Inflammatory Bowel Disease: Ulcerative Colitis

Abstract

Ulcerative colitis is a chronic, relapsing idiopathic inflammation of the rectum and variable lengths of the adjoining colon. Onset usually occurs during the third and fourth decades of life and commonly presents with bloody diarrhea. A diagnosis is made using a combination of endoscopic and histological evidence to distinguish it from other inflammatory colitides, in particular Crohn's disease. The extent of the disease in terms of the amount of colon involved and the severity of the attacks both vary, and treatment is tailored depending on both these factors. Ulcerative colitis predisposes individuals to colorectal cancer, and surveillance is required for most sufferers. Acute severe colitis is the most serious manifestation of the disease and initially requires hospital treatment with intravenous steroids. Emergency surgery in the form of a subtotal colectomy and end ileostomy is vital in those not responding to medical treatment to avoid colonic perforation. There are two major elective procedures: restorative proctocolectomy (ileoanal pouch procedure) and panproctocolectomy. Laparoscopic surgery is now an option for both emergency and elective procedures.