Ulcerative Colitis

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Basics

Description

  • Ulcerative colitis (UC) is a chronic relapsing and remitting inflammatory disease affecting the large intestine.
  • Characterized by recurrent episodes of bloody and mucoid diarrhea often associated with abdominal pain, urgency, stool incontinence, fever, and weight loss
  • Colonic involvement is universal and may be accompanied by other systemic manifestations including large joint arthritis, ocular inflammation, skin lesions, biliary disease, liver disease, thromboembolic disease, and pulmonary complications.

Epidemiology

Incidence
  • North America: 19.2/100,000 person-years (1)
  • Europe: 24.3/100,000 person-years (1)
  • Asia/Middle East: 6.3/100,000 person-years (1)

Prevalence
  • North America: 249/100,000 persons (1)
  • Europe: 505/100,000 persons (1)

Etiology and Pathophysiology

  • Idiopathic inflammatory disorder; hypothesized to result from autoimmune dysfunction in response to colonic microbiome, genetic predisposition, and distinct risk factors
  • Typically associated with inflammation of the terminal colon. >95% of patients have rectal involvement, 50% have disease limited to the rectum and sigmoid, and 20% have pancolitis. The absence of rectal involvement has been noted in <5% of adult patients, and in up to 1/3 of pediatric patients.

Genetics
  • Genetic factors contribute to inflammatory bowel disease (IBD) susceptibility.
  • Several genetic syndromes have been associated with IBD (Turner syndrome, Hermansky-Pudlak syndrome, and glycogen storage disease type 1b).

Risk Factors

  • Variable age of onset, peak incidence 15 to 30 years
  • More common in Jewish compared with non-Jewish populations
  • Theorized risk factors include disruption of the colonic microbiome by enteric infection, dietary factors (Western diet in particular), antibiotic use, lack of breastfeeding in infant, obesity, and NSAID use.

General Prevention

Smoking may lower the risk of UC.

Pregnancy Considerations

  • Variable disease course in pregnancy
  • Increased risk of preterm delivery and small for gestational age in women with active disease
  • Consultation with gastroenterologist and/or maternal–fetal medicine specialist recommended

Pediatric Considerations

  • Breastfeeding may protect against pediatric IBD.
  • Pancolonic involvement more likely at onset; shorter time from diagnosis to colectomy (~11 years) than adults

Commonly Associated Conditions

  • Common:
    • Arthritis: large joint, sacroiliitis, ankylosing spondylitis; erythema nodosum; aphthous ulcers; fatty liver; osteoporosis
  • Rare:
    • Pyoderma gangrenosum; episcleritis; uveitis; autoimmune liver disease; cirrhosis; primary sclerosing cholangitis; bile duct carcinoma; thromboembolic disease, anemia; colon cancer

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Basics

Description

  • Ulcerative colitis (UC) is a chronic relapsing and remitting inflammatory disease affecting the large intestine.
  • Characterized by recurrent episodes of bloody and mucoid diarrhea often associated with abdominal pain, urgency, stool incontinence, fever, and weight loss
  • Colonic involvement is universal and may be accompanied by other systemic manifestations including large joint arthritis, ocular inflammation, skin lesions, biliary disease, liver disease, thromboembolic disease, and pulmonary complications.

Epidemiology

Incidence
  • North America: 19.2/100,000 person-years (1)
  • Europe: 24.3/100,000 person-years (1)
  • Asia/Middle East: 6.3/100,000 person-years (1)

Prevalence
  • North America: 249/100,000 persons (1)
  • Europe: 505/100,000 persons (1)

Etiology and Pathophysiology

  • Idiopathic inflammatory disorder; hypothesized to result from autoimmune dysfunction in response to colonic microbiome, genetic predisposition, and distinct risk factors
  • Typically associated with inflammation of the terminal colon. >95% of patients have rectal involvement, 50% have disease limited to the rectum and sigmoid, and 20% have pancolitis. The absence of rectal involvement has been noted in <5% of adult patients, and in up to 1/3 of pediatric patients.

Genetics
  • Genetic factors contribute to inflammatory bowel disease (IBD) susceptibility.
  • Several genetic syndromes have been associated with IBD (Turner syndrome, Hermansky-Pudlak syndrome, and glycogen storage disease type 1b).

Risk Factors

  • Variable age of onset, peak incidence 15 to 30 years
  • More common in Jewish compared with non-Jewish populations
  • Theorized risk factors include disruption of the colonic microbiome by enteric infection, dietary factors (Western diet in particular), antibiotic use, lack of breastfeeding in infant, obesity, and NSAID use.

General Prevention

Smoking may lower the risk of UC.

Pregnancy Considerations

  • Variable disease course in pregnancy
  • Increased risk of preterm delivery and small for gestational age in women with active disease
  • Consultation with gastroenterologist and/or maternal–fetal medicine specialist recommended

Pediatric Considerations

  • Breastfeeding may protect against pediatric IBD.
  • Pancolonic involvement more likely at onset; shorter time from diagnosis to colectomy (~11 years) than adults

Commonly Associated Conditions

  • Common:
    • Arthritis: large joint, sacroiliitis, ankylosing spondylitis; erythema nodosum; aphthous ulcers; fatty liver; osteoporosis
  • Rare:
    • Pyoderma gangrenosum; episcleritis; uveitis; autoimmune liver disease; cirrhosis; primary sclerosing cholangitis; bile duct carcinoma; thromboembolic disease, anemia; colon cancer

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