Gastroenterology
Ulcerative Colitis
궤양성대장염
IBD with continuous mucosal inflammation starting at rectum, extending proximally
- How common
- 100–200 per 100,000
- Typical age
- Peak ages 15–30
What is it?
Genetic predisposition (HLA), environment (smoking protective), aberrant immune response, dysbiosis cause mucosa-limited chronic inflammation.
Commonly affected: Rectum (100%) → sigmoid → left colon → pancolitis
How it develops
- Genetic/environmentalHLA, non-smoking, urbanization
- Barrier defectMucus and tight junction defects
- Th2/Tc2 responseIL-5, IL-13, TNFα mediated
- Continuous mucosal inflammationContinuous from rectum proximally
Symptoms
- Bloody diarrheaMucus and blood, 4-20x/day
- Urgency/tenesmusRectal urgency from inflammation
- Abdominal crampingLeft lower quadrant pain
- Systemic symptomsFever, weight loss, fatigue
- ExtraintestinalArthritis, erythema nodosum, uveitis
How it is examined
- DREMucus, blood
- Colonoscopy + biopsyConfirm continuous mucosal involvement
- Lab studiesElevated CRP/ESR, anemia, fecal calprotectin
Imaging
AXR for toxic megacolon or perforation.
- Colon >6 cm diameter
- Free air
Colonoscopy is standard for diagnosis and severity.
- Continuous erythema/erosion
- Pseudopolyps
- Loss of vascular pattern
Non-surgical care
- 5-ASA mesalamineOral + suppository/enema (proctitis 1g supp; left-sided 4g enema)
- Topical corticosteroidBudesonide MMX or rectal foam
- Oral/IV steroidModerate-severe flare (prednisolone 40-60mg)
- ImmunomodulatorAzathioprine 2-2.5mg/kg, 6-MP
- Biologics/small moleculeInfliximab, adalimumab, vedolizumab, ustekinumab; JAK inhibitor (tofacitinib)
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Medical failure, megacolon, perforation, hemorrhage, dysplasia/cancer
Procedures that may be discussed
- Total proctocolectomy + IPAA (J-pouch)
- Emergency subtotal colectomy + ileostomy
- Brooke ileostomy
Outlook
Remission maintained 50-70%; pancolitis >8yr needs cancer surveillance every 1-2 yr.