Ulcerative colitis is a type of inflammatory bowel disease that affects the lining of the large intestine and rectum, causing ulcers, bleeding, and diarrhea. The exact cause is unknown but may involve genetic and immune factors. Symptoms include abdominal pain, diarrhea, and rectal bleeding. The diagnosis is confirmed through endoscopy and biopsies of the colon. Treatment involves medications to reduce inflammation like aminosalicylates, corticosteroids, and immunomodulators. Surgery may be needed if medications are not effective.

1. Ulcerative colitis
Ulcerative colitis is a type of inflammatory bowel disease (IBD) that affects
the lining of the large intestine and rectum. It is a superficial inflammation
of the large intestine, not caused by bacteria, which results in ulceration
and bleeding. Multiple ulcerations and diffuse inflammation occurs in
superficial mucosa and submucosa of colon. Ulcers form where
inflammation has killed the cells that usually line the colon, then bleed and
produce pus. Inflammation in the colon also causes the colon to empty
frequently, causing diarrhea.
When the inflammation occurs in the rectum and lower part of the colon it
is called ulcerative proctitis. If the entire colon is affected it is called
pancolitis. If only the left side of the colon is affected it is called limited or
distal colitis.

2. CAUSES AND RISK FACTORS
The exact cause of ulcerative colitis is unknown. Hereditary, infectious
and immunological factors have been proposed as possible causes.
Stress and certain foods can trigger symptoms; they do not cause
ulcerative colitis. Environmental agents such as pesticides, tobacco,
radiation, and food additives may precipitate an exacerbation. The
disease usually begins in the rectal area, and may involve the entire
large intestine over time. Risk factors include a family history of
ulcerative colitis, or Jewish ancestry.

3. CLINICAL MANIFESTATIONS
Symptoms of ulcerative colitis primarily affect the digestive tract and
include appetite loss, diarrhea, weight loss, rectal bleeding, nausea, and
abdominal cramping. Persistent diarrhea can cause malnutrition,
weakness, and electrolyte imbalances; younger individuals may be small or
or experience delayed growth. A small percentage of those affected may
have symptoms in other body areas or organs.

4. • Pathophysiology:
• The pathophysiology of ulcerative colitis involves an
ongoing cycle of inflammation and tissue damage in the
colon. The immune system overreacts to normal gut
bacteria, triggering an inflammatory response. This immune
response causes increased blood flow to the colon and the
release of various inflammatory substances, leading to tissue
tissue damage and ulcer formation. The chronic
inflammation disrupts the normal functioning of the colon,
resulting in symptoms such as diarrhea, abdominal pain, and
and rectal bleeding.
• The inflammation in UC is primarily limited to the mucosal
layer of the colon, starting in the rectum and potentially
extending proximally to involve other parts of the colon.

5. DIAGNOSTIC EVALUATIONS
Stool specimens are collected for cultivation and microscopy to exclude
infection caused by bacteria and parasites. The diagnosis is confirmed by
means of an endoscopy in the large intestine and the rectum. Small
tissue samples from the mucosa are usually obtained during the
procedure, which can in many cases confirm the diagnosis. An
endoscopic examination of the entire intestine (colonoscopy), flexible
sigmoidoscopy and barium enema X-ray examination can help
determine the extent of the disease. Blood samples can help determine
the severity of the inflammation, and show whether the patient suffers
from anaemia (low haemoglobin count).

6. • Medical management
• Medications: Aminosalicylates: These anti-inflammatory
drugs, such as sulfasalazine and mesalamine, are often used
as first-line therapy for mild-to-moderate UC.
• Corticosteroids: These potent anti-inflammatory
medications may be prescribed for moderate-to-severe UC
to induce remission. However, long-term use is avoided due
to significant side effects.
• Immunomodulators: Drugs like azathioprine,
mercaptopurine, or methotrexate can help reduce
inflammation by suppressing the immune system. They are
used for maintaining remission and reducing the need for
corticosteroids.

7. Biologics: Targeted therapies, including anti-tumor necrosis factor (anti-
TNF) agents (e.g., infliximab, adalimumab), anti-integrin agents (e.g.,
vedolizumab), or Janus kinase (JAK) inhibitors (e.g., tofacitinib), are
prescribed for moderate-to-severe UC when other treatments fail.
Symptomatic Relief:
Anti-diarrheal agents: Medications like loperamide may help control
diarrhea in mild cases.
Pain relievers: Over-the-counter pain medications or prescription drugs
can be used to alleviate abdominal pain or cramping.
Iron supplements: Oral or intravenous iron may be necessary to correct
anemia resulting from chronic bleeding.

8. • Nutritional Support:
• In cases of severe UC, when oral intake is limited, nutritional
supplementation or total parenteral nutrition (TPN) may be
required to provide adequate nutrition.
• Surgery: Surgery may be considered if medical therapy fails,
or in cases of severe complications such as toxic megacolon
or perforation.
• Colectomy (removal of the colon) may be performed, and in
some cases, an ileal pouch-anal anastomosis (IPAA)
procedure may be done to create a pouch from the small
intestine to replace the removed colon.