Ulcerative Colitis Disease
One of a group of inflammatory bowel diseases of unknown etiology characterized by intermittent bouts of inflammation of all or portions of the colon. Manifested by recurrences of rectal bleeding and various constitutional symptoms.
- System(s) affected: Gastrointestinal
- Genetics: Family aggregates common, positive family history in 8-11%. More likely vertical than horizontal. More common in Jews.
- Incidence/Prevalence in USA: 70-150 per 100,000. Incidence 6-8 new cases per 100,000 population.
- Predominant age: Between ages of 15 and 35 years. There is a second and smaller peak in the 7th decade.
- Predominant sex: Male = Female
- Bloody diarrhea
- Abdominal pain
- Fever
- Weight loss
- Arthralgias and arthritis (15-20%)
- Spondylitis (3-6%)
- Ocular complications (4-10%) includes episcleritis, uveitis, cataracts, keratopathy, marginal corneal ulceration, and central serous retinopathy
- Erythema nodosum
- Pyoderma gangrenosum
- Aphthous ulcers of mouth (5-10%)
- Asymptomatic fatty liver common - occasional hepatomegaly
- Pericholangitis (uncommon)
- Primary sclerosing cholangitis (1-4%)
- Cirrhosis of liver (1-5%)
- Bile duct carcinoma
- Thromboembolic disease (1-6%)
- Pericarditis (rare)
- Amyloidosis (rare)
Unknown (genetic, infectious, immunologic, and psychological factors have all been suggested)
- None known
- Higher incidence in Jews and those with positive family history
- Negative association with smoking
- Nonspecific. Usually reflects the degree of severity of the bleeding and inflammation.
- Anemia may reflect chronic disease as well as iron deficiency from blood loss
- Leukocytosis during exacerbation
- Elevated sedimentation rate
- Electrolyte abnormalities, especially hypokalemia
- Hypoalbuminemia
- Elevated liver function tests (if there is associated hepatobiliary disease)
Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A
Inflammation of the colonic mucosa with ulcerations. These appear hyperemic and hemorrhagic. Rectum involved 95% of time. The inflammation extends proximally in a continuous fashion, but for a variable distance. May affect terminal ileum - referred to as "backwash ileitis."
- Sigmoidoscopy, may include biopsy
- Colonoscopy, may include biopsy for evaluation for premalignant features; also used to differentiate from Crohn's disease, and to investigate abnormalities that appear on radiography, such as stricture or mass lesions. Colonoscopy useful to define the extent of involvement and specific segments involved as this has bearing on therapy and prognosis.
Outpatient, except for severe exacerbations which may require hospitalization
Goal is to control inflammation, prevent complications, replace nutritional losses and blood volume
Complications or refractory disease may require surgical intervention
Full activity as tolerated
No specific diet; milk products not withheld unless an associated lactase deficiency exists
- Close doctor/patient relationship encouraged
- Self-help organizations such as:
- National Foundation for Ileitis and Colitis
444 Park Avenue S., 11th Floor, New York, NY 10016-7374, (800)343-3637
- National Foundation for Ileitis and Colitis
Colonoscopic evaluation for cancer surveillance with biopsy evaluation of the mucosa for evidence of dysplasia must be performed every 1-2 years after the disease has been present for 7-8 years. This is particularly important in pancolitis. Low grade dysplasia warrants more frequent evaluation (e.g., every 3-6 months) and high grade dysplasia (or low grade dysplasia within a mass) warrant consideration of colectomy.
- Annual liver tests
- Cholangiography for cholestasis
- Perforation
- Toxic megacolon
- Liver disease
- Stricture formation (less than Crohn's disease)
- Colon cancer (may occur in as many as 30% of those with pancolitis for 25 years). Incidence of cancer is cumulative and begins after 7-8 years of disease; risk may be considerably less in left sided disease.
- Course extremely variable; mortality for initial attack approximately 5%. Approximately 75-85% of patients experience relapse, and up to 20% in some studies eventually require colectomy.
- Colon cancer risk is the single most important risk factor affecting long-term prognosis
- Left-sided colitis and ulcerative proctitis have very favorable prognosis with probable normal life span
Ankylosing spondylitis
Pediatric:
- Approximately 20% of patients are 21 years or younger
- Cancer surveillance is important since occurrence of cancer relates to the duration and extent of disease, whether frequently symptomatic or not
Geriatric: Increased mortality with initial attack in patients over 60
Others: N/A
- Outcome of pregnancy similar to general population. One study showed 30% of those with inactive disease at onset of pregnancy relapsed and 14% did so in first trimester.
- Treatment with sulfasalazine does not seem to affect outcome of pregnancy
- Recommend patient delay pregnancy until time when disease is inactive
N/A
N/A
Clinical Investigations
- Cardiology
- Dermatology
- General Destistry
- Cardiology
- Dermatology
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