Medically Fit For Exams
Medically Fit For Exams

Ulcerative Colitis


  • Is an inflammatory bowel disease (IBD), affecting the rectum and colon only


Risk factors

  • Family history
  • Poor diet
  • Recent smoking cessation


Differential diagnoses

  • Crohn’s disease
  • Infective colitis
  • Coeliac disease
  • Colorectal cancer
  • Diverticulitis
  • IBS



  • Affects 10 per 100,000 in UK (slightly more than Crohn’s)
  • Affects men and women equally
  • Peak incidence between 15-20



  • ?Autoimmune – reaction to gut flora
    • Predominantly a Th2 response (with a little bit of Th17) – high levels in gut mucosa
    • Involves cytokines IL-5 and IL-13, but key Th2 cytokine IL-4 is not raised in UC
  • Unknown
  • Genetic – family history in 35-40% of cases


Clinical features

  • Diarrhoea with blood and mucus – an acute attack can cause 10-20 liquid stools per day
  • Lower abdominal discomfort
  • Anorexia, malaise
  • Weight loss
  • Fever
  • Anaemia
  • Urgency of going to toilet
  • Proctitis (inflammation of anus and rectum)
  • Tenesmus
  • Toxic megacolon – severe dilation of colon with 15-20% chance of death – emergency surgery is required
  • Clubbing



  • Superficial inflammation involving mucosa only (not submucosa as in Crohn’s disease)
  • Starts distally, with rectum, and can spread proximally
  • Can spread up whole colon to the iliocaecal junction
  • Inflammation is continuous, no gaps
  • Crypt atrophy and abscesses
  • Goblet cells are depleted
  • Pseudopolyps – projecting masses of scar tissue that form from granulation tissue, during healing process of repeated ulceration
  • Shallow ulcers
  • Haemorrhage
  • Paneth cell metaplasia



  • Colonoscopy with biopsies
  • Abdominal imaging to check for megacolon
  • Blood tests and microbiology for C. diff
  • Serology for markers to distinguish from Crohn’s
    • p-ANCA more common in ulcerative colitis (antibody ASCA more common in Crohn’s)



  • Topical (cream, pessary or enema) aminosalicylate-1 – induce remission and lengthen remission
  • Oral aminosalicylate-1 if topic is ineffective
  • Oral prednisolone
  • >30% require bowel resection (colectomy) with ileostomy
    • This can be curative



  • Doubles the risk of colon cancer
  • Risk of complications that can be life-threatening, such as mega-colon
Ulcerative colitis.docx
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