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Ulcerative colitis - Inflammatory bowel disease

Inflammatory bowel disease - Ulcerative colitis

Ulcerative colitis - Inflammatory bowel disease

< Inflammatory bowel disease Ulcerative colitis Crohn's disease >

When noting ulcerative colitis, always remember that is continuous – or otherwise, “a disease of continuity”. Ulcerative colitis starts from the rectum extending proximally, a fashion described as “retrograde”. Colonic involvement can result to easy bleeding and friability, and depending on severity, ulcerations can occur along the entire length of the colon. In response to the tissue damage, regenerating tissues gradually form pseudopolyps, and may perhaps contribute again to obstruction and hence constipation.

Ulcerative colitis should not be taken lightly, such that it can lead to neural damage and may even cause the colon to excessively swell and become gangrenous (condition otherwise called the megacolon). Any damage to the neural plexus will result to neural shutdown, and hence, inability of the muscles in the rectum to pass out feces through contractions. It can also predispose greatly to colon cancer – its most feared complication - due to the changes in the epithelium of the colonic mucosa eventually resulting to dysplasia (defined as the abnormality in the development of cells in terms of shape and organization).

The common presentation of the disease is via frequent attacks of bloody diarrhea that often persists for days to months, then recurrence after an interval of months to years. Patients are considered fortunate if the first attack is the last attack. This is because an attack brings with it a lot of consequences that are life-threatening, such as causing serious bleeding as well as imbalances in fluids and electrolytes. Among the first manifestations of the disease is abdominal pain with cramping, accompanied by bloody diarrhea with marked stringy mucus. This is usually relieved through defecation. But as the disease progresses, constipation appears due to disruption of the normal peristaltic movements. Usually attacks are precipitated by severe stressful conditions.


Canada has one of the highest rates of ulcerative colitis in the world. A new breakthrough treatment has just been approved by Health Canada.



The prevalence of ulcerative colitis among males and females is 1:1, and it is reported that cigarette smoking results to a greater risk for ulcerative colitis rather than Crohn's disease.

Comparisons of various factors in Crohn's disease and ulcerative colitis

Crohn's disease Ulcerative colitis
Terminal ileum involvement Commonly Seldom
Colon involvement Usually Always
Rectum involvement Seldom Usually[80]
Involvement around the anus Common[81] Seldom
Bile duct involvement No increase in rate of primary sclerosing cholangitis Higher rate[82]
Distribution of Disease Patchy areas of inflammation (Skip lesions) Continuous area of inflammation[80]
Endoscopy Deep geographic and serpiginous (snake-like) ulcers Continuous ulcer
Depth of inflammation May be transmural, deep into tissues[1][81] Shallow, mucosal
Fistulae Common[81] Seldom
Stenosis Common Seldom
Autoimmune disease Widely regarded as an autoimmune disease No consensus
Cytokine response Associated with Th17 [43] Vaguely associated with Th2
Granulomas on biopsy May have non-necrotizing non-peri-intestinal crypt granulomas[81][83][84] Non-peri-intestinal crypt granulomas not seen[80]
Surgical cure Often returns following removal of affected part Usually cured by removal of colon
Smoking Higher risk for smokers Lower risk for smokers[80]



< Inflammatory bowel disease Ulcerative colitis Crohn's disease >

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