Ulcerative Colitis 101

General Information

  • Recurrent inflammation that starts at the rectum and extends proximally and continuously

Clinical Manifestation

  • Acute complications include severe bleeding, megacolon, and perforation
  • Chronic complications include stricture, dysplasia, and colorectal cancer
  • Extraintestinal manifestations
    • Arthritis
    • Uveitis/episcleritis
    • Erythema nodosum
    • Pyoderma gangrenosum
    • Primary sclerosing cholangitis
    • Venous & arterial thromboembolism

Management

  • Initial approach for mild proctitis: topical 5-ASA
  • Add oral 5-ASA for more extensive involvement
  • May require oral steroids or cyclosporine, infliximab, or colectomy in worse cases

Surveillance

  • Colonoscopy after 8-10 years of disease due to CRC risk. Then, repeat:
    • Second decade of disease: every three years
    • Third decade of disease: every two years
    • Fourth decade of disease or pts with PSC: yearly