Ulcerative Colitis

The pathophysiology of ulcerative colitis, as well as its counterpart Crohn's disease, is thought to be multifactorial including genetic, environmental, immunological, and microbiological factors. For some patients, especially those with primary sclerosing cholangitis or ankylosing spondylitis, the extraintestinal manifestations may be more problematic than the bowel disease. Nutritional requirements are increased in severe ulcerative colitis because of the catabolism associated with fever and inflammation. Formulations of 5-aminosalicylic acid (5-ASA, mesalamine, mesalazine) have been the primary therapies to treat mild to moderately active ulcerative colitis and to maintain remission. Surgery plays a relatively small role in the management of extraintestinal manifestation in ulcerative colitis. Patients with extensive ulcerative colitis have an increased risk for colon cancer compared with the general population. An effective approach to colonoscopic surveillance in ulcerative colitis came from the observation that colon cancer in ulcerative colitis is associated with dysplasia elsewhere in the colon.