This document provides information about ulcerative colitis (UC), including: - UC is a type of inflammatory bowel disease that affects only the large intestine. It causes inflammation and ulcers in the lining of the intestine. - Symptoms include bloody diarrhea, abdominal pain, and frequent bowel movements. The disease involves periods of remission and flares of symptoms. - UC is diagnosed through patient history, physical exam, lab tests, endoscopy, and biopsy of the intestine. Treatment aims to induce and maintain remission of symptoms and includes mesalamine, corticosteroids, immunomodulators, and surgery in severe cases.

1. Ulcerative Colitis

2. Agenda
 Revising the digestive system
 Understanding Inflammatory Bowel Disease (IBD)
 Learning about Ulcerative Colitis

3. Digestive system
 IBD affects the digestive
system. Before we learn about
the disease lets revise the
parts of the digestive system

4. Large intestine
 One form of IBD, ulcerative colitis affects
only the large intestine
 The parts of the large intestine are important
to remember
 In order these are parts of the large intestine
 Ascending colon
 Transverse colon
 Descending colon
 Sigmoid colon
 Rectum

5. Inflammatory Bowel Disease(IBD)
 IBD refers to recurrent chronic diseases that cause inflammation of the
intestines
 There are two main types of IBD
 Ulcerative colitis (UC)
 Crohn’s disease (CD)
Normal Colon Inflamed Colon

6. Difference between CD and UC
 UC affects only the large intestine
 CD can affect any part of the gastrointestinal
tract. But most frequently attacks terminal
ileum and colon
 Approx. 15% of patients have signs that falls
between UC and CD (indeterminate colitis)

7. Ulcerative colitis (UC)
 It is a type of IBD
 Affects only the large intestine
 Rectum is always involved in ulcerative colitis
 Always starts in rectum
 The inflammation is in a continuous stretch
 For instance if ulcerates colitis affects the descending
colon, then there will be inflammation in the
descending colon, sigmoid colon and rectum
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8. Ulcerative colitis (UC)
 Out of the four layers in the wall of the large
intestine, the inflammation involves the mucosa
and submucosa
 The mucosa look ulcerated and granular
 With a severe attack, the mucosa becomes
hemorrhagic (bleeds easily) & ulcerated
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9.  UC can be divided into 5
types based on the how of
the large intestine is affected
 Proctitis
 Proctosigmoiditis
 Distal colitis
 Extensive colitis
 Pancolitis

10. Distribution of the subtypes of UC in India
 In patients with UC have
 Pancolitis (entire colon) 42.8%
 Left sided colitis 38.8 %
 Proctitis alone in 18.3 %
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11. What is the cause of UC? (Pathophysiology)
 UC is an autoimmune disease
 Meaning that the immune system is attacking the
body
 The exact cause is not yet known
 It is known that three factors interact to cause UC
 They include the immune system, certain genes and
some environmental factors
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12. What are the symptoms of UC?
 Bloody diarrhea with or without mucus is
the hallmark of ulcerative colitis
 Diarrhea
 Rectal bleeding
 Tenesmus
 Passage of mucus
 Abdominal pain

13. How is ulcerative colitis diagnosed?
 Ulcerative colitis cannot be diagnosed by a single tests
 The diagnosis of UC involves the following
 History of the patient
 Physical examination
 Laboratory tests
 Endoscopy
 Tissue biopsy
 Based on the findings of all these investigations a diagnosis of UC
can be made

14. How is ulcerative colitis classified based
on severity?
 Ulcerative colitis can be classified on the basis of how severe the
symptoms are
 Based on this the severity is as follows;
 Mild
 Moderate
 Severe
 Fulminant
 The severity of UC is determined by certain clinical scores

15. Clinical Score to Determine Severity
>30>30< 30ESR
Transfusion required<75% of normalNormalHemoglobin
>90>90NormalPulse
>37.5> 37.5NormalTemperature (C)
ContinuousFrequentIntermittentBlood in Stool
>10>6 - <10<4Stools (per day)
ESR :Erythrocyte sedimentation rate
MODERATE
>4
Intermittent
Normal
Normal
Normal
< 30
SEVERE FULMINANTMILD
Truelove and Witts Criteria
Depending on the criteria that are fulfilled in the table above, the severity
can be determined

16. Clinical Score to Determine Severity
 There are numerous clinical scores to determine the severity of UC
 It includes the
 Truelove and Witts Criteria
 Disease Activity Index
 Clinical Activity Index
 Endoscopic Index
 Histology Index
 Research papers often use one of these criteria's to determine the severity of
UC
ESR :Erythrocyte sedimentation rate

17. What is the pattern of UC
 UC follows a pattern of remission and flares
 Remission is a period in which there are no or few symptoms. In the period
the patient free from the disease.
 Flare is a period when the symptoms are presents. In the period the disease
is active and affects the patient

18. Goals of Therapy for Ulcerative Colitis
 Ulcerative Colitis cannot be cured by medicine
 Thus the goals of therapy includes
 Inducing remission (Reducing the symptoms of the disease)
 Maintaining remission (Maintaining a long symptoms free period)
 Restoring and maintaining nutrition
 Maintaining patient’s quality of life

19. What is used to treat UC?
 Clinical therapy
 Mesalazine/Mesalamine
 Corticosteroids
 Immunomodulators
 Ciclosporin
 Infliximab
 Surgery

20. What is the first line of treatment for UC?
 Flares
 In a flare the goal is to get the symptoms under control as soon as possible
 Hence corticosteroids are used along with mesalamine
 Remission
 In remission safe and effective drugs are used.
 Here, mesalamine is preferred and is used in most UC patients
 A patient will use other drugs only if they are not responding well to
mesalamine

21. What are the formulations of mesalamine?
 Oral Mesalamine
 Used for all types of UC
 Suppositories
 Used for proctitis
 Foam enema
 Used for proctitis and proctosigmoiditis
 Liquid enema
 Used for proctitis, proctosigmoiditis and left sided colitis

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