Ulcerative colitis: Symptoms, Complications & Treatments

Ulcerative colitis is one of the most common inflammatory bowel diseases, with an incidence of 2.2-14.3 per 100,000 in North America. Mucosa, submucosa, and a continuous lesion involving the recto-sigmoid region confined to the colon. Major symptoms include diarrhea, rectal bleeding, and mucus stool. On endoscopy, mucosal friability and mucosal vascularity disappear with continuous lesion including rectum. Crypt abscess may also appear. Barium enema and sigmoidoscopy can be diagnosed, with the loss of haustration on the barium enema resulting in a distinctive lead pipe appearance. Subsequent complications include toxic megacolon, perforation, obstruction, and colon carcinoma. One of the most serious complications, colon carcinoma, is associated with the duration of the disease and the extent of the lesion, and the risk increases gradually if UC persists for more than 10 years. Therefore, colonoscopic surveillance with multiple colon biopsy every two years is necessary for UC patients.

Treatments
Basically, medication is performed. Commonly used drugs are used for maintenance in mild to moderate UC with sulfasalazine, such as the 5-ASA line mesalazine. In UC, sulfasalazine is known to be effective in both induction and maintenance of therapy, but limited in Chron's disease. Moderate to severe UC, in the case of CD, steroids are used. Since they are drugs used for induction, once they reach remission, they must be stopped by tapering. In the treatment of IBD, azathioprine may be used as a maintenance therapy if it appears to be steroid dependent. In addition, anti-TNF therapy such as methotrexate, cyclosporine, and infliximab can be used to treat IBD.
Surgical treatment is also possible. Basically, total colectomy is performed as curative therapy for UC, and partial colectomy for CD is performed. The indications for surgery in UC include complications such as toxic megacolon, and surgical treatment in cases where CD does not improve due to medication or complication.

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