Ulcerative Colitis

Ulcerative Colitis• Is a relapsing and remitting disease characterised by acute

non-infectious inflamation of the colorectal mucosa• Confluent inflamation and shallow ulceration extend

proximally from the anal margin in contiguous pattern• May have :– Proctitis (always involves rectum)– Left side colitis (s/d fleksura lienalis)– Extensive colitis (termasuk colon tranversum)– Pan-colitis

• E/ : primary dysregulation of the mucosal immune system execessive immunologic response to normal microflora

Clinical Feature & Diagnosis

Diagnostic Testing• Laboratory study :– Exam for ova and parasites– Stool culture and testing for C.difficile

• Barium enema & Small-bowel barium follow through– A contiguous superficial inflamatory process– Loss of haustration

• Colonoscopy + biopsy :– Loss of typical vascular pattern– Friability– Exudates– Ulceration– Granulation in contiunuos and circumferential pattern

Differential Diagnosis• Crohn’s disease• Anal fissure• Infectious colitis– Stool culture for bacteria, parasitic, protozoa

• Pseudomembran colitis – History of antibiotic exposure, toxin assay for

C.difficile• Food sensitive colitis• Ischaemic colitis, diverticulitis, colonic tumour

Causal & Immunological aspects

Management• 5-aminosalicycylic acid (rectal and systemic)– Sulphasalazine– Balsalzide– Mesalazine

• Topical treatment proctitis• Foam enema, liquid enema, gel enema

(mesalazine)• Corticosteroid• Azathioprine : immunosupresive drugs

Maintenance of remission

• Sulphasalazine and 5-ASA : equally effective– Potential nephrotoxic monitoring renal function

• Azathioprine : px with steroid resistant or dependent disease

Surgical Management

• Colectomy for UC :– Px who develop dysplasis or cancer– Resistant to maximal medical therapy– Massive hemorrhage– Perforation– Toxic Megacolon (dilatation of transverse colon >

5,5cm on supine abdominal radiography)• Surgical treatment of UC curative• Cancer screening

Severe Active Ulcerative Colitis• > 6x bloody stools per day• And one of the following findings :– T > 37,8 C– Pulse rate > 90x/min– Hemoglobin < 10,5 g/dl– Erythrocyte sedimentation rate > 30 mm/h

• Clinical activity : confirmed by endoscopy presence of spontaneous bleeding, deep ulceration and mucosal island.

Severe Active Ulcerative Colitis• Treatment– Corticosteroids (CS) : prednisolone 0,75-1

mg/kg/day (60mg/day), topical hydrocortisone, antibiotic, iv line, nil by mouth

– Bowel rest : complicated severe UC (colonic dilatation, impending megacolon, clinical/radiological bowel obstruction)

– Antibiotic– Cyclosporin– Infliximab