Ulcerative colitis

Ulcerative colitis is a form of inflammatory bowel disease that causes inflammation and ulcers in the colon. Ulcerative colitis affects the colon and rectum only, occasionally involving the last part of terminal ileum.
Ulcerative colitis is often characterised by periods of exacerbation and remission requiring medical management to achieve remission. Surgery is needed only if there is failure of medical management.
The disease is more prevalent in northern and western countries of the world. Although UC has no definite known cause, there is a presumed genetic component to susceptibility. The disease may be triggered in a susceptible person by environmental factors.
Ulcerative colitis often presents with diarrhoea mixed with blood. Other presentations include weight loss and anemia. Patients may have abdominal pain or may present with extra-intestinal symptoms.
The best test of diagnosis of ulcerative colitis is endoscopy. This may be a flexible sigmoidoscopy or colonoscopy and biopsies are taken to confirm the diagnosis.
Management of ulcerative colitis is with anti-inflammatory drugs (including oral medication and rectal preparations), immunosuppression, and biological therapy targeting specific components of the immune response. Colectomy is occasionally needed if the disease is severe, does not respond to treatment, or if significant complications develop. A total proctocolectomy (removal of the entirety of the large bowel and rectum) can cure ulcerative colitis as the disease only affects the large bowel and rectum and does not recur after removal of the latter.
Ileo-anal pouch can be constructed after colectomy in ulcerative colitis patients. Colectomy and pouch formation can be performed laparoscopically in majority of patients and this may improve postoperative recovery.
There is a significantly increased risk of colorectal cancer in patients with ulcerative colitis after ten years. It is recommended that patients have screening colonoscopies with random biopsies to look for dysplasia after eight years of disease activity, at one to two year intervals.

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