Ulcerative Colitis

Definition of Ulcerative Colitis

1. It is an inflammatory bowel disease (IBD) that affects the large intestine (colon and rectum). Ulcerative colitis affects only the large intestine.
2. It is marked by the diffuse, superficial inflammation of the colonic mucosa, starting in the rectum and spreading to the neighboring length of the colon.
3. The small intestine is mostly not involved.

Ulcerative colitis pathogenesis

1. This is considered to be an autoimmune disease.
2. This is due to inflammation caused by the immune system, mainly in the large intestine.
3. Ulcerative colitis is classified as:
   1. Proctitis, limited to the rectum.
   2. Proctosigmoiditis or left-side colitis, where it extends to splenic flexure.
   3. Pancolitis, where it extends to the transverse colon.
4. The severity of ulcerative colitis depends upon the length of the colon involved and the severity of the inflammation.
   1. Mild disease.
   2. Moderate disease.
   3. Severe disease.
   4. Fulminant ulcerative colitis.

Histologic features of ulcerative colitis:

1. Histologically can see the following changes:
   1. Acute superficial inflammation with distortion of the normal crypt structure.
   2. Next stage, you may see a crypt abscess.
   3. There is no inflammation in the dormant stage of ulcerative colitis, but the normal architecture of the crypts is disturbed; there are branched abnormal crypts.

Signs and symptoms of Ulcerative colitis:

The followings are the signs and symptoms of Ulcerative colitis.

1. Ulcerative colitis is insidious in onset. There is no history of abrupt onset.
2. Diarrhea, often with blood or pus.
   1. Diarrhea is the passage of mucus without a stool, indicating the extent of the colon’s involvement.
3. Abdominal pain and cramping preceding bowel movements are common.
   1. Abdominal pain or tenderness on palpation indicates transmural inflammation, which is a sign of severe disease.
4. Rectal pain.
5. Rectal bleeding, there is passing a small amount of blood with stool, and this is a consistent feature.
   1. Bleeding is variable; it may be gross or microscopic.
6. The urgency to defecate, and there is tenesmus.
7. Inability to defecate despite the urgency.
8. Systemic symptoms seen are:
   1. Night sweating.
   2. Nausea and vomiting.
   3. Weight loss.
   4. Fatigue.
   5. Fever.
9. Extraintestinal symptoms may include eye, skin, liver, and joint inflammation.
10. In children, failure to grow.

Diagnosis of ulcerative colitis:

1. The diagnosis of ulcerative colitis depends upon the following:
   1. Clinical history of the patients.
   2. Finding on endoscopy.
   3. Histologic findings on biopsy.
   4. The barium enema is replaced by endoscopy.

Treatment of the Ulcerative Colitis:

It  includes:

1. Medicine.
2. Diet.
3. Surgery.

Crohn’s disease

Signs and symptoms of Crohn’s disease:

The following are the main signs and symptoms of active Crohn’s disease.

1. Crohn’s disease involves most frequently terminal ileum and cecum. It can involve various parts of the gastrointestinal tract.
   1. Chron’s disease of the esophagus, stomach, and duodenum.
   2. Chron’s disease of a jejunoileitis.
   3. Chron’s disease of ileitis and ileocecal areas.
   4. Chron’s disease colitis.
2. Crohn’s disease has different anatomical site involvement.
3. Perianal Crohn’s disease

3. Diarrhea with cramps.
4. Fever and fatigue.
5. Abdominal pain and cramping.
6. Blood was seen in the stools.
7. Mouth ulcers.
8. There is a decrease in appetite.
9. There is weight loss.
10. There is the involvement of the perianal area.

Diagnosis of Crohn’s disease:

1. Crohn’s disease is diagnosed on the basis of the following:
   1. Clinical history of the patient.
   2. Radiographic changes.
   3. Endoscopy findings.
   4. Histologic criteria on biopsy tissue.
2. Most patients are anemic. This is due to iron deficiency, vitamin B12, or folic acid.
   1. Or anemia may be of chronic disease.
3. Leucocytosis is common.
4. Thrombocytosis is common, and this may be related to inflammation or iron deficiency.
5. ESR  is raised. C-reactive protein is positive.
6. Serum albumin is reduced due to inflammation or enteric protein loss.
7. Serological test: Anti-Sac-charomyces cerevisiae antibody and antibody to the outer core of the E.coli are positive.
8. Radiographic findings are diagnostic of Chron’s disease.
   1. Barium studies will show complications like strictures or fistule.
9. Colonoscopic studies of Chron’s disease are more diagnostic.
   1. It will show the sparing of the rectum with focal inflammatory changes in the proximal colon and terminal ileum.
10. The histology of the biopsy shows an aphthous ulcer.
    1. Minute ulceration extends as linear or transmural.
    2. There is a mixed inflammatory infiltrate of lymphocytes, plasma cells, and neutrophils.
    3. There is nonspecific chronic noncaseating granuloma seen on biopsy or resected segments of the intestine.

Treatment of Chron’s disease:

1. It depends upon the location, extent, and severity of the disease,
2. Treatment is focussed on remission and then trying to maintain the remission.
3. It is treated like irritable bowel syndrome.
4. Surgery is indicated in a few cases with complications.
5. Can try anti-inflammatory agents like Aminisalicylates and corticosteroids.

Comparison Table of Ulcerative Colitis VS Chron’s Disease:

Questions and answers: