Ulcerative Colitis

• Inflammatory bowel disease


  Inflammation in the small and large intestine
• Colitis


  Inflammation in the colon, or the large intestine
• Ulcerative colitis


  A type of inflammatory bowel disease that tends to form ulcers along the inner-surface or lumen of the large intestine, including both the colon and the rectum
• Ulcerative colitis


  1. Flare (new damage occurs)

  2. Remission (tissue starts to heal)
• Ulcerative colitis


  • Inflammation and ulcers in the mucosa and submucosa of the large intestine only
  • Differs from Crohn's disease, another inflammatory bowel disease
• Environmental factors like diet and stress

  Make symptoms of ulcerative colitis worse, but not the cause
• Autoimmune origin


  Ulcerative colitis is thought to be caused by the immune system, specifically cytotoxic T cells, destroying the cells lining the walls of the large intestine
• Patients with ulcerative colitis often have p-ANCAs (perinuclear antineutrophilic cytoplasmic antibodies) in their blood, which may be due to an immune reaction to gut bacteria
• Patients with ulcerative colitis often have a higher proportion of gut bacteria that produce sulfides, which is correlated with periods of active inflammation
• The precise mechanism behind mucosal destruction in ulcerative colitis is not fully understood, but is likely a combination of environmental stimuli and genetic predisposition
• Ulcerative colitis is more common in young women from the teens to 30s, with more prevalence among Caucasians and Eastern European Jews
• Pattern of ulceration in ulcerative colitis


  • Circumferential and continuous, starting in the rectum and continuing along the large intestine without any apparent breaks of "normal" or unaffected tissue
• Destruction of mucosa and epithelium in ulcerative colitis


  Leads to release of blood and serum into the lumen, and reduced water absorption, contributing to diarrhea
• Diagnosis of ulcerative colitis


  1. Colonoscopy (to see ulcers and take biopsy)

  2. Radiological imaging (CT scan, MRI, barium enema)
• Treatment of ulcerative colitis


  1. Anti-inflammatory medications (sulfasalazine, mesalamine)

  2. Immunosuppressant drugs (corticosteroids, azathioprine, cyclosporine)

  3. Biologic treatments (infliximab, adalimumab, golimumab)

  4. Colectomy (surgical removal of the colon) if other treatments fail
• Removal of the colon generally cures ulcerative colitis, but has to be weighed against the loss of the large intestine