↑ 5.0 5.1 5.2 5.3 5.4 Basson, MD (14 November 2014). Anand, BS; Grosso, MA; Jacocks, J; Le, TH; Lovato, LM; Minocha, A; Talavera, F; Williams, N, ed. "Ulcerative Colitis Treatment & Management". Medscape Reference. New York, USA: WebMD. Retrieved 9 January 2015.