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Ulcerative colitis - Oral Mucosal Lesion
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Ulcerative colitis - Oral Mucosal Lesion

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Contributors: Jonathan Lin, Julia Minocha MD, Jonathan Cotliar MD, Jennifer J. Findeis-Hosey MD
Other Resources UpToDate PubMed

Synopsis

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 and in those of Jewish as well as Northern European ancestry.

The pathophysiology of this disease has not been fully elucidated; however, it is believed to be in part related to an atypical Th2 immune response resulting in increased natural killer T cells and IL-13 in the colonic mucosa leading to epithelial cell cytotoxicity, apoptosis, and epithelial barrier dysfunction. Autoimmunity and genetic factors may play a role in UC.

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

Cutaneous involvement manifests as aphthous stomatitis or perianal disease. The most commonly associated dermatologic conditions are erythema nodosum and pyoderma gangrenosum.

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.

Risk Factors:
UC has been linked with a Westernized lifestyle including high-fat and high-sugar diets, medication use, stress, and high socioeconomic status. Twenty-five percent of UC cases also possess a familial component.

Timeline:
The course of UC is often random and unpredictable. The initial presentation can vary from mild / asymptomatic to severe (toxic hemorrhagic colitis). Patients can then present with variable episodes of exacerbation as well as complete remission.

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.

Codes

ICD10CM:
K51.919 – Ulcerative colitis, unspecified with unspecified complications

SNOMEDCT:
64766004 – Ulcerative colitis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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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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References

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Last Reviewed: 01/17/2018
Last Updated: 01/30/2018
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Ulcerative colitis - Oral Mucosal Lesion
See also in: Overview
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View all Images (4)
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Ulcerative colitis : Abdominal pain, Diarrhea, Abdominal cramp, Hyperactive bowel sounds, Weight loss, Hematochezia, Tenesmus
Clinical image of Ulcerative colitis
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