Ulcerative colitis

Introduction
Ulcerative colitis (ulcerative colitis or proctocolitis or idiopathic) is an inflammatory bowel disease (IBD: inflammatory bowel disease) that affects only the large intestine. The first location is always the last to load the intestinal tract (rectum) and may extend gradually upstream.

Ulcerative colitis Signs and symptoms
The clinical aspects vary in dependence of the intensity of inflammation and its extent in the organ. In relation to the latter parameter characterizes a limited from a last intestinal tract (proctosigmoiditis), an extended form in the colon until the splenic flexure downward (left colitis) and a form that involves the entire organ up to the ileocecal valve (total colitis).

The most frequent symptoms consist of abdominal pain, tenesmus (a feeling of urgent evacuation without success) and diarrhea with mucus and blood, the latter shows' coating the feces if the disease is rectal, the unmingled stool if the disease is more extensive.

Causes Ulcerative colitis
It is not known a single cause of the disease; it is considered valid to the hypothesis of multifactorial origin that in inflammatory bowel disease (including Crohn's disease) causes a chronic mucosal immune function in genetically predisposed individuals.

Ulcerative colitis Diagnosis
The clinical features (diarrhea with mucus and blood) orient the gastroenterologist to perform a colonoscopy, which is the fundamental exam for the diagnosis and evaluation of the intensity and extent of disease. The endoscopic appearance of a mucosa, which is frail and with typical ulceration, and histology, with the chronic inflammatory process limited to the superficial layers of the mucosa, allowing the diagnosis.

Ulcerative colitis Complications
The dreaded complications of acute ulcerative colitis are: the 'massive hemorrhage, intestinal perforation, toxic megacolon (acute colonic distention with fever, dehydration and electrolyte unbalance) and require surgical treatment (colectomy or hemicolectomy).

Systemic complications, i.e. inflammatory manifestations in other organs, are not frequent.

A late complication is the neoplastic transformation of an inflamed mucosa whose probability is proportional to disease duration and extent of inflammation.


Ulcerative colitis Therapy
The goal of therapy is to control inflammation for remission status.

Medical therapy takes anti-inflammatory drugs (aminosalicylates) and corticosteroids, are used in refractory case's immunosuppressants (azathioprine, cyclosporine), and even more rarely monoclonal antibodies (infliximab). Surgical intervention is necessary in acute complications (toxic megacolon, perforation) and in the presence of dysplasia or neoplastic changes.