Ulcerative colitis

Last reviewed: 25 Aug 2022
Last updated: 23 Aug 2022

Summary

Definition

History and exam

Key diagnostic factors

  • rectal bleeding
  • diarrhea
  • blood in stool
More key diagnostic factors

Other diagnostic factors

  • abdominal pain
  • arthritis and spondylitis
  • malnutrition
  • abdominal tenderness
  • fever
  • weight loss
  • constipation
  • skin rash
  • uveitis and episcleritis
  • pallor
Other diagnostic factors

Risk factors

  • family history of inflammatory bowel disease
  • human leukocyte antigen-B27
  • infection
  • nonsteroidal anti-inflammatory drugs (NSAIDs)
  • not smoking or former smoker
More risk factors

Diagnostic investigations

1st investigations to order

  • stool studies for infective pathogens
  • fecal calprotectin
  • CBC
  • comprehensive metabolic panel (including LFTs)
  • erythrocyte sedimentation rate (ESR)
  • CRP
  • plain abdominal radiograph
  • flexible sigmoidoscopy
  • colonoscopy
  • biopsies
More 1st investigations to order

Investigations to consider

  • CT scan
More investigations to consider

Treatment algorithm

ACUTE

acute severe ulcerative colitis

moderate-to-severe disease

mild disease

ONGOING

disease in remission

Contributors

Authors

Hesam A. Nooredinvand, MBBS, MRCP, BSc (Hons)

Research Fellow in Gastroenterology

St George's Hospital

London

UK

Disclosures

HAN declares that he has no competing interests.

Andrew Poullis, BSc, MBBS, MD, FRCP

Consultant Gastroenterologist

Department of Gastroenterology

St George’s Hospital

London

UK

Disclosures

AP is an author of a reference cited in this topic.

Acknowledgements

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.

Disclosures

BS, AS, RH, WJSD, and HM declare that they have no competing interests.

Peer reviewers

Trevor Winter, MD, PhD

Associate Professor of Medicine

Division of Digestive Diseases and Nutrition

University of Kentucky

Lexington

KY

Disclosures

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

Cleveland

OH

Disclosures

SS received a fee for educational courses on laparoscopic surgery, paid for in part by Covidien, Olympus, and Applied Medical.

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