Individuals with ulcerative colitis can present rectal bleeding, mucous discharge from the rectum, and/or frequent stools. Individuals, who suffer from more severe cases of ulcerative colitis, can also have lower abdominal pain caused by purulent rectal discharge, severe dehydration, diarrhea and cramps, fever, leukocytosis, and/or abdominal distention. Fifteen percent of cases will have severe enough attacks to require steroid therapy and a hospital stay.

A potentially severe condition associated with ulcerative colitis is primary sclerosing cholangistis (PSC). This condition can result in jaundice and liver failure, leading to the need for a liver transplant. 75% of patients with PSC have IBD.

In severe cases requiring pouch procedures, additional symptoms can occur.

• 2% of patients who undergo a pouch procedure become completely incontinent
• 3% of males experience sexual dysfunction due to impotence or retrograde ejaculation
• 6% of females experience sexual dysfunction

Ulcerative colitis can be associated with extra colonic problems such as:

• Erythema nodosum
• Uveitis
• Pleuritis
• Spondyloarthropathies
• Ankylosing spondylitis
• Pyoderma gangrenosum

Multiple sclerosis, immunobullous disease of the skin, and recurrent subcutaneous abscesses unrelated to pyoderma gangrenosum can also be associated with ulcerative colitis [1] [2].

Laboratory studies are typically used to assess the patient’s nutritional status and exclude other diagnoses, but the presence of serologic markers can be helpful in diagnosing an IBD. Acute infective enterocolitis, caused by Entamoeba histolytica, cytomegalovirl colitis, and Salmonela, Shigella, Isospora, or Yersinia may present with similar findings to ulcerative colitis, especially on CT scans. It is possible to diagnose ulcerative colitis in its early stages through the use of a double-contrast barium enema examination, because it is capable is picking up finer details. A complete blood count which includes anemia (hemoglobin < 14 g/dL in males and <12 g/dL in females) and thrombocytosis (platelet count > 350,000/µL) should be done. Hypoalbuminemia (albumin < 3.5 g/dL), hypokalemia (postassium < 3.5 mEq/L), elevated alkaline phosphatase, and hypomagnesemia (magnesium, 1.5 mg/dL) will be looked for in a comprehensive metabolic panel.

Inflammation markers such as an elevation of C-reactive protein levels and erythrocyte sedimentation rates may also be looked for. Stool studies will be conducted in order to determine if there is an underlying cause that is not ulcerative colitis.

Ulcerative colitis is typically diagnosed with a mucosal biopsy and an endoscopy for histopathology. Additional laboratory studies can be conducted in order to assess the patient’s nutritional health, and to exclude other diagnoses. The presence of serologic markers help to diagnose the existence of an IBD. A chromoendoscopy can also be conducted upon the doctor’s recommendation, to examine the colitis setting for precancerous changes and polyps.

Treatment for ulcerative colitis depends on extent of involvement and severity. The goal is to induce and maintain remission. Corticosteroids and anti-inflammatory agents together with symptomatic treatment are commonly used. Surgery is indicated when medical treatment fails or in case of a surgical emergency.

While ulcerative colitis can lead to disease related death, mortality is typically not increased in patients who suffer from it. When an increased mortality rate is seen it is typically in older patients or in cases where complications develop. Specifically the development of toxic megacolon is related to increased mortality. The longer that a person suffers from ulcerative colitis, the higher their risk of developing a colonic malignancy is.

Ulcerative colitis is thought to have etiology in the areas of genetics, immune reactions, environmental factor, as well as others [1] [2] [3] [4].

Genetics

It is currently believed that abnormality of cell-mediated and humoral immunity occur in individuals who are more susceptible to ulcerative colitis. Individuals with ulcerative colitis also appear to be more sensitive to the bowels naturally occurring bacteria. A family history of ulcerative colitis increases the individual’s risk of suffering from it at some time in their life. Multiple loci have been identified which are associated with ulcerative colitis, Crohn's disease, and sometimes colorectal cancer.

Immune reactions

Patients with ulcerative colitis, often have serum and mucosal antibodies which attack the epithelial barrier of the intestines. This is a possible cause of ulcerative colitis. Additionally, a correlation between having an appendectomy and decreased risk of developing ulcerative colitis has been identified.

Environmental factors

Sulfate reducing bacteria’s are commonly found in patients with ulcerative colitis leading to higher amounts of sulfide, and altering the naturally occurring bacteria flora that lives in our intestines.

Other

Lower levels of vitamins A and E are found in 16% of children with ulcerative colitis. Smoking and milk consumption can trigger ulcerative colitis. Ulcerative colitis can be agitated by psychological and psychosocial stressors.

With 1 million people in the US affected, ulcerative colitis has a prevalence rate of 35-100 cases in 100,000, and an incidence rate of 10.4-12 cases in 100,000. Higher numbers of Caucasians than African Americans suffer from ulcerative colitis, with Ashkenazi Jews being 2-4 times more likely to have it [5]. Women are more likely to suffer from ulcerative colitis than men, and it is typically diagnosed in age ranges of 15-25 years old and 55-65 years old. Twenty to twenty-five percent of cases occur in people 20 or younger with only 2 in 100,000 children affected. Incidences of ulcerative colitis are low in Asia and the Far East.

Ulcerative colitis is characterized by changes to the immune system. The lamina propia accumulates extra T-cells, which are cytotoxic to the colonic epithelium. In addition, B cells, plasma cells, and immunoglobulin G and E increase. Ulcerative colitis patients have been observed to have anticolonic antibodies, as well as antiskeletal antibodies in limited cases. These antibodies attack the colon or skeletal system causing the patient discomfort or pain.

Microscopic changes include abscesses, inflamed crypts of Lieber Kuhn, and acute chronic inflamed infiltrate of the lamina propria. Granulation tissue will quickly cover the ulcerated areas. Ulcerative colitis typically begins at the anal verge and extends, without interruption, to all, or part of the colon. Ninety-five percent of cases involve the rectum. The terminal ileum is impacted in about 10% of cases. Superficial mucosal inflammation is caused by noxious inflammatory mediates backing up.

There are no guidelines for prevention of ulcerative colitis.

Ulcerative colitis along with Crohn's disease, are both types of inflammatory bowel diseases (IBD). Ulcerative colitis typically affects the large bowel, while Crohn's disease impacts the whole gastrointestinal tract. The origins of ulcerative colitis are unknown, but it seems to be caused by a genetic predisposition and immune dysfunction. There is a strong correlation with histocompatibility human leukocyte antigen, (HLA)-B27 but the risk of having ulcerative colitis is not increased by having HLA-B27.

Ulcerative colitis can be impacted by the patient’s diet by agitating their already damaged mucous linings [1] [2]. Though it can occur at any age, ulcerative colitis typically occurs between the ages of 15 and 25 or between the ages of 55 and 65. Ulcerative colitis sufferers typically have a wall lining that is thin to normal in thickness. But it can present as thickened due to hypertrophy and enema.

Ulcerative colitis has several synonyms: Colitis gravis, idiopathic non-specific ulcerative colitis, chronic non-specific ulcerative colitis, and idiopathic proctocolitis.

Ulcerative colitis is an inflammatory bowel disease that impacts the large intestine (i.e. colon). With ulcerative colitis the lining of the large intestines is inflamed, can have sores, produce mucous or pus, and can develop ulcers. As a result you can experience abdominal discomfort and the need to frequently empty your intestines. Ulcerative colitis is an auto immune disease which impacts your intestines because your body has misinterpreted the bacteria, food and other materials located in the large intestines as germs which need to be destroyed. If you have ulcerative colitis you could experience urgent and looser bowel movements, bloody stool, persistent diarrhea, and/or crampy abdominal pain. You may lose your appetite, feel fatigued, and or lose weight. It is possible for you to experience no discomfort at all between colitis flare-ups.

1. Cotran RS, Collins T, Robbins SL, Kumar V. Pathologic Basis of Disease. Philadelphia, Pa: WB Saunders; 1998.
2. Xavier RJ, Podolsky DK. Unravelling the pathogenesis of inflammatory bowel disease. Nature. Jul 26 2007;448(7152):427-34.
3. Barrett JC, Lee JC, Lees CW, et al. Genome-wide association study of ulcerative colitis identifies three new susceptibility loci, including the HNF4A region. Nat Genet. Dec 2009;41(12):1330-4.
4. Bousvaros A, Zurakowski D, Duggan C, et al. Vitamins A and E serum levels in children and young adults with inflammatory bowel disease: effect of disease activity. J Pediatr Gastroenterol Nutr. Feb 1998;26(2):129-35.
5. Garland CF, Lilienfeld AM, Mendeloff AI, Markowitz JA, Terrell KB, Garland FC. Incidence rates of ulcerative colitis and Crohn's disease in fifteen areas of the United States. Gastroenterology. Dec 1981;81(6):1115-24.