Ulcerative colitis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 30 Nov 2025

Last updated: 14 Nov 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.

Definition

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.

História e exame físico

Principais fatores diagnósticos

rectal bleeding
diarrhea
blood in stool

Detalhes completos

Outros fatores diagnósticos

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

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

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

Detalhes completos

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 (UC)

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

Stephen B Hanauer, MD

Professor of Medicine

Gastroenterology and Hepatology

Northwestern University

Evanston

Declarações

SW declares that he has no competing interests.

Créditos aos pareceristas

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Referências

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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 update: ulcerative colitis in adults. Am J Gastroenterol. 2025 Jun 3;120(6):1187-224.Texto completo Resumo

Moran GW, Gordon M, Sinopolou V, et al. British Society of Gastroenterology guidelines on inflammatory bowel disease in adults: 2025. Gut. 2025 Jun 23;74(Suppl 2):s1-101.Texto completo Resumo

Singh S, Loftus EV Jr, Limketkai BN, et al. AGA living clinical practice guideline on pharmacological management of moderate-to-severe ulcerative colitis. Gastroenterology. 2024 Dec;167(7):1307-43.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.

Diagnósticos diferenciais
- Crohn disease
- Indeterminate colitis
- Radiation colitis
Mais Diagnósticos diferenciais
Diretrizes
- Preventive care in inflammatory bowel disease
- Management of inflammatory bowel disease in adults
Mais Diretrizes
Folhetos informativos para os pacientes
Ulcerative colitis: what is it?
Ulcerative colitis: what are the treatment options?
Mais Folhetos informativos para os pacientes
Videos
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Mais vídeos
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Ulcerative colitis

Summary

Definition

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Tests to avoid

Investigações a serem consideradas

Algoritmo de tratamento

acute severe ulcerative colitis (UC)

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

Stephen B Hanauer, MD

Declarações

Créditos aos pareceristas

Declarações

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