Ulcerative Colitis

Ulcerative colitis is an inflammatory bowel disease which affects the large bowel, otherwise known as the colon. Whilst it does have extra-gastrointetinal manifestations its impact on inflammation in the gut is limited to the large bowel. Ulcerative colitis can be further subclassified into categories depending on the extent to which the colon is affected. In all patients with ulcerative colitis the very last part of the bowel is affected, this is known as proctitis. In those where the inflammation extends more proximally (upwards  toward the mouth) the disease can be labelled recto -sigmoid or distal, left sided, subtotal or pancolitis depending on the extent of disease.

Typically patients with colitis present with bloody stools often mixed with mucus, diarrhoea and urgency. Nocturnal symptoms are sometimes a marker of more severe disease.

Treatments are similar, though not identical as those used in Crohn’s disease. There is greater evidence for efficacy of 5ASAs (mesalazine) in ulceratice colitis, in both treating relapse and maintaining remission. In the context of acute relapse steroids can be useful, but are not a long-term treatment. Immunomodulators and biologicals also have an important role in prevention and treatment of relapse. Surgery is an option in patients with fulminant (very severe) disease and those where cancer is a complication, as well as those with disease which is not respnding to aggressive medical (tablets and drugs) intervention.