Ulcerative colitis
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Ulcerative colitis (UC) is a chronic inflammatory bowel disease affecting the colon, almost always starting in the rectum and extending proximally in a continuous pattern.
Key features
- Involves colon and rectum only (small bowel typically spared, except possible backwash ileitis in severe pancolitis)
- Continuous inflammation rather than skip lesions
- Inflammation is mainly mucosal (not transmural like Crohn disease)
- Symptoms commonly include:
- bloody diarrhea
- urgency/tenesmus
- lower abdominal cramping, often relieved by defecation
- weight loss/fatigue in more severe disease
(Goldman-Cecil Medicine; Robbins Pathology)
Endoscopic and histologic findings
- Diffuse erythema, friability, loss of vascular pattern
- Granular, edematous mucosa in mild disease; ulceration in severe disease
- Pseudopolyps from repeated injury/regeneration
- Histology: cryptitis, crypt abscesses, crypt architectural distortion in chronic disease
- Absence of granulomas supports UC over Crohn disease
(Goldman-Cecil Medicine; Robbins Pathology)
Extraintestinal associations
- Arthropathies (including sacroiliitis/ankylosing spondylitis)
- Eye and skin inflammatory disease
- Strong association with primary sclerosing cholangitis (PSC)
(Robbins Pathology; Rosen Emergency Medicine)
Complications
- Severe flare/fulminant colitis
- Toxic megacolon (medical emergency)
- Perforation (if severe/untreated)
- Increased colorectal neoplasia risk with long disease duration and greater extent of colitis
(Rosen Emergency Medicine; Robbins Pathology)
Diagnosis
Usually based on:
- Clinical picture (bloody diarrhea/urgency)
- Colonoscopy with biopsies
- Histopathology consistent with continuous colitis from rectum
- Supportive labs/inflammatory markers (CRP/ESR, fecal calprotectin), anemia/albumin trends
- Serologies (pANCA/ASCA) are supportive, not diagnostic alone
(Goldman-Cecil Medicine)
Treatment overview
- Mild-moderate: 5-ASA agents (e.g., mesalamine, often rectal ± oral by extent)
- Flares: corticosteroids for induction
- Steroid-sparing maintenance/severe disease: immunomodulators and biologics (e.g., anti-TNF and others)
- Colectomy for refractory disease, dysplasia/cancer, or severe complications; colectomy cures intestinal UC but extraintestinal manifestations can persist
(Robbins Pathology; Goldman-Cecil Medicine)
If you want, I can give you a practical, stepwise UC management algorithm (by severity: proctitis vs left-sided vs extensive disease), or a quick comparison table of UC vs Crohn for exams/clinical use.
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