Ulcerative colitis is a type of inflammatory bowel disease characterized by diffuse inflammation of the colonic mucosa and a relapsing, remitting course.
Patients commonly experience bloody diarrhea, chronic diarrhea (or both), lower abdominal pain, fecal urgency, and extraintestinal manifestations, particularly those related to activity of the colitis.
Diagnosis requires endoscopy with biopsy and negative stool culture.
Relapses are often associated with pathogens; therefore, stool should be obtained for culture in all cases of disease flare-up.
Treatment aims to induce and maintain remission. Drug choice and formulation depends on the severity and extent of disease.
Toxic megacolon can occur with associated risk of perforation. Bowel adenocarcinoma is a complication in 3% to 5% of patients.
Ulcerative colitis (UC) is a type of inflammatory bowel disease that characteristically involves the rectum and extends proximally to affect a variable length of the colon. It is recognized as a multifactorial polygenic disease, as the exact etiology is still unknown. Included in the etiologic theories are environmental factors, immune dysfunction, and a likely genetic predisposition.
History and exam
Key diagnostic factors
- rectal bleeding
- blood in stool
Other diagnostic factors
- abdominal pain
- arthritis and spondylitis
- abdominal tenderness
- weight loss
- skin rash
- uveitis and episcleritis
- family history of inflammatory bowel disease
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- not smoking or former smoker
1st investigations to order
- stool studies for infective pathogens
- fecal calprotectin
- comprehensive metabolic panel (including LFTs)
- erythrocyte sedimentation rate (ESR)
- plain abdominal radiograph
- flexible sigmoidoscopy
Investigations to consider
- CT scan
acute severe ulcerative colitis
disease in remission
Hesam A. Nooredinvand, MBBS, MRCP, BSc (Hons)
Research Fellow in Gastroenterology
St George's Hospital
HAN declares that he has no competing interests.
Andrew Poullis, BSc, MBBS, MD, FRCP
Department of Gastroenterology
St George’s Hospital
AP is an author of a reference cited in this topic.
Dr Hesam A. Nooredinvand, and Dr Andrew Poullis would like to gratefully acknowledge Dr Ben Shandro, Dr Anet Soubieres, Dr Rhys Hewett, Dr Willem J.S. de Villiers, and Dr Houssam Mardini, previous contributors to this topic.
BS, AS, RH, WJSD, and HM declare that they have no competing interests.
Trevor Winter, MD, PhD
Associate Professor of Medicine
Division of Digestive Diseases and Nutrition
University of Kentucky
TW declares that he has no competing interests.
Sharon Stein, MD
Assistant Professor of Surgery
Division of Colon and Rectal Surgery
University Hospital Case Medical Center
SS received a fee for educational courses on laparoscopic surgery, paid for in part by Covidien, Olympus, and Applied Medical.
- Crohn disease
- Indeterminate colitis
- Radiation colitis
- Dietary guidance for inflammatory bowel disease
- Clinical nutrition in inflammatory bowel disease
Ulcerative colitis: what is it?
Ulcerative colitis: what treatments work?More Patient leaflets
Venepuncture and phlebotomy: animated demonstrationMore videos
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer