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Ulcerative colitis in Adult
Other Resources UpToDate PubMed

Ulcerative colitis in Adult

Contributors: Michael W. Winter MD, Jonathan Lin, Julia Minocha MD, Jonathan Cotliar MD, Jennifer J. Findeis-Hosey MD, Paritosh Prasad MD
Other Resources UpToDate PubMed


Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that affects the colon and rectum. UC is the most common form of IBD and has an annual incidence of 1.2-20.3 cases per 100 000 persons, with a bimodal age distribution with peaks in the third and seventh decades of life. UC has a higher incidence in males, Ashkenazi Jews, and people of Northern European ancestry. Worldwide, the incidence of UC is increasing.

The pathophysiology has not been fully elucidated. There are hypothesized genetic, environmental, and immune factors that likely contribute to the development of UC. Most likely, the etiology is multifactorial.

Clinical manifestations include relapsing episodes of bloody diarrhea, abdominal pain, fever, malaise, and weight loss. Patients may be anemic.

UC is associated with extraintestinal manifestations. These include dermatologic conditions (ie, erythema nodosum, pyoderma gangrenosum, psoriasis), inflammatory arthritis, uveitis, and primary sclerosing cholangitis.

Although 83% of patients will suffer from at least one relapse during the first 10 years after initial onset, the prognosis for UC in general is good. Over half of patients report remission or only mild intestinal symptoms.

On endoscopy, UC almost always presents with continuous involvement of the rectum and/or colon. During the active phase of disease, the mucosa can appear erythematous and friable. Pseudopolyps and inflammatory polyps may also be present as a result of chronic inflammation.

Risk factors: UC is most common in developed countries. This is suggestive of environmental risk factors for the development of UC.

There are myriad genes associated with UC, but no identifiable genetic cause of UC.

Smoking cessation is a risk factor for the development of UC.

Timeline: The course of UC is unpredictable. The initial presentation can vary from mild / asymptomatic to severe (toxic hemorrhagic colitis). Some patients have a quiescent disease course, while others can have progressive worsening of bowel inflammation.

Pediatric patient considerations: The mean age at time of diagnosis of IBD among children is 10.3 years. Pediatric-onset disease has a worse course, with more extensive disease, a higher colectomy rate (30%-40% at 10 years compared with 20% in adult-onset disease), and more frequent hospitalizations.


K51.90 – Ulcerative colitis, unspecified, without complications

64766004 – Ulcerative colitis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Infectious colitis (eg, Clostridioides difficile colitis, Amebic colitis, Strongyloidiasis)
  • Drug-induced diarrhea
  • Microscopic colitis
  • Crohn disease
  • Ischemic colitis
  • Segmental (diverticular disease-associated) colitis (see Diverticulitis)
  • Bile acid diarrhea
  • Behçet syndrome
  • HIV colopathy (see Human immunodeficiency virus disease)
  • Adult sexual abuse
  • Allergic colitis
  • Chronic graft-versus-host disease (in patients with history of bone marrow transplant)

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Reviewed:05/13/2021
Last Updated:10/16/2022
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Ulcerative colitis in Adult
A medical illustration showing key findings of Ulcerative colitis : Abdominal pain, Diarrhea, Abdominal cramp, Hematochezia, Tenesmus, Unexplained weight loss
Clinical image of Ulcerative colitis - imageId=2527215. Click to open in gallery.  caption: 'Widespread erythematous nodules on the shins and feet of a patient.'
Widespread erythematous nodules on the shins and feet of a patient.
Copyright © 2024 VisualDx®. All rights reserved.