Ulcerative colitis

概述 
理论 
诊断 
治疗 
随访 
资源 

最后审阅： 17 Aug 2025

最后更新： 29 Jul 2025

Ulcerative colitis (UC) 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.

定义

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.[1][2][3]

This topic covers the diagnosis and treatment of ulcerative colitis in adults.

病史和体格检查

关键诊断因素

rectal bleeding
diarrhea
blood in stool

完整详情

其他诊断因素

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

完整详情

危险因素

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

完整详情

诊断性检查

首要检查

stool studies for infective pathogens
fecal calprotectin (FC)
CBC
comprehensive metabolic panel (including LFTs)
erythrocyte sedimentation rate (ESR)
CRP
plain abdominal radiograph
flexible sigmoidoscopy
colonoscopy
biopsies

完整详情

Tests to avoid

serologic antibody testing

Detalhes completos

Investigações a serem consideradas

CT scan
intestinal ultrasound

Detalhes completos

Algoritmo de tratamento

AGUDA

acute severe ulcerative colitis

moderate-to-severe disease

mild disease

CONTÍNUA

disease in remission

Colaboradores

Autores

Andrew Poullis, BSc, MBBS, MD, FRCP

Consultant Gastroenterologist

Department of Gastroenterology

St George’s Hospital

London

Declarações

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

Sailish Honap, MBChB (Hons), MRes, MRCP (UK)

Consultant Gastroenterologist

Department of Gastroenterology

St George’s Hospital

London

Declarações

SH has received honoraria from Pfizer (speaker, consultant, advisory board member, and received travel grants), Janssen (speaker fees, travel grants), AbbVie (speaker fees, consultant, travel grants), Takeda (speaker fees), Ferring (travel grants), Pharmacosmos (travel grants), Galapagos (travel grants).

Kamal Patel,

Declarações

all disclosures

Aaron Bhakta, BMedSci (Hons), BMBS, MSc, MRCP

Clinical Fellow in Gastroenterology

Department of Gastroenterology

St George’s Hospital

London

Declarações

AB declares that he has no competing interests.

Agradecimentos

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.

Declarações

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

Revisores

Trevor Winter, MD, PhD

Associate Professor of Medicine

Division of Digestive Diseases and Nutrition

University of Kentucky

Lexington

Declarações

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

Declarações

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

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

World Gastroenterology Organisation. Global guidelines: inflammatory bowel disease. Aug 2015 [internet publication].Texto completo

Rubin DT, Ananthakrishnan AN, Siegel CA, et al. ACG clinical guideline: ulcerative colitis in adults. Am J Gastroenterol. 2019 Mar;114(3):384-413. Resumo

Feuerstein JD, Isaacs KL, Schneider Y, et al. AGA clinical practice guidelines on the management of moderate to severe ulcerative colitis. Gastroenterology. 2020 Apr;158(5):1450-61.Texto completo Resumo

Harbord M, Eliakim R, Bettenworth D, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: current management. J Crohns Colitis. 2017 Jul 1;11(7):769-84.Texto completo Resumo

National Institute for Health and Care Excellence (UK). Ulcerative colitis: management. May 2019 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

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Ulcerative colitis

小结

定义

病史和体格检查

关键诊断因素

其他诊断因素

危险因素

诊断性检查

首要检查

Tests to avoid

Investigações a serem consideradas

Algoritmo de tratamento

acute severe ulcerative colitis

moderate-to-severe disease

mild disease

disease in remission

Colaboradores

Autores

Andrew Poullis, BSc, MBBS, MD, FRCP

Declarações

Sailish Honap, MBChB (Hons), MRes, MRCP (UK)

Declarações

Kamal Patel,

Declarações

Aaron Bhakta, BMedSci (Hons), BMBS, MSc, MRCP

Declarações

Agradecimentos

Declarações

Revisores

Trevor Winter, MD, PhD

Declarações

Sharon Stein, MD

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Videos

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice