Ulcerative colitis

Non-granulomatous relapsing and remitting continuous inflammation in colonic mucosa
Etiology Age of onset 15-30 years.
Epidemiology
Clinical presentation PR bleeding
axial/peripheral arthritis, erythema nodosum, pyoderma gangrenosum, anal skin tags, fistulae (in any location), osteopenia, uveitis/episcleritis, anaemia.
Pathogenesis
Diagnostic investigations stool culture, faecal calprotectin
Colonoscopy + biopsy: inflammatory infiltrate; ↓ goblet cells; mucosal ulcers; crypt abscesses; backwash ileitis
Management See below

inducing remission

mild to moderate first presentation

  • first line: topical aminosalicylate
  • second line: ADD oral aminosalicylate
  • third line: topical/oral corticosteroid

acute severe

  • first line: IV corticosteroid (ciclosporin possible as alternative)
  • second line: ADD ciclosporin to IV corticosteroid
    • infliximab if ciclosporin contraindicated