Colonooscopy of Ulcerative Colitis
Ulcerative colitis (UC) is one of the 2 major types of inflammatory bowel disease (IBD), along with Crohn disease. Unlike Crohn disease, which can affect any part of the gastrointestinal (GI) tract, UC characteristically involves the large bowel.

Ulcerative colitis is a chronic disease characterized by diffuse mucosal inflammation of the colon. Ulcerative colitis always involves the rectum (i.e., proctitis), and it may extend proximally in a contiguous pattern to involve the sigmoid colon (i.e., proctosigmoiditis), the descending colon (i.e., left-sided colitis), or the entire colon (i.e., pancolitis). This article reviews the diagnosis and treatment of ulcerative colitis from a primary care perspective.

What are the complications of ulcerative colitis?

Colon cancer- Although most patients with ulcerative colitis will not develop colon cancer, patients with ulcerative colitis are at a 2 to 5 fold increased risk of developing colon cancer compared to persons without ulcerative colitis. Researchers believe the increased risk of colon cancer is related to chronic inflammation in the colon. In order to detect colon cancer at an early stage, most patients with ulcerative colitis will need to undergo colonoscopies on a regular interval that is more frequent than for patients without ulcerative colitis. The risk of colon cancer may be even higher in individuals who have a condition of the liver called primary sclerosing cholangitis (PSC) or with family members who have had colon cancer. All patients with ulcerative colitis should discuss the timing and frequency of colonoscopy with their gastroenterologist.
Surgery- Most patients with ulcerative colitis will not require surgery. However, some patients may not respond to medications or have other severe symptoms that require removal of the colon. Removal of the colon is the closest thing to a "cure" for ulcerative colitis because unlike Crohn's disease, ulcerative colitis does not affect other parts of the digestive system and should not recur after complete removal of the colon. After removal of the colon, patients may require either an ostomy (bag), or reconstructive surgery, referred to as a "J-pouch" or ileal pouch-anal anastomosis (IPAA). The choice of these options is between the patient and the surgeon as each option has its' advantages and disadvantages.

Ulcerative colitis is a chronic disease with recurrent symptoms and significant morbidity. The precise etiology is still unknown. As many as 25 percent of patients with ulcerative colitis have extraintestinal manifestations. The diagnosis is made endoscopically.
Patients with UC predominantly complain of the following:

Rectal bleeding
Frequent stools
Mucous discharge from the rectum
Tenesmus (occasionally)
Insidious onset
Lower abdominal pain and severe dehydration from purulent rectal discharge (in severe cases, especially in the elderly)
In some cases, UC has a fulminant course marked by the following:

Severe diarrhea and cramps
Fever
Leukocytosis
Abdominal distention
UC is associated with various extracolonic manifestations, as follows:

Uveitis
Pyoderma gangrenosum
Pleuritis
Erythema nodosum
Ankylosing spondylitis
Spondyloarthropathies
Other conditions associated with UC include the following:

Primary sclerosing cholangitis (PSC)
Recurrent subcutaneous abscesses unrelated to pyoderma gangrenosum
Multiple sclerosisImmunobullous disease of the skin
Physical findings are typically normal in mild disease, except for mild tenderness in the lower left abdominal quadrant. In severe disease, the following may be observed:

Fever
Tachycardia
Significant abdominal tenderness
Weight loss
The severity of UC can be graded as follows:

Mild: Bleeding per rectum, fewer than 4 bowel motions per day
Moderate: Bleeding per rectum, more than 4 bowel motions per day
Severe: Bleeding per rectum, more than 4 bowel motions per day, and a systemic illness with hypoalbuminemia (30 g/L).
A colonoscopy or sigmoidoscopy are the most accurate methods for making a diagnosis of ulcerative colitis and ruling-out other possible conditions, such as Crohn's disease, diverticular disease, or cancer. For both tests, the doctor inserts an endoscope-a long, flexible, lighted tube connected to a computer and TV monitor-into the anus to see the inside of the colon and rectum. The doctor will be able to see any inflammation, bleeding, or ulcers on the colon wall. During the exam, the doctor may do a biopsy, which involves taking a sample of tissue from the lining of the colon to view with a microscope.

Sometimes x rays such as a barium enema or CT scans are also used to diagnose ulcerative colitis or its complications.

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