Inflammatory Bowel Disease - Ulcerative Colitis

Question 1

What is the epidemiology of UC?

Answer 1

• Incidence ranges from 10-20 / 100,000 people.
• Slightly more common in men than women.
• Most patients are aged 20-40 years at diagnosis. Another peak occurs at age 60.

Question 2

What is the pathophysiology of UC?

Answer 2

• Most cases arise in the rectum, with some patients developing terminal ileitis due to an incompetent ileocaecal valve.
• The term ‘proctitis’ is used when it’s limited to the rectum.
• Microscopically:
- UC usually involves only the mucosa.
- Formation of crypt abscesses and depletion of mucin

Question 3

What is the prognosis of UC?

Answer 3

• Mortality isn’t increased in those with UC compared to the general population.
• Most common cause of death is toxic megacolon.

Question 4

What are the risk factors associated with UC?

Answer 4

• FH of IBD.
• HLA-B27.
• Infection.
• NSAIDs - can flare disease).
• Former smoker - risk of development of UC.

Question 5

What are the signs and symptoms of UC?

Answer 5

• Rectal bleeding.
• Diarrhoea.
• Blood in stool.
• Abdominal pain and tenderness.
• Arthritis and spondylitis.
• Malnutrition.
• Weight loss.

Question 6

What investigations would you do if UC was suspected?

Answer 6

• Stool studies:
  
  • Faecal calprotectin elevated.
  • WBC present.
• FBC. Anaemia, leukocytosis or thrombocytosis.
• LFT’s.
• CRP and ESR.
• Abdominal x-ray.
• Colonoscopy and biopsies.

Question 7

Suggest some differential diagnoses.

Answer 7

· Crohn's disease. 
· Colitis. 
· Diverticulitis. 
· IBS. 
· Infective colitis.

Question 8

What are the treatment options for UC?

Answer 8

· Mild to moderate disease:

• Topical mesalazine.
• Topical corticosteroids or oral mesalazine.
• Oral corticosteroids +/- oral tacrolimus.

· Surgery

Question 9

What complications can occur with UC?

Answer 9

· Inflammatory pseudopolyps. 
· Benign stricture. 
· Toxic megacolon. 
· Perforation.
· Infection - CMV and C. Diff. 
· Colonic adenocarcinoma. 
· PSC