Ulcerative colitis

Epidemiology

• Prevalence = 80 to 120 / 100000
• Uncommon in smokers

Pathology

• Limited to colon
• Inflammation spreads proximally from the rectum
• Mucosal inflammation
• Leads to erythema, oedema and ulceration
• Inflammatory infiltrate
• Crypt abscesses
• Goblet cell depletion

Clinical features

• Diarrhoea
• Blood or mucous per rectum
• Mouth ulcers

Disease associations

• Uveitis/iritis/conjunctivitis
• Erythema nodosum/pyoderma gangrenosum
• Arthritis/sacroiliitis/ankylosing spondylitis
• Sclerosing cholangitis

Investigations

• Colonoscopy and biopsy
• Indicators of acute severe colitis urgent treatment
• > Six stools a day
• Fever > 37.5 degrees celcius
• Tachycardia >90 bpm
• ESR >30 mm/hr
• Haemoglobin <10 g/dL
• Albumin <30 g/L

Management

• 5-ASA, e.g. mesalazine
• Steroids, e.g. prednisolone
• Azathioprine
• Surgery
• Topical 5-ASA or steroids (enemas)

Complications

• Toxic megacolon
• Iron deficiency anaemia
• Increased risk of colorectal cancer
• Thromboembolism