Overview of Ulcerative Colitis

Maia Kayal, MD: Ulcerative colitis is an immune-mediated condition that is characterized by episodes of recurring and relapsing inflammation. Ulcerative colitis starts in the rectum and typically extends proximally to involve other parts of the colon. It's characterized by symptoms of urgency, frequency, bleeding, and pain. It has a significant impact on quality of life obviously because of the significant symptoms that it's associated with and can be quite debilitating to patients. The reason it's so important to consider ulcerative colitis and start with a prompt diagnosis and management is because it is associated with an increased risk of colon cancer in the long term. For patients who have had the disease for about 10 years, the risk of colon cancer is about 8%.

The different phenotypes of ulcerative colitis include proctitis, which is disease that's limited to the rectum, left-sided colitis, which is disease that involves the colon distal to the splenic flexure, and pan-colitis, which is disease that involves the entire colon. We typically use the Montreal Classification to assess severity of ulcerative colitis. So, mild ulcerative colitis includes patients who have four or less bowel movements per day, with no significant symptoms of systemic toxicity. Moderate ulcerative colitis is for patients who have more than four bowel movements a day, with or without blood, with minimal signs of toxicity, and then severe ulcerative colitis includes patients who have more than six bloody bowel movements a day, with an increase of heart rate, fever, increase of inflammatory markers, or anemia.

In patients who are presenting with urgency or frequency or abdominal pain, the diagnosis of irritable bowel syndrome is sometimes given to patients even though they might have an underlying diagnosis of ulcerative colitis. So, you can see that irritable bowel syndrome, or IBS, is a common co-morbidity for patients with IBD and that's why it's super important at the beginning to really make a diagnosis early by sending labs, stool studies, and doing a colonoscopy. However, in ulcerative colitis, up to 25% of patients will have extra-intestinal manifestations which can be comorbid to their diagnosis. This includes entities like primary sclerosing cholangitis, arthritis, ankylosing spondylitis, uveitis, in addition to skin manifestations like eczema, psoriasis, and pyoderma gangrenosum.

Transcript Edited for Clarity