Ulcerative colitis in Adult
Alerts and Notices
SynopsisUlcerative 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
Differential Diagnosis & Pitfalls
- Infectious colitis (eg, Clostridioides difficile colitis, amebic colitis, strongyloidiasis)
- Medication-induced colitis
- Microscopic colitis
- Crohn disease
- Ischemic colitis
- Segmental (diverticular disease-associated) colitis (see diverticulitis)
- Bile acid diarrhea
- Behçet disease
- HIV colopathy (see HIV disease)
- Sexual abuse
- Allergic colitis
- Graft-versus-host disease (in patients with history of bone marrow transplant)
Drug Reaction DataBelow 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.
Ulcerative colitis in Adult