Ulcerative colitis

Ulcerative colitis
Endoscopic image of a colon affected by ulcerative colitis. The internal surface of the colon is blotchy and broken in places. Mild-moderate disease.
Specialty	Gastroenterology
Symptoms	Abdominal pain, diarrhea mixed with blood, weight loss, fever, anemia,[1] dehydration, loss of appetite, fatigue, sores on the skin, urgency to defecate, inability to defecate despite urgency, rectal pain[2]
Complications	Megacolon, inflammation of the eye, joints, or liver, colon cancer[1][3]
Usual onset	15–30 years or >60 years[1]
Duration	Long term[1]
Causes	Unknown[1]
Diagnostic method	Colonoscopy with tissue biopsies[1]
Differential diagnosis	Dysentery, Crohn's disease, ischemic colitis[4]
Treatment	Dietary changes, medication, surgery[1]
Medication	Sulfasalazine, mesalazine, steroids, immunosuppressants such as azathioprine, biological therapy[1]
Frequency	2–299 per 100,000[5]
Deaths	47,400 together with Crohn's (2015)[6]

Ulcerative colitis (UC) is one of the two types of inflammatory bowel disease (IBD), with the other type being Crohn's disease.^[1] It is a long-term condition that results in inflammation and ulcers of the colon and rectum.^[1][7] The primary symptoms of active disease are abdominal pain and diarrhea mixed with blood (hematochezia).^[1] Weight loss, fever, and anemia may also occur.^[1] Often, symptoms come on slowly and can range from mild to severe.^[1] Symptoms typically occur intermittently with periods of no symptoms between flares.^[1] Complications may include abnormal dilation of the colon (megacolon), inflammation of the eye, joints, or liver, and colon cancer.^[1][3]

The cause of UC is unknown.^[1] Theories involve immune system dysfunction, genetics, changes in the normal gut bacteria, and environmental factors.^[1][8] Rates tend to be higher in the developed world with some proposing this to be the result of less exposure to intestinal infections, or to a Western diet and lifestyle.^[7][9] The removal of the appendix at an early age may be protective.^[9] Diagnosis is typically by colonoscopy with tissue biopsies.^[1]

Several medications are used to treat symptoms and bring about and maintain remission, including aminosalicylates such as mesalazine or sulfasalazine, steroids, immunosuppressants such as azathioprine, and biologic therapy.^[1] Removal of the colon by surgery may be necessary if the disease is severe, does not respond to treatment, or if complications such as colon cancer develop.^[1] Removal of the colon and rectum generally cures the condition.^[1][9]