ULCERATIVE COLITIS

BY DR.VISHAL P. BHATT
Definition of UC

• Ulcerative colitis is a diffuse non-

specific inflammatory disease of
the large intestine of unknown
cause, primarily affecting the
mucosa, characterized by
erosions and/or ulcerations.
• The disease is characterized by
repeated cycles of relapses and
remissions, occasionally
accompanied by extra-intestinal
manifestations.
Etiology of UC
• The exact etiology of ulcerative colitis is
unknown,
• genetic factors,
• immune system reactions,
• environmental factors,
• nonsteroidal anti-inflammatory drug
(NSAID) use,
• low levels of antioxidants,
• psychological stress factors, and
• consumption of milk products.
• Ingestion of animal fat can increase the
occurrence of UC.
Pathophysiology
• A variety of immunologic changes have been
documented in UC.
• T cells accumulate in the lamina propria of the
diseased colonic segment. these T cells are
cytotoxic to colonic epithelium.
• This change is accompanied by an increase in
the population of B cells and plasma cells, with
increased production of immunoglobulin G
(IgG) and immunoglobulin E (IgE).[9]

• Anticolonic antibodies have been detected in

patients with UC.
• Microscopically, acute and chronic
inflammatory infiltrate of the lamina propria,
and villous atrophy are present in ulcerative
colitis.
• Microscopic changes also include
inflammation.
• These findings are accompanied by a
discharge of mucus from the goblet cells, the
number of which is reduced as the disease
progresses.
• The ulcerated areas are soon covered by
granulation tissue.
• Excessive fibrosis is not a feature of the
disease.
• The undermining of mucosa and an excess of
granulation tissue lead to the formation of
pseudopolyps.
Clinical presentation
• A major symptom of UC is bloody diarrhea,
occasionally accompanied by abdominal
pain

• UC should be suspected in cases with a

history of persistent or repetitive mucous
bloody stool/bloody feces.

• Patients with UC often have no abnormal

findings on physical examination, but
anemia, weight loss, abdominal tenderness
and fresh bleeding on digital rectal
examination are occasionally seen.
Extra – intestinal complication of IBD
• Anemia due to Iron deficiency, inflammation
• Thromboembolic events from Hypercoagulopathies,
platelet activation
• Osteopathy due to Steroid therapy, vitamin D deficiency
inflammation
• Growth failure and Malnutrition
• Urinary stones from Dehydration, hyperoxaluria, low
urinary PH
Diagnostic criteria of UC
(A) Symptoms: continuous or repeated bloody diarrhea;
(B) endoscopy: diffuse inflammation, loss of vascular pattern, friability
(bleeding at contact), abundant mucus and (i) granular appearance;
(ii) multiple erosions, ulcers; and (iii) pseudopolyps, loss of haustration
(lead-pipe pattern), lumen narrowing, and colonic shortening.
(C) Histology: active: inflammatory cells infiltration, crypt
abscess, goblet cell depletion. Remission: crypt architectural
abnormalities (distortion branching), atrophic crypts.
These changes usually begin in the rectum and extend proxi-mally in
continuity.
Definite diagnosis: A+one item of B and C.
Investigations
1- Colonoscopy is the basic tool for diagnosis of UC

Typically, UC shows endoscopic findings such as loss of

vascular pattern, granular mucosa, easy
bleeding, and ulceration in a continuous manner.
2-Serological markers
- ANCA is most commonly associated with ulcerative colitis
while ASCA(anti saccharomyces cerevisiae antibobies)
is more highly associated with Crohn disease and is
present in 60% of cases

3- Markers of activity
a) Acute phase reactants ESR , CRP , TLC
b) Fecal calprotectin can reflect the severity of the
disease
4- Radiological assessment
• Double-contrast barium enema examination is a
valuable technique for diagnosing ulcerative colitis even
in patients with early disease.
Treatment :
1- Anti-inflammatory drugs ( reduces
inflammation )

2- Immune system suppressors ( suppress immune

system that increases inflammation )

3- Antibiotics (reduce harmful intestinal bacteria )

4- Surgery
5- Diet control
Comparison between UC and Crohns disease