eMedicine Specialties > Gastroenterology > Colon

Ulcerative Colitis

Author: Tri H Le, MD, Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, Penn State Milton S Hershey Medical Center
Contributor Information and Disclosures

Updated: Mar 17, 2010

Introduction

Background

Ulcerative colitis (UC) is an idiopathic chronic inflammatory disorder limited to the colon (see the image below). Ulcerative colitis is a lifelong illness that has a profound emotional and social impact on patients who are affected.

Ulcerative colitis as visualized with a colonosco...

Ulcerative colitis as visualized with a colonoscope.

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Ulcerative colitis as visualized with a colonosco...

Ulcerative colitis as visualized with a colonoscope.


Pathophysiology

The rectum is involved in more than 95% of cases, although some authorities believe that the rectum is always involved in untreated patients. Ulcerative colitis extends proximally from the anal verge in an uninterrupted pattern to involve part or all of the colon.

Frequency

United States

The annual incidence of ulcerative colitis is 10.4-12 cases per 100,000 people. The prevalence rate is 35-100 cases per 100,000 people.

International

Prevalence rates may be lower in South America, Asia, and Africa.

Race

  • Ulcerative colitis occurs more frequently in white people.
  • The incidence of ulcerative colitis is reported to be 2-4 times higher in Jewish people. However, population studies in North America do not completely support this assertion.

Sex

Ulcerative colitis seems to have a female preponderance. Ulcerative colitis affects 30% more females than males.

Age

The incidence of ulcerative colitis peaks in people aged 15-25 years and in people aged 55-65 years, although it can occur in people of any age.1

Clinical

History

  • Frequent episodes of rectal bleeding occur, with or without mucus. The characteristic feature is blood in each bowel movement.
  • Urgency and tenesmus
  • Abdominal cramps
  • Weight loss in severe cases
  • Extracolonic manifestations
    • Synovitis
    • Ankylosing spondylitis (HLA-B27)
    • Sacroiliitis
    • Erythema nodosum
    • Pyoderma gangrenosum
    • Aphthous stomatitis
    • Episcleritis
    • Iritis
    • Primary sclerosing cholangitis (PSC)
    • Uric acid renal stones
    • Rarely, thromboembolic events or syndromes (CNS venous thrombosis)

Physical

Physical findings are typically normal in patients with mild disease, except for mild tenderness in the lower left quadrant. 

Patients with severe disease can have signs of volume depletion and toxicity, including the following:

  • Fever
  • Tachycardia
  • Significant abdominal tenderness
  • Weight loss

Causes

  • Autoimmune phenomena: Serum and mucosal autoantibodies against intestinal epithelial cells may be involved. Persons with ulcerative colitis are often found to have p-antineutrophil cytoplasmic antibodies.
  • Immune-mediated phenomena: Abnormalities of humoral and cell-mediated immunity and/or generalized enhanced reactivity against intestinal bacterial antigens may be causes. A loss of tolerance against indigenous enteric flora is believed to be the central event in the pathogenesis of inflammatory bowel disease (IBD). 
  • Genetic susceptibility (chromosomes 12 and 16) is a factor associated with ulcerative colitis. A positive family history (observed in 1 in 6 relatives) is associated with a higher risk for developing the disease.
  • Smoking is negatively associated with ulcerative colitis. This relationship is reversed in Crohn disease.
  • Environmental factors may be involved.
  • Dietary factors: Milk consumption may exacerbate the disease.
  • Appendectomies have a negative association with ulcerative colitis.

More on Ulcerative Colitis

Overview: Ulcerative Colitis
Differential Diagnoses & Workup: Ulcerative Colitis
Treatment & Medication: Ulcerative Colitis
Follow-up: Ulcerative Colitis
Multimedia: Ulcerative Colitis
References
Further Reading
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References

  1. Jang ES, Lee DH, Kim J, et al. Age as a clinical predictor of relapse after induction therapy in ulcerative colitis. Hepatogastroenterology. Sep-Oct 2009;56(94-95):1304-9. [Medline].

  2. Andersson T, Lunde OC, Johnson E, et al. Long-term functional outcome and quality of life after restorative proctocolectomy with ileo-anal anastomosis for colitis. Colorectal Dis. Dec 14 2009;[Medline].

  3. da Luz Moreira A, Kiran RP, Lavery I. Clinical outcomes of ileorectal anastomosis for ulcerative colitis. Br J Surg. Jan 2010;97(1):65-9. [Medline].

  4. [Best Evidence] Sandborn WJ, Rutgeerts P, Feagan BG, et al. Colectomy rate comparison after treatment of ulcerative colitis with placebo or infliximab. Gastroenterology. Oct 2009;137(4):1250-60; quiz 1520. [Medline].

  5. Parente F, Molteni M, Marino B, et al. Are colonoscopy and bowel ultrasound useful for assessing response to short-term therapy and predicting disease outcome of moderate-to-severe forms of ulcerative colitis?: a prospective study. Am J Gastroenterol. Dec 8 2009;[Medline].

  6. Pekow JR, Hetzel JT, Rothe JA, et al. Outcome after surveillance of low-grade and indefinite dysplasia in patients with ulcerative colitis. Inflamm Bowel Dis. Dec 21 2009;[Medline].

  7. Alcalde Encinas MM, Perez-Gracia A, Hallal H, et al. [Cerebral venous sinus thrombosis and ulcerative colitis]. Rev Esp Enferm Dig. Feb 2000;92(2):105-8. [Medline].

  8. Brown MO. Inflammatory bowel disease. Prim Care. Mar 1999;26(1):141-70. [Medline].

  9. Fichera A, Michelassi F. Indication for surgery: a surgeon's opinion. In: Sartor RB, Sandborn WJ. Kirsner's Inflammatory Bowel Diseases. 6th ed. New York: Saunders; 2004:596-601/39.

  10. Froehlich F, Larequi-Lauber T, Gonvers JJ, et al. 11. Appropriateness of colonoscopy: inflammatory bowel disease. Endoscopy. Oct 1999;31(8):647-53. [Medline].

  11. Hanauer SB. Inflammatory bowel disease. N Engl J Med. Mar 28 1996;334(13):841-8. [Medline].

  12. Itzkowitz SH, Present DH. Consensus conference: Colorectal cancer screening and surveillance in inflammatory bowel disease. Inflamm Bowel Dis. Mar 2005;11(3):314-21. [Medline].

  13. Jayanthi V, Probert CS, Mayberry JF. Epidemiology of inflammatory bowel disease. Q J Med. Jan 1991;78(285):5-12. [Medline].

  14. Kamm MA, Sandborn WJ, Gassull M, et al. Once-daily, high-concentration MMX mesalamine in active ulcerative colitis. Gastroenterology. Jan 2007;132(1):66-75; quiz 432-3. [Medline].

  15. Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. Jul 2004;99(7):1371-85. [Medline].

  16. Lichtenstein GR, Abreu MT, Cohen R, et al. American Gastroenterological Association Institute technical review on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. Gastroenterology. Mar 2006;130(3):940-87. [Medline].

  17. Rioux JD, Silverberg MS, Daly MJ, et al. Genomewide search in Canadian families with inflammatory bowel disease reveals two novel susceptibility loci. Am J Hum Genet. Jun 2000;66(6):1863-70. [Medline].

  18. Stenson WF, Korzenik J. Inflammatory bowel disease. In: Yamada T, ed. Textbook Of Gastroenterology. Vol 2. 4th ed. Philadephia: Lippincott Williams & Wilkins; 2003:1699-1759.

  19. Thomas GA, Rhodes J, Green JT. Role of smoking in inflammatory bowel disease: implications for therapy. Postgrad Med J. May 2000;76(895):273-9. [Medline].

  20. Tremaine WJ. Collagenous colitis and lymphocytic colitis. J Clin Gastroenterol. Apr 2000;30(3):245-9. [Medline].

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Further Reading

Related eMedicine Topics

Clinical Trials

Clinical Guidelines

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Keywords

ulcerative colitis, IBS, colitis, Crohn’s disease, Crohn disease, irritable bowel syndrome, IBD, inflammatory bowel disease, ulcerative colitis treatment, ulcerative colitis symptoms, colonic inflammation, rectal inflammation, toxic megacolon, ileus, diverticulitis, primary sclerosing cholangitis, rectal bleeding, bloody bowel movements

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Contributor Information and Disclosures

Author

Tri H Le, MD, Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, Penn State Milton S Hershey Medical Center
Tri H Le, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society of Gastrointestinal Endoscopy, and Crohns and Colitis Foundation of America
Disclosure: Nothing to disclose.

Medical Editor

Anil Minocha, MD, FACP, FACG, Clinical Professor, School of Pharmacy, Professor of Medicine, Director of Digestive Diseases, Medical Director of Nutrition Support, Medical Director of Gastrointestinal Endoscopy, Internal Medicine Department, University of Mississippi Medical Center
Anil Minocha, MD, FACP, FACG is a member of the following medical societies: American Academy of Clinical Toxicology, American Association for the Study of Liver Diseases, American College of Forensic Examiners, American College of Gastroenterology, American College of Physicians, American Federation for Clinical Research, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Noel Williams, MD, Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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