Ulcerative Colitis

Inflammatory bowel diseases are autoimmune disorders characterized by chronic or remitting intestinal inflammation. In some patients, inflammation is present, but the designation of ulcerative colitis vs Crohn's disease is difficult. About 5-15% of cases are considered "indeterminant" colitis (although this may be a temporary label, as some cases will become more definitive over time). Endoscopy Most patients with inflammatory bowel disease are diagnosed in their teens/early 20s; with ulcerative colitis, we see a second "peak" in patients in their 60's or 70's. Genetic factors play a role in development of disease. Environmental factors are also important (ie., diet, cigarette smoking, medications ). Ulcerative colitis is an autoimmune disorder, it is the result of detrimental interactions between the host immune response, intestinal microbiota, and intestinal barrier defects. Inflammatory bowel disease is associated with neoplasia, which is influenced by the duration and severity of the disease. UC primarily targets the colon and rectum, and is characterized by continuous lesions (in contrast to Crohn's disease, which typically spares the rectum and causes patchy inflammation). Lesions are characterized by mucosal and submucosal inflammation. Inflammation creates sunken, red/bloody ulcers with a friable or crumbly appearance (the remaining tissue of the GI tract appears as light/beige patches rising above the sunken ulcers), and destroys the submucosal vascular network. Pseudopolyps may form. See Gross Appearance: Endoscope Intestinal section When inflammation is active, the mucosa becomes bloody. UC is characterized by branching and distention of the intestinal crypts, with neutrophils present during active inflammation. See Histology Sample _endoscopic_biopsy.jpg) UC inflammation is Th2 cell-mediated. Patients experience bloody diarrhea with rectal bleeding, abdominal pain, fever, and weight loss. Toxic ulceritis, toxic megacolon, and intestinal perforation. Dysplasia and adenocarcinoma can occur and are more likely when the entire colon is involved (pancolitis). Anti-inflammatories, immune suppressors, and colectomy. Oddly enough, patients who smoke cigarettes are more likely to experience bouts of ulcerative colitis upon quitting. Skin lesions are most common (in up to 40% of patients), uveitis, and arthritis. Less common, but potentially deadly, include involvement of the liver/gallbladder, lung, pancreas, and kidneys.