Ulcerative Colitis (UC) is an inflammatory bowel disease, characterized by noninfectious inflammation of the gastrointestinal tract which always involves the rectum and extends proximally to involve the entire colon. It is a relapsing and remitting disorder with disease-free intervals alternating with periods of symptomatic inflammation (flares). Disease extent can be broadly divided into a distal and more extensive disease. ‘‘Distal’’ disease refers to colitis confined to the rectum (proctitis) or rectum and sigmoid colon (proctosigmoiditis). More extensive disease includes ‘‘left-sided colitis’’ (up to the splenic flexure), and pancolitis (affecting the whole colon).
UC is a multifactorial disease involving genetic susceptibility, the host’s immune response, and environmental factors. UC is a worldwide disorder with high prevalence rates having been reported from Northern and Western Europe and North America. Typical symptoms include rectal bleeding or bloody diarrhea, abdominal pain, fever, weight loss, and malaise. Patients may manifest signs and symptoms of disease in areas outside the Gastrointestinal (GI) tract. These extra-intestinal manifestations may occur in various body regions like eyes, joints, skin & biliary tract. Diagnosis may include stool cultures to examine for infectious causes of diarrhea. Endoscopic approaches are typically used and may include proctosigmoidoscopy, and colonoscopy in patients with suspected UC. Diagnosis of ulcerative colitis is confirmed by characteristic histological features like cryptitis, crypt abscesses, lymphoplasma cellular infiltrates in lamina propria.
In patients who do not respond to first-line therapy, they would be started on steroids to achieve remission which will be tapered gradually. Steroids are also available in oral tablets or topical suppositories, foam or liquid enemas.
In patients with severe ulcerative colitis, who are steroid dependent or have frequent relapses on tapering steroids, they would be started on immunosuppressive drugs (Azathioprine) or biological therapies (Infliximab).