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Encyclopedia > Ulcerative colitis
Ulcerative colitis
Classification & external resources
Endoscopic image of a sigmoid colon afflicted with ulcerative colitis. Note the vascular pattern of the colon granularity and focal friability of the mucosa.
ICD-10 K51.
ICD-9 556
OMIM 191390
DiseasesDB 13495
eMedicine med/2336 

Ulcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD). Ulcerative colitis is a form of colitis, a disease of the intestine, specifically the large intestine or colon, that includes characteristic ulcers, or open sores, in the colon. The main symptom of active disease is usually diarrhea mixed with blood, of gradual onset. Ulcerative colitis is, however, a systemic disease that affects many parts of the body outside the intestine. Because of the name, IBD is often confused with irritable bowel syndrome ("IBS"), a troublesome, but much less serious condition. Ulcerative colitis has similarities to Crohn's disease, another form of IBD. Ulcerative colitis is an intermittent disease, with periods of exacerbated symptoms, and periods that are relatively symptom-free. Although the symptoms of ulcerative colitis can sometimes diminish on their own, the disease usually requires treatment to go into remission. Image File history File links UC_granularity. ... Colonoscopy is the minimally invasive endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. ... The sigmoid colon is the part of the large intestine after the descending colon and before the rectum. ... The mucous membranes (or mucosa) are linings of ectodermic origin, covered in epithelium, that line various body cavities and internal organs. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... In medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. ... Colitis is a digestive disease characterized by inflammation of the colon. ... This article is about the medical term. ... In anatomy, the intestine is the segment of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ... It has been suggested that this article or section be merged with Large intestine. ... An ulcer (from Latin ulcus) is an open sore of the skin, eyes or mucous membrane, often caused by an initial abrasion and generally maintained by an inflammation and/or an infection. ... Types 5-7 on the Bristol Stool Chart are often associated with diarrhea Diarrhea (in American English) or diarrhoea (in British English) is a condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning through-flowing). Acute infectious diarrhea is a common cause... Systemic Relating to, or affecting a particular body system; especially the nervous system. ... Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining between). ... Remission is the state of absence of disease activity in patients with known chronic illness. ...


Ulcerative colitis is a rare disease, with an incidence of about one person per 10,000 in North America. The disease tends to be more common in northern areas. Although ulcerative colitis has no known cause, there is a presumed genetic component to susceptibility. The disease may be triggered in a susceptible person by environmental factors. Although dietary modification may reduce the discomfort of a person with the disease, ulcerative colitis is not thought to be caused by dietary factors. Although ulcerative colitis is treated as though it were an autoimmune disease, there is no consensus that it is such. Treatment is with anti-inflammatory drugs, immunosuppression (suppressing the immune system), and biological therapy targeting specific components of the immune response. Colectomy (partial or total removal of the large bowel through surgery) is occasionally necessary, and is considered to be a cure for the disease. A rare disease (sometimes known as an orphan disease) has such a low prevalence in a population that a doctor in a busy general practice would not expect to see more than one case a year. ... This article is about the general scientific term. ... Autoimmunity is the failure of an organism to recognize its own constituent parts (down to the sub-molecular levels) as self, which results in an immune response against its own cells and tissues. ... Immunosuppression is the medical suppression of the immune system. ... The anti-tumor necrosis factor α monoclonal antibody infliximab is a mainstay of the biological therapy for inflammatory bowel disease Biological therapy refers to the use of medication that is tailored to specifically target an immune or genetic mediator of disease. ... Colectomy is the surgical procedure by means of which part of the colon is removed. ...

Contents

Causes

While the cause of ulcerative colitis is unknown, several, possibly interrelated, causes have been suggested.


Genetic factors

A genetic component to the etiology of ulcerative colitis can be hypothesized based on the following:[1] This article is about the general scientific term. ...

  • Aggregation of ulcerative colitis in families.
  • Identical twin concordance rate of 10% and dizygotic twin concordance rate of 3%[2]
  • Ethnic differences in incidence
  • Genetic markers and linkages

There are 12 regions of the genome which may be linked to ulcerative colitis. This includes chromosomes 16, 12, 6, 14, 5, 19, 1, 16, and 3 in the order of their discovery.[3] However, none of these loci has been consistently shown to be at fault, suggesting that the disorder arises from the combination of multiple genes. For example, chromosome band 1p36 is one such region thought to be linked to inflammatory bowel disease.[4] Some of the putative regions encode transporter proteins such as OCTN1 and OCTN2. Other potential regions involve cell scaffolding proteins such as the MAGUK family. There are even HLA associations which may be at work. In fact, this linkage on chromosome 6 may be the most convincing and consistent of the genetic candidates.[3] Twin study - Wikipedia /**/ @import /skins-1. ... An ethnic group is a group of people who identify with one another, or are so identified by others, on the basis of a boundary that distinguishes them from other groups. ... A genetic marker is a known DNA sequences (e. ... Genetic linkage occurs when particular alleles are inherited jointly. ... In biology the genome of an organism is the whole hereditary information of an organism that is encoded in the DNA (or, for some viruses, RNA). ... The word locus (plural loci) is Latin for place. In biology, a locus is the position of a gene (or other significant sequence) on a chromosome. ... The initialism HLA can stand for: Hapag Lloyd Airlines,a German charter airline Harvey L. Atwater, a U.S. politician Henry Louis Aaron, a baseball player High Level Architecture, a distributed computer simulation standard House of Lords Act, a U.K. constitutional reform Human Leukocyte Antigen, a key part of...


Multiple autoimmune disorders have been recorded with the neurovisceral and cutaneous genetic porphyrias including ulcerative colitis, Crohn's disease, celiac disease, dermatitis herpetiformis, systemic and discoid lupus, rheumatoid arthritis, ankylosing spondylitis, scleroderma, Sjogren's disease and scleritis. Physicians should be on high alert for porphyrias in families with autoimmune disorders and care must be taken with potential porphyrinogenic drugs, including sulfasalazine. The porphyrias are a group of inherited or acquired disorders of certain enzymes in the heme biosynthetic pathway (also called porphyrin pathway). ... Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining between). ... Coeliac disease (also termed non-tropical sprue, celiac disease and gluten intolerance) is an autoimmune disease characterised by chronic inflammation of the proximal portion of the small intestine caused by exposure to certain dietary gluten proteins. ... Dermatitis herpetiformis (DH) or Duhrings Disease, is a skin disorder often associated with celiac disease. ... // Lupus may refer to: Wolf (latin). ... Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. ... Scleroderma is a rare, chronic disease characterized by excessive deposits of collagen in the skin or other organs. ... Sjögrens syndrome is an autoimmune disorder in which immune cells attack and destroy the exocrine glands that produce tears and saliva. ... Scleritis is a serious inflammatory disease that affects the white outer coating of the eye, known as the sclera. ... Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ...


Environmental factors

Many hypotheses have been raised for environmental contributants to the pathogenesis of ulcerative colitis. They include the following:

  • Diet: as the colon is exposed to many different dietary substances which may encourage inflammation, dietary factors have been hypothesized to play a role in the pathogenesis of both ulcerative colitis and Crohn's disease. There have been few studies to investigate such an association, but one study showed no association of refined sugar on the prevalence of ulcerative colitis.[5]
  • Smoking: unlike Crohn's disease, ulcerative colitis has a lesser prevalence in smokers than non-smokers.[6]
  • Breastfeeding: There have been conflicting reports of the protection of breastfeeding in the development of inflammatory bowel disease. One Italian study showed a potential protective effect.[7]
  • Other childhood exposures, or infections[citation needed]

In nutrition, the diet is the sum of food consumed by a person or other organism. ... It has been suggested that this article or section be merged with Large intestine. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Pathogenesis is the mechanism by which a certain etiological factor causes disease (pathos = disease, genesis = development). ... Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining between). ... In statistics, an association (statistics) comes from two variables who are related. ... This article is about sugar as food and as an important and widely traded commodity. ... The cigarette is the most common method of smoking tobacco. ... In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. ... An infant breastfeeding International Breastfeeding Symbol (Matt Daigle, Mothering magazine contest winner 2006) Breastfeeding is the feeding of an infant or young child with milk from a womans breasts. ...

Autoimmune disease

Some sources list ulcerative colitis as an autoimmune disease, a disease in which the immune system malfunctions, attacking some part of the body. As discussed above, ulcerative colitis is a systemic disease that affects many areas of the body outside the digestive system. Surgical removal of the large intestine often cures the disease, including the manifestations outside the digestive system.[8] This suggests that the cause of the disease is in the colon itself, and not in the immune system or some other part of the body. Autoimmunity is the failure of an organism to recognize its own constituent parts (down to the sub-molecular levels) as self, which results in an immune response against its own cells and tissues. ... A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ...


Alternative theories

Levels of sulfate-reducing bacteria tend to be higher in persons with ulcerative colitis. This could mean that there are higher levels of hydrogen sulfide in the intestine. An alternative theory suggests that the symptoms of the disease may be caused by toxic effects of the hydrogen sulfide on the cells lining the intestine.[9][10] Sulfate-reducing bacteria comprise several groups of bacteria that use sulfate as an oxidizing agent, reducing it to sulfide. ... Hydrogen sulfide (hydrogen sulphide in British English) is the chemical compound with the formula H2S. This colorless, toxic and flammable gas is responsible for the foul odor of rotten eggs and flatulence. ...


Epidemiology

The incidence of ulcerative colitis in North America is 10-12 cases per 100,000, with a peak incidence of ulcerative colitis occurring between the ages of 15 and 25. There is thought to be a bimodal distribution in age of onset, with a second peak in incidence occurring in the 6th decade of life. The disease affects females more than males.[11] The incidence of disease is defined as the number of new cases of disease occurring in a population during a defined time interval. ... North America North America is a continent[1] in the Earths northern hemisphere and (chiefly) western hemisphere. ... In statistics, a bimodal distribution is a distribution with two different peaks — that is, there are two distinct values that measurements tend to center around. ... In phonetics and phonology, a syllable onset is the part of a syllable that precedes the syllable nucleus. ...


The geographic distribution of ulcerative colitis and Crohn's disease is similar worldwide,[12] with highest incidences in the United States, Canada, the United Kingdom, and Scandinavia. Higher incidences are seen in northern locations compared to southern locations in Europe and the United States[13] . Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining between). ... For other uses, see Scandinavia (disambiguation). ... Northern may refer to the following articles: North Northern (automobile), an early American automobile Northern Bank, commercial bank in Northern Ireland. ... For other uses, see Europe (disambiguation). ...


As with Crohn's disease, ulcerative colitis is thought to occur more commonly among Ashkenazi Jewish people than non-Jewish people. Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining between). ... Ashkenazi Jews, also known as Ashkenazic Jews or Ashkenazim (אַשְׁכֲּנָזִי אַשְׁכֲּנָזִים Standard Hebrew, Aškanazi,Aškanazim, Tiberian Hebrew, ʾAškănāzî, ʾAškănāzîm, pronounced sing. ...


Clinical presentation

GI symptoms

The clinical presentation[11] of ulcerative colitis depends on the extent of the disease process. Patients usually present with diarrhea mixed with blood and mucus, of gradual onset. They also may have signs of weight loss, and blood on rectal examination. The disease is usually accompanied with different degrees of abdominal pain, from mild discomfort to severely painful cramps. Types 5-7 on the Bristol Stool Chart are often associated with diarrhea Diarrhea (in American English) or diarrhoea (in British English) is a condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning through-flowing). Acute infectious diarrhea is a common cause... Mucus is a slippery secretion of the lining of the mucous membranes in the body. ...


Ulcerative colitis is a systemic disease that affects many parts of the body. Sometimes the extra-intestinal manifestations of the disease are the initial signs, such as painful, arthritic knees in a teenager. It is, however, unlikely that the disease will be correctly diagnosed until the onset of the intestinal manifestations.


Extent of involvement

Diagram of the Human Intestine

Ulcerative colitis is normally continuous from the rectum up the colon. The disease is classified by the extent of involvement, depending on how far up the colon the disease extends: Diagram of the Human Intestine. ... Diagram of the Human Intestine. ... It has been suggested that this article or section be merged with Large intestine. ...

  • Distal colitis, potentially treatable with enemas:[8]
    • Proctitis: Involvement limited to the rectum.
    • Proctosigmoiditis: Involvement of the rectosigmoid colon, the portion of the colon adjacent to the rectum.
    • Left-sided colitis: Involvement of the descending colon, which runs along the patient's left side, up to the splenic flexure and the beginning of the transverse colon.
  • Extensive colitis, inflammation extending beyond the reach of enemas:
    • Pancolitis: Involvement of the entire colon, extending from the rectum to the cecum, beyond which the small intestine begins.

Proctitis (Noun) Inflammation of the rectum. ... The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. ...

Severity of disease

In addition to the extent of involvement, UC patients may also be characterized by the severity of their disease.[8]

  • Mild disease correlates with fewer than four stools daily, with or without blood, no systemic signs of toxicity, and a normal erythrocyte sedimentation rate (ESR). There may be mild abdominal pain or cramping. Patients may believe they are constipated when in fact they are experiencing tenesmus, which is a constant feeling of the need to empty the bowel accompanied by involuntary straining efforts, pain, and cramping with little or no fecal output. Rectal pain is uncommon.
Colonic pseudopolyps of a patient with intractable ulcerative colitis. Colectomy specimen.
Colonic pseudopolyps of a patient with intractable ulcerative colitis. Colectomy specimen.
  • Moderate disease correlates with more than four stools daily, but with minimal signs of toxicity. Patients may display anemia (not requiring transfusions), moderate abdominal pain, and low grade fever, 38 to 39 °C (99.5 to 102.2 °F).
  • Severe disease, correlates with more than six bloody stools a day, and evidence of toxicity as demonstrated by fever, tachycardia, anemia or an elevated ESR.
  • Fulminant disease correlates with more than ten bowel movements daily, continuous bleeding, toxicity, abdominal tenderness and distension, blood transfusion requirement and colonic dilation (expansion). Patients in this category may have inflammation extending beyond just the mucosal layer, causing impaired colonic motility and leading to toxic megacolon. If the serous membrane is involved, colonic perforation may ensue. Unless treated, fulminant disease will soon lead to death.

Systemic Relating to, or affecting a particular body system; especially the nervous system. ... The erythrocyte sedimentation rate (ESR), also called a sedimentation rate, sed rate or Biernacki Reaction, is a non-specific measure of inflammation that is commonly used as a medical screening test. ... Constipation or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest; it may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. ... Tenesmus is the constant feeling of the need to empty the bowel, accompanied by pain, cramping, and involuntary straining efforts. ... Image File history File links Chronic_Ulcerative_Colitis_1. ... Image File history File links Chronic_Ulcerative_Colitis_1. ... It has been suggested that this article or section be merged with Large intestine. ... Colectomy is the surgical procedure by means of which part of the colon is removed. ... This article needs additional references or sources for verification. ... This article or section does not cite any references or sources. ... Toxic megacolon (megacolon toxicum) is a life-threatening complication of other intestinal conditions. ... A serous membrane is a very thin layer of cells (usually one row) covering internal body cavity. ...

Extraintestinal features

As ulcerative colitis is a systemic disease, patients may present with symptoms and complications outside the colon. These include the following: Systemic Relating to, or affecting a particular body system; especially the nervous system. ... The term symptom (from the Greek meaning chance, mishap or casualty, itself derived from συμπιπτω meaning to fall upon or to happen to) has two similar meanings in the context of physical and mental health: Strictly, a symptom is a sensation or change in health function experienced by a patient. ... Complication, in medicine, is a unfavorable evolution of a disease, a health condition or a medical treatment. ...

Patients with ulcerative colitis can occasionally have aphthous ulcers involving the tongue, lips, palate and pharynx
Patients with ulcerative colitis can occasionally have aphthous ulcers involving the tongue, lips, palate and pharynx

Taken 21 April 2005. ... Taken 21 April 2005. ... Mouth ulcer on the lower lip A mouth ulcer (from Latin ulcus) is the name for the appearance of an open sore inside the mouth caused by a break in the mucous membrane or the epithelium on the lips or surrounding the mouth. ... This article includes a list of works cited or a list of external links, but its sources remain unclear because it lacks in-text citations. ... The mouth, also known as the buccal cavity or the oral cavity, is the opening through which an animal or human takes in food. ... The palate is the roof of the mouth in humans and vertebrate animals. ... The pharynx (plural: pharynges) is the part of the neck and throat situated immediately posterior to the mouth and nasal cavity, and cranial, or superior, to the esophagus, larynx, and trachea. ... Mouth ulcer on the lower lip A mouth ulcer (from Latin ulcus) is the name for the appearance of an open sore inside the mouth caused by a break in the mucous membrane or the epithelium on the lips or surrounding the mouth. ... Iritis is a form of anterior uveitis and refers to the inflammation of the iris of the eye. ... Uveitis specifically refers to inflammation of the middle layer of the eye, termed the uvea but in common usage may refer to any inflammatory process involving the interior of the eye. ... This article or section does not cite its references or sources. ... Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions where there is damage caused to the joints of the body. ... Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions where there is damage caused to the joints of the body. ... In medicine, sacroiliitis is an inflammation of the sacroiliac joint. ... Erythema nodosum is a form of inflammation of the subcutaneous fatty tissue. ... Panniculitis is a group of diseases whose hallmark is inflammation of subcutaneous fatty and muscle tissue. ... Beyond overall skin structure, refer below to: See-also. ... It has been suggested that Deep Vein Thrombosis be merged into this article or section. ... Autoimmune hemolytic anemia (AIHA) is one type of hemolytic anemias caused by excessive hemolyisis and it is identified by auto-antibodies that react with RBCs. ... Clubbing is also used to refer to the activity of gathering socially at nightclubs. ... Primary sclerosing cholangitis (PSC) is a form of cholangitis due to an autoimmune reaction. ... X-Ray of the bile duct during a laprascopic cholecystectomy A bile duct is any of a number of long tube-like structures that carry bile. ...

Similar conditions

Endoscopic image of ulcerative colitis affecting the left side of the colon. The image shows confluent superficial ulceration and loss of mucosal architecture. Crohn's disease may be similar in appearance, a fact that can make diagnosing UC a challenge.
Endoscopic image of ulcerative colitis affecting the left side of the colon. The image shows confluent superficial ulceration and loss of mucosal architecture. Crohn's disease may be similar in appearance, a fact that can make diagnosing UC a challenge.

The following conditions may present in a similar manner as ulcerative colitis, and should be excluded: Image File history File linksMetadata UC_endo_2. ... Image File history File linksMetadata UC_endo_2. ... Endoscopy means looking inside and refers to looking inside the human body for medical reasons. ... It has been suggested that this article or section be merged with Large intestine. ...

Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining between). ... Infection is also the title of an episode of the television series Babylon 5; see Infection (Babylon 5). ... The word culture comes from the Latin root colere (to inhabit, to cultivate, or to honor). ... Pseudomembranous colitis is an infection of the colon often, but not always, caused by the bacterium Clostridium difficile. ... Binomial name Hall & OToole, 1935 Clostridium difficile or CDF/cdf (commonly mistaken  , alternatively and correctly pronounced ) (also referred to as C. diff or C-diff) is a species of bacteria of the genus Clostridium which are gram-positive, anaerobic, spore-forming rods (bacillus). ... Ischemic colitis is inflammation of the intestine (colitis) caused by inadequate blood supply (ischemia) to meet the metabolic demands. ... Radiation proctitis (and the related radiation colitis) is inflammation and damage to the lower parts of the colon after exposure to x-rays or other ionizing radiation as a part of radiation therapy. ... Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... Chemical colitis is a type of colitis, an inflammation of the large intestine or colon, caused by the introduction of harsh chemicals to the colon by an enema or other procedure. ...

Comparison to Crohn's Disease

The most common disease that mimics the symptoms of ulcerative colitis is Crohn's disease, as both are inflammatory bowel diseases that can affect the colon with similar symptoms. It is important to differentiate these diseases, since the course of the diseases and treatments may be different. In some cases, however, it may not be possible to tell the difference, in which case the disease is classified as indeterminate colitis. Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining between). ... It has been suggested that this article or section be merged with Large intestine. ...

Comparisons of various factors in Crohn's disease and ulcerative colitis
Crohn's Disease Ulcerative Colitis
Involves terminal ileum? Commonly Seldom
Involves colon? Usually Always
Involves rectum? Seldom Usually
Peri-anal involvement? Commonly Seldom
Bile duct involvement? Not associated Higher rate of Primary sclerosing cholangitis[14]
Distribution of Disease Patchy areas of inflammation Continuous area of inflammation
Endoscopy Linear and serpiginous (snake-like) ulcers Continuous ulcer
Depth of inflammation May be transmural, deep into tissues Shallow, mucosal
Fistulae, abnormal passageways between organs Commonly Seldom
Biopsy Can have granulomata
Surgical cure? Often returns following removal of affected part Usually cured by removal of colon, can be followed by pouchitis
Smoking Higher risk for smokers Lower risk for smokers
Autoimmune disease? Generally regarded as an autoimmune disease No consensus
Cancer risk? Lower than ulcerative colitis Higher than Crohn's

This page meets Wikipedias criteria for speedy deletion. ... Primary sclerosing cholangitis (PSC) is a form of cholangitis due to an autoimmune reaction. ... Endoscopic images of a duodenal ulcer. ... In medicine, a fistula (pl. ... H&E section of non-caseasting granuloma seen in the colon of a patient with Crohns disease In medicine (anatomical pathology), a granuloma is a group of epithelioid macrophages surrounded by a lymphocyte cuff. ... Inflammation of the ileal pouch or internal reservoir. ...

Diagnosis and workup

General

H&E stain of a colonic biopsy showing a crypt abscess, a classic finding in ulcerative colitis
H&E stain of a colonic biopsy showing a crypt abscess, a classic finding in ulcerative colitis

The initial diagnostic workup for ulcerative colitis includes the following:[15][8] Image File history File linksMetadata Ulcerative_colitis_(2)_active. ... Image File history File linksMetadata Ulcerative_colitis_(2)_active. ... In general, diagnosis (plural diagnoses) has two distinct dictionary definitions. ...

Although ulcerative colitis is a disease of unknown causation, inquiry should be made as to unusual factors believed to trigger the disease.[8] Factors may include: recent cessation of tobacco smoking; recent administration of large doses of iron or vitamin B6; hydrogen peroxide in enemas or other procedures. Schematics of shorthand for complete blood count commonly used by physicians. ... Thrombocytosis is the presence of high platelet counts in the blood, and can be either reactive or primary (also termed essential and caused by a myeloproliferative disease). ... A 250 ml bag of newly collected platelets. ... An electrolyte is a substance containing free ions that behaves as an electrically conductive medium. ... In medicine (nephrology) renal function is an indication of the state of the kidney and its role in physiology. ... Types 5-7 on the Bristol Stool Chart are often associated with diarrhea Diarrhea (in American English) or diarrhoea (in British English) is a condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning through-flowing). Acute infectious diarrhea is a common cause... Hypokalemia is a potentially fatal condition in which the body fails to retain sufficient potassium to maintain health. ... Hypomagnesemia is an electrolyte disturbance in which there is an abnormally low level of magnesium in the blood. ... Liver function tests (LFTs or LFs), which include liver enzymes, are groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patients liver. ... Primary sclerosing cholangitis (PSC) is a form of cholangitis due to an autoimmune reaction. ... In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... A urinalysis (or UA) is an array of tests performed on urine and one of the most common methods of medical diagnosis. ... The erythrocyte sedimentation rate (ESR), also called a sedimentation rate, sed rate or Biernacki Reaction, is a non-specific measure of inflammation that is commonly used as a medical screening test. ... C-reactive protein (CRP) is a plasma protein, an acute phase protein produced by the liver. ... For other uses, see Iron (disambiguation). ... Pyridoxine Pyridoxal phosphate Vitamin B6 is a water-soluble vitamin. ... R-phrases , , , , S-phrases , , , ,, , , , Flash point Non-flammable Related Compounds Related compounds Water Ozone Hydrazine Except where noted otherwise, data are given for materials in their standard state (at 25 Â°C, 100 kPa) Infobox disclaimer and references Hydrogen peroxide (H2O2) is a very pale blue liquid which appears colourless in...


Endoscopic

Biopsy sample (H&E stain) that demonstrates marked lymphocytic infiltration (blue/purple) of the intestinal mucosa and architectural distortion of the crypts.
Biopsy sample (H&E stain) that demonstrates marked lymphocytic infiltration (blue/purple) of the intestinal mucosa and architectural distortion of the crypts.

The best test for diagnosis of ulcerative colitis remains endoscopy. Full colonoscopy to the cecum and entry into the terminal ileum is attempted only if diagnosis of UC is unclear. Otherwise, a flexible sigmoidoscopy is sufficient to support the diagnosis. The physician may elect to limit the extent of the exam if severe colitis is encountered to minimize the risk of perforation of the colon. Endoscopic findings in ulcerative colitis include the following: Image File history File linksMetadata Download high-resolution version (2040x1536, 1122 KB) Histopathological image of the active stage of ulcerative colitis. ... Image File history File linksMetadata Download high-resolution version (2040x1536, 1122 KB) Histopathological image of the active stage of ulcerative colitis. ... H&E stained lung tissue sample from an end-stage emphysema patient. ... A scanning electron microscope (SEM) image of a single human lymphocyte. ... For the Physics term GUT, please refer to Grand unification theory The gastrointestinal or digestive tract, also referred to as the GI tract or the alimentary canal or the gut, is the system of organs within multicellular animals which takes in food, digests it to extract energy and nutrients, and... Endoscopic images of a duodenal ulcer A flexible endoscope. ... A bowel perforation is a complete penetration of the intestinal wall resulting in the potential for bacterial contamination of the abdominal cavity (a condition known as peritonitis). ...

Ulcerative colitis is usually continuous from the rectum, with the rectum almost universally being involved. There is rarely peri-anal disease, but cases have been reported. The degree of involvement endoscopically ranges from proctitis or inflammation of the rectum, to left sided colitis, to pancolitis, which is inflammation involving the ascending colon. Erythema is an abnormal redness of the skin caused by capillary congestion. ... The mucous membranes (or mucosa) are linings of ectodermic origin, covered in epithelium, that line various body cavities and internal organs. ... This page is a candidate to be copied to Wiktionary using the Transwiki process. ... Polyp of sigmoid colon as revealed by colonoscopy. ... The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. ... The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. ... Proctitis (Noun) Inflammation of the rectum. ... Colitis is a digestive disease characterized by inflammation of the colon. ...


Histologic

Biopsies of the mucosa are taken to definitively diagnose UC and differentiate it from Crohn's disease, which is managed differently clinically. Microbiological samples are typically taken at the time of endoscopy. The pathology in ulcerative colitis typically involves distortion of crypt architecture, inflammation of crypts (cryptitis), frank crypt abscesses, and hemorrhage or inflammatory cells in the lamina propria. In cases where the clinical picture is unclear, the histomorphologic analysis often plays a pivotal role in determining the management. Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... Diagnosis (from the Greek words dia = by and gnosis = knowledge) is the process of identifying a disease by its signs, symptoms and results of various diagnostic procedures. ... Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining between). ... A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... In anatomy, the intestine is the segment of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ... For the death metal band, see Abscess (band). ... The lamina propria is a thin vascular layer of connective tissue beneath the epithelium of an organ. ...


Course and complications

Progression or remission

Patients with ulcerative colitis usually have an intermittent course, with periods of disease inactivity alternating with "flares" of disease. Patients with proctitis or left-sided colitis usually have a more benign course: only 15% progress proximally with their disease, and up to 20% can have sustained remission in the absence of any therapy. Patients with more extensive disease are less likely to sustain remission, but the rate of remission is independent of the severity of disease. Proctitis (Noun) Inflammation of the rectum. ... Remission is the state of absence of disease activity in patients with known chronic illness. ...


Ulcerative colitis and colorectal cancer

There is a significantly increased risk of colorectal cancer in patients with ulcerative colitis after 10 years if involvement is beyond the splenic flexure. Those with only proctitis or rectosigmoiditis usually have no increased risk.[8] It is recommended that patients have screening colonoscopies with random biopsies to look for dysplasia after eight years of disease activity[16] Colorectal cancer, also called colon cancer or bowel cancer, includes cancerous growths in the colon, rectum and appendix. ... It has been suggested that this article or section be merged with Large intestine. ... Proctitis (Noun) Inflammation of the rectum. ... Colonoscopy is the minimally invasive endoscopic examination of the large colon and the distal part of the small bowel with a fiber optic camera on a flexible tube passed through the anus. ... Dysplasia (from Greek, roughly: bad form) is a term used in pathology to refer to an abnormality in maturation of cells within a tissue. ...


Primary sclerosing cholangitis

Ulcerative colitis has a significant association with primary sclerosing cholangitis (PSC), a progressive inflammatory disorder of small and large bile ducts. As many as 5% of patients with ulcerative colitis may progress to develop primary sclerosing cholangitis.[17] Primary sclerosing cholangitis (PSC) is a form of cholangitis due to an autoimmune reaction. ... A bile duct is any of a number of long tube-like structures that carry bile. ...


Mortality

The effect of ulcerative colitis on mortality is unclear, but it is thought that the disease primarily affects quality of life, and not lifespan. The well-being or quality of life of a population is an important concern in economics and political science. ...


Treatment

Standard treatment for ulcerative colitis depends on extent of involvement and disease severity. The goal is to induce remission initially with medications, followed by the administration of maintenance medications to prevent a relapse of the disease. The concept of induction of remission and maintenance of remission is very important. The medications used to induce and maintain a remission somewhat overlap, but the treatments are different. Physicians first direct treatment to inducing a remission which involves relief of symptoms and mucosal healing of the lining of the colon and then longer term treatment to maintan the remission. This article concerns the treatment of ulcerative colitis, a form of inflammatory bowel disease (IBD). ... The anti-tumor necrosis factor α monoclonal antibody infliximab is a mainstay of the biological therapy for inflammatory bowel disease Biological therapy refers to the use of medication that is tailored to specifically target an immune or genetic mediator of disease. ... Remission is the state of absence of disease activity in patients with known chronic illness. ...


Drugs used

Aminosalicylates

Sulfasalazine has been a major agent in the therapy of mild to moderate UC for over 50 years. In 1977 Mastan S.Kalsi et al determined that 5-aminosalicyclic acid (5-ASA and mesalazine) was the therapeutically active compound in sulfasalazine. Since then many 5-ASA compounds have been developed with the aim of maintaining efficacy but reducing the common side effects associated with the sulfapyridine moiety in sulfasalazine.[18] Sulfasalazine is a sulfa drug, a derivative of Mesalazine (5-aminosalicylic acid abbreviated as 5-ASA), used primarily as an anti-inflammatory agent in the treatment of inflammatory bowel disease as well as for rheumatoid arthritis. ... Mesalazine (INN, BAN), also known as Mesalamine (USAN) or 5-aminosalicylic acid (5-ASA), is an anti-inflammatory drug used to treat inflammation of the digestive tract (Crohns disease) and mild to moderate ulcerative colitis. ... Sulfasalazine is a sulfa drug, a derivative of Mesalazine (5-aminosalicylic acid abbreviated as 5-ASA), used primarily as an anti-inflammatory agent in the treatment of inflammatory bowel disease as well as for rheumatoid arthritis. ... Sulfasalazine is a sulfa drug, a derivative of Mesalazine (5-aminosalicylic acid abbreviated as 5-ASA), used primarily as an anti-inflammatory agent in the treatment of inflammatory bowel disease as well as for rheumatoid arthritis. ...

Mesalazine (INN, BAN), also known as Mesalamine (USAN) or 5-aminosalicylic acid (5-ASA), is an anti-inflammatory drug used to treat inflammation of the digestive tract (Crohns disease) and mild to moderate ulcerative colitis. ... Sulfasalazine is a sulfa drug, a derivative of Mesalazine (5-aminosalicylic acid abbreviated as 5-ASA), used primarily as an anti-inflammatory agent in the treatment of inflammatory bowel disease as well as for rheumatoid arthritis. ... Balsalazide is an anti-inflammatory drug used in the treatment of Inflammatory Bowel Disease. ... Olsalazine is an anti-inflammatory drug used in the treatment of Inflammatory Bowel Disease and Ulcerative Colitis. ...

Corticosteroids

Cortisone (IPA:ˈkôrtəˌsōn) is a steroid hormone. ... Prednisone is a synthetic corticosteroid drug which is usually taken orally but can be delivered by intramuscular injection and can be used for a great number of different conditions. ... Prednisolone is the active metabolite of prednisone. ... Hydrocortisone is a synthetic corticosteroid drug which may be given by injection or by topical application. ... Methylprednisolone (molecular weight 374. ... Beclometasone is an inhaled corticosteroid drug for the use of prophylaxis of asthma. ... Budesonide is a glucocorticoid steroid for the treatment of asthma, non-infectious rhinitis (including hay fever and other allergies), and for treatment and prevention of nasal polyposis. ...

Immunosuppressive drugs

Mercaptopurine: chemical structure Mercaptopurine (also called 6-MP or by its brand name Purinethol®) is an immunosuppressive drug used to treat leukemia. ... Azathioprine is a chemotherapy drug, now rarely used for chemotherapy but more for immunosuppression in organ transplantation, autoimmune disease such as rheumatoid arthritis or inflammatory bowel disease such as Crohns disease. ... Amethopterin redirects here. ... Tacrolimus (also FK-506 or Fujimycin) is an immunosuppressive drug whose main use is after allogenic organ transplant to reduce the activity of the patients immune system and so the risk of organ rejection. ...

Biological treatment

The anti-tumor necrosis factor α monoclonal antibody infliximab is a mainstay of the biological therapy for inflammatory bowel disease Biological therapy refers to the use of medication that is tailored to specifically target an immune or genetic mediator of disease. ... Infliximab (brand name Remicade®) is a drug used to treat auto-immune disorders. ... Visilizumab (marketed under the trade name Nuvion® by PDL BioPharma Inc. ...

Surgery

Unlike Crohn's disease, ulcerative colitis can generally be cured by surgical removal of the large intestine. This procedure is necessary in the event of: exsanguinating hemorrhage, frank perforation or documented or strongly suspected carcinoma. Surgery is also indicated for patients with severe colitis or toxic megacolon. Patients with symptoms that are disabling and do not respond to drugs may wish to consider whether surgery would improve the quality of life. Exsanguination (also known colloquially as bleeding out) is the fatal process of total blood loss. ... This article or section does not adequately cite its references or sources. ... In medicine, carcinoma is any cancer that arises from epithelial cells. ...


Ulcerative colitis is a disease that affects many parts of the body outside the intestinal tract. In rare cases the extra-intestinal manifestations of the disease may require removal of the colon.[8]


Alternative treatments

Dietary modification

Dietary modification may reduce the symptoms of the disease.

  • Lactose intolerance is noted in many ulcerative colitis patients. Those with suspicious symptoms should get a lactose breath hydrogen test.
  • Patients with abdominal cramping or diarrhea may find relief or a reduction in symptoms by avoiding fresh fruits and vegetables, caffeine, carbonated drinks and sorbitol-containing foods.
  • Many dietary approaches have purported to treat UC, including the Elaine Gottschall's specific carbohydrate diet and the "anti-fungal diet" (Holland/Kaufmann).

Sorbitol, also known as glucitol, is a sugar alcohol the body metabolises slowly. ... Elaine Gottschall BA, M.Sc. ...

Fats and oils

  • Fish oil. Eicosapentaenoic acid (EPA), derived from fish oil. This is an Eicosanoid that inhibits leukotriene activity. It is effective as an adjunct therapy. There is no recommended dosage for ulcerative colitis. Dosages of EPA of 180 to 1500 mg/day are recommended for other conditions. [1]
  • Short chain fatty acid (butyrate) enema. The colon utilizes butyrate from the contents of the intestine as an energy source. The amount of butyrate available decreases toward the rectum. Inadequate butyrate levels in the lower intestine have been suggested as a contributing factor for the disease. This might be addressed through butyrate enemas. The results however are not conclusive.

Eicosapentaenoic acid (EPA or also icosapentaenoic acid) is an omega-3 fatty acid. ... In biochemistry, eicosanoids are a class of oxygenated hydrophobic molecules that largely function as autocrine and paracrine mediators. ... Leukotrienes are autocrine and paracrine eicosanoid lipid mediators derived from arachidonic acid by 5-lipoxygenase. ... The butyrate (also butanoate) ion is C3H7COO- (butyric acid minus one hydrogen ion). ...

Herbals

  • Herbal medications are used by patients with ulcerative colitis. Compounds that contain sulphydryl may have an effect in ulcerative colitis (under a similar hypothesis that the sulpha moiety of sulfasalazine may have activity in addition to the active 5-ASA component).[19] One randomized control trial evaluated the over-the-counter medication methionine-methyl sulphonium chloride (abbreviated MMSC, but more commonly referred to as Vitamin U) and found a significant decreased rate of relapse when the medication was used in conjunction with oral sulfasalazine.[20]

An herbal is a book, often illustrated, that describes the appearance, medical properties, and other characteristics of plants used in herbal medicine. ... Sulfasalazine is a sulfa drug, a derivative of Mesalazine (5-aminosalicylic acid abbreviated as 5-ASA), used primarily as an anti-inflammatory agent in the treatment of inflammatory bowel disease as well as for rheumatoid arthritis. ... Vitamin U is not a vitamin. ... Sulfasalazine is a sulfa drug, a derivative of Mesalazine (5-aminosalicylic acid abbreviated as 5-ASA), used primarily as an anti-inflammatory agent in the treatment of inflammatory bowel disease as well as for rheumatoid arthritis. ...

Bacterial recolonization

  • Probiotics may have benefit. One study which looked at a probiotic known as VSL#3 has shown promise for people with ulcerative colitis.[21]
  • Fecal bacteriotherapy involves the infusion of human probiotics through fecal enemas.[22] It suggests that the cause of ulcerative colitis may be a previous infection by a still unknown pathogen. This initial infection resolves itself naturally, but somehow causes an imbalance in the colonic bacterial flora, leading to a cycle of inflammation which can be broken by "recolonizing" the colon with bacteria from a healthy bowel. There have been several reported cases of patients who have remained in remission for up to 13 years.[23]

Probiotics are dietary supplements containing potentially beneficial bacteria. ... Fecal bacteriotherapy is a promising new treatment for patients suffering from pseudomembranous colitis, ulcerative colitis and Crohns disease. ...

Intestinal parasites

Inflammatory bowel disease is less common in the developing world. Some have suggested that this may be because intestinal parasites are more common in underdeveloped countries. Some parasites are able to reduce the immune response of the intestine, an adaptation that helps the parasite colonize the intestine. The decrease in immune response could reduce or eliminate the inflammatory bowel disease


Helminthic therapy using the whipworm Trichuris suis has been shown in a randomized control trial from Iowa to show benefit in patients with ulcerative colitis. The therapy tests the hygiene hypothesis which argues that the absence of helminths in the colons of patients in the developed world may lead to inflammation. Both helminthic therapy and fecal bacteriotherapy induce a characteristic Th2 white cell response in the diseased areas, which is somewhat paradoxical given that ulcerative colitis immunology was thought to classically involve Th2 overproduction[24] Helminthic therapy is currently considered one of the most promising alternative treatments for Crohns disease, Multiple Sclerosis, Asthma and Ulcerative colitis. ... Binomial name Trichuris trichiura (Linnaeus, 1771) The human Whipworm (Trichuris trichiura or Trichocephalus trichiuris), is a roundworm, which causes trichuriasis when it infects a human large intestine. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ... In medicine, the hygiene hypothesis says that an excessively hygienic environment in early childhood may predispose some people towards asthma, allergies, and other autoimmune diseases. ... A worm is an elongated soft-bodied invertebrate animal. ... It has been suggested that this article or section be merged with Large intestine. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Helminthic therapy is currently considered one of the most promising alternative treatments for Crohns disease, Multiple Sclerosis, Asthma and Ulcerative colitis. ... Fecal bacteriotherapy is a promising new treatment for patients suffering from pseudomembranous colitis, ulcerative colitis and Crohns disease. ... A T helper cell (sometimes also known as effector T cells or TH cells) are a group of lymphocytes (a type of white blood cell or leukocyte) that play a cornerstone role in establishing and maximising the ability of the immune system. ...


Nicotine It has been shown that smokers on a dose-based schedule have their ulcerative colitis symptoms effectively reduced by cigarettes. The effect disappears if the user quits. This article is about the chemical compound. ...


Ongoing research

Recent evidence from the ACT-1 trial suggests that infliximab may have a greater role in inducing and maintaining disease remission. This article does not cite any references or sources. ... Infliximab (brand name Remicade®) is a drug used to treat auto-immune disorders. ... This article is about the medical term. ...


An increased amount of colonic sulfate-reducing bacteria has been observed in some patients with ulcerative colitis, resulting in higher concentrations of the toxic gas hydrogen sulfide. The role of hydrogen sulfide in pathogenesis is unclear. It has been suggested that the protective benefit of smoking that some patients report is due to hydrogen cyanide from cigarette smoke reacting with hydrogen sulfide to produce the nontoxic isothiocyanate. Another unrelated study suggested sulphur contained in red meats and alcohol may lead to an increased risk of relapse for patients in remission[9] Sulfate-reducing bacteria comprise several groups of bacteria that use sulfate as an oxidizing agent, reducing it to sulfide. ... Hydrogen sulfide (hydrogen sulphide in British English) is the chemical compound with the formula H2S. This colorless, toxic and flammable gas is responsible for the foul odor of rotten eggs and flatulence. ...


There is much research currently being done to elucidate further genetic markers in ulcerative colitis. Linkage with Human Leukocyte Antigen B-27, associated with other autoimmune diseases, has been proposed. Human Leukocyte Antigen B*27 (subtypes B*2701-2724) is a class I surface antigen encoded by the B locus in the major histocompatibility complex (MHC) on chromosome 6. ...


Low dose naltrexone is under study for treatment of Crohn's disease and ulcerative colitis. Low dose naltrexone (LDN), where naltrexone is used in doses approximately one-tenth those used for drug/alcohol rehabilitation purposes, is being used as an off-label treatment for certain immunologically-related disorders. ...


See also

Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining between). ... An ileo-anal pouch, sometimes referred to as a j-pouch or a w-pouch, is an internal reservoir formed by connecting the end of the small intestine (the ileum) to the rectum. ... An ileostomy is a stoma that has been constructed by bringing the end of the small intestine (the ileum) out onto the surface of the skin. ... In medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. ... Primary sclerosing cholangitis (PSC) is a form of cholangitis due to an autoimmune reaction. ...

External links

General Information

Organizations

References

  1. ^ Orholm M, Binder V, Sorensen TI, Rasmussen LP, Kyvik KO. Concordance of inflammatory bowel disease among Danish twins. Results of a nationwide study. Scand J Gastroenterol 2000;35:1075-81. PMID 11099061.
  2. ^ Tysk C, Lindberg E, Jarnerot G, Floderus-Myrhed B (1988). ""Ulcerative colitis and Crohn's disease in an unselected population of monozygotic and dizygotic twins. A study of heritability and the influence of smoking". Gut 29: 990–996. 
  3. ^ a b Baumgart DC, Carding SF (May 2007). ""Inflammatory bowel disease: cause and immunobiology"". Lancet 369 (9573). doi:10.1016/S0140-6736(07)60750-8. 
  4. ^ Cho JH, Nicolae DL, Ramos R, Fields CT, Rabenau K, Corradino S, Brant SR, Espinosa R, LeBeau M, Hanauer SB, Bodzin J, Bonen DK. Linkage and linkage disequilibrium in chromosome band 1p36 in American Chaldeans with inflammatory bowel disease. Hum Mol Genet 2000;9:1425-32. Fulltext. PMID 10814724.
  5. ^ Jarnerot G, Jarnmark I, Nilsson K. Consumption of refined sugar by patients with Crohn's disease, ulcerative colitis, or irritable bowel syndrome. Scand J Gastroenterol 1983;18:999-1002. PMID 6673083.
  6. ^ Calkins BM. A meta-analysis of the role of smoking in inflammatory bowel disease. Dig Dis Sci 1989;34:1841-54. PMID 2598752.
  7. ^ Corrao G, Tragnone A, Caprilli R, Trallori G, Papi C, Andreoli A, Di Paolo M, Riegler G, Rigo GP, Ferrau O, Mansi C, Ingrosso M, Valpiani D. Risk of inflammatory bowel disease attributable to smoking, oral contraception and breastfeeding in Italy: a nationwide case-control study. Cooperative Investigators of the Italian Group for the Study of the Colon and the Rectum (GISC). Int J Epidemiol 1998;27:397-404. PMID 9698126.
  8. ^ a b c d e f g Ulcerative Colitis Practice Guidelines in Adults, Am. Coll. Gastroenterology, 2004. PDF
  9. ^ a b Roediger WE, Moore J, Babidge W. Colonic sulfide in pathogenesis and treatment of ulcerative colitis. Dig Dis Sci 1997;42:1571-9. PMID 9286219.
  10. ^ Levine J, Ellis CJ, Furne JK, Springfield J, Levitt MD. Fecal hydrogen sulfide production in ulcerative colitis. Am J Gastroenterol 1998;93:83-7. PMID 9448181.
  11. ^ a b Hanauer SB. Inflammatory bowel disease. N Engl J Med 1996;334:841-848. PMID 8596552.
  12. ^ Podolsky DK. Inflammatory bowel disease. N Engl J Med 2002;347:417-424. PMID 12167685.
  13. ^ Shivananda S, Lennard-Jones J, Logan R, Fear N, Price A, Carpenter L, van Blankenstein M. Incidence of inflammatory bowel disease across Europe: is there a difference between north and south? Results of the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD). Gut 1996;39:690-7. PMID 9014768.
  14. ^ Broome U, Bergquist A. Primary sclerosing cholangitis, inflammatory bowel disease, and colon cancer. Semin Liver Dis 2006 February;26(1):31-41. PMID 16496231.
  15. ^ Al-Ataie MB, Shinoy VN. eMedicine: Ulcerative colitis. Fulltext.
  16. ^ Leighton JA, Shen B, Baron TH, Adler DG, Davila R, Egan JV, Faigel DO, Gan SI, Hirota WK, Lichtenstein D, Qureshi WA, Rajan E, Zuckerman MJ, VanGuilder T, Fanelli RD; Standards of Practice Committee, American Society for Gastrointestinal Endoscopy. ASGE guideline: endoscopy in the diagnosis and treatment of inflammatory bowel disease. Gastrointest Endosc 2006;63:558-65. PMID 16564852.
  17. ^ Olsson R, Danielsson A, Jarnerot G, Lindstrom E, Loof L, Rolny P, Ryden BO, Tysk C, Wallerstedt S. Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis. Gastroenterology 1991;100(5 Pt 1):1319-23. PMID 2013375.
  18. ^ S. Kane (2006). Asacol - A Review Focusing on Ulcerative Colitis.
  19. ^ Brzezinski A, Rankin G, Seidner D, Lashner B. "Use of old and new oral 5-aminosalicylic acid formulations in inflammatory bowel disease.". Cleve Clin J Med 62 (5): 317-23. PMID 7586488. 
  20. ^ Salim A (1992). "Role of sulphydryl-containing agents in the management of recurrent attacks of ulcerative colitis. A new approach.". Pharmacology 45 (6): 307-18. PMID 1362613. 
  21. ^ Bibiloni R, Fedorak RN, Tannock GW, Madsen KL, Gionchetti P, Campieri M, De Simone C, Sartor RB. VSL#3 probiotic-mixture induces remission in patients with active ulcerative colitis. Am J Gastroenterol 2005 Jul;100(7):1539-46. PMID 15984978.VSL#3 company site
  22. ^ Borody TJ, Warren EF, Leis SM, Surace R, Ashman O, Siarakas S. Bacteriotherapy using fecal flora: toying with human motions. J Clin Gastroenterol 2004;38:475-83. PMID 15220681.Fulltext(PDF)
  23. ^ Borody TJ, Warren EF, Leis S, Surace R, Ashman O. Treatment of ulcerative colitis using fecal bacteriotherapy. J Clin Gastroenterol 2003;37:42-7. PMID 12811208.Fulltext(PDF)
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  Results from FactBites:
 
ulcerative colitis: Definition and Much More from Answers.com (3947 words)
The causes of ulcerative colitis and Crohn's disease are unknown.
The pathology in ulcerative colitis typically involves distortion of crypt architecture, inflammation of crypts (cryptitis), frank crypt abcesses, and hemorrhage or inflammatory cells in the lamina propria.
The incidence of ulcerative colitis in North America is 10-12 cases per 100,000, with a peak incidence of ulcerative colitis occurring between the ages of 15 and 25.
Ulcerative colitis - WrongDiagnosis.com (1068 words)
Ulcerative colitis is a disease that causes inflammation and sores, called ulcers, in the top layers of the lining of the large intestine.
Ulcerative colitis is a form of colitis, a disease of the intestine, specifically the large intestine or colon, that includes characteristic ulcers, or open sores, in the colon.
Ulcerative colitis is an intermittent disease, with periods of exacerbated symptoms, and periods that are relatively symptom-free.
  More results at FactBites »

 
 

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