Ulcerative Colitis - Erler Zimmer

Ulcerative Colitis - Erler Zimmer

Clinical History

A 36-year-old woman was admitted to the hospital due to a three-week history of gastrointestinal issues, including bloody diarrhea and lower abdominal pain. Further inquiry revealed four similar episodes of such symptoms over the past seven years. Sigmoidoscopy revealed an inflamed, ulcerated, and swollen rectal mucosa. Despite initiating steroid treatment, her condition did not improve, leading to a total colectomy.

Pathology

The excised colon has been longitudinally cut to display the mucosal surface. Extensive contiguous ulceration, separated by swollen islands of remaining mucosa, is evident. The ulcers exhibit necrotic bases with projecting edges, forming some 'pseudo'-polyps. Bowel mucosal histology indicates acute inflammatory changes with crypt abscesses, focal necrosis, and ulceration, characteristic of acute ulcerative colitis (UC).

Further Information

Ulcerative colitis is a persistent ulcerative inflammatory condition primarily affecting the rectum, with potential extension to other colon segments in a continuous manner. The inflammatory process is diffuse, mainly confined to the mucosal and superficial submucosal layers. The causative factor for UC remains unknown. Onset typically occurs between 15-25 years, with a slightly higher prevalence in females.

Patients with UC may experience symptoms such as diarrhea with blood or mucus, urgency, frequent bowel movements, tenesmus, colicky abdominal pain, weight loss, anemia, and fatigue. Colonic inflammation may lead to complications like toxic megacolon, colonic perforation, or colon cancer. Extraintestinal manifestations encompass anterior uveitis, migrating polyarthritis, sacroiliitis, ankylosing spondylitis, erythema nodosum, pyoderma gangrenosum, and primary sclerosing cholangitis.

Treatment options for UC involve anti-inflammatory medications like steroids, disease-modifying rheumatoid drugs, and TNF (tumor necrosis factor) inhibitors. Colectomy effectively resolves intestinal symptoms, although extraintestinal manifestations may persist.